#21

a work in progress

Borderboys, Banishment, and the Blame

When Antonio died, we buried him ourselves. In Appalachia, you do a lot of things yourself. You don’t need a backhoe to dig a grave. One shovel, and some arms will do.

I was pissed. But then, I’m always pissed.

I stopped writing about the fucking funerals. I just don’t want to hear it from the haters and the stalkers and the REAL Internet pedophiles — as opposed to the literary or poetic imaginary ones — who beg me via email to put them in touch with such and such a boy.

It would be so much easier if you people — so many of you from Texas — just restrained yourselves, and you decide to not go there. You do not want me to even try to find you.

Because I will.

I make distinctions. Just before the Cure. I argue that to love them, really love them, has nothing to do with sex, and everything to do with survival. Just before the cure is not unlike just before the disease, and it will not be unlike after the cure is found.

The scum of the world is ubiquitous they are in every fucking goddamn place, and every goddamn time.

Antonio did not make it. There was no way he could hold out anything except the hand we all held.

The uncomfortable reality is that antiretrovirals do not work for everyone. They won’t tell you that at your local AIDS org.

They won’t tell you that at AIDS dot gov. If there is a website anywhere on the Internet that is the epitome of irrelevance, it is AIDS dot gov.

Where they love to trot out celebrities.

You tell me. What the fuck does Justin Bieber performing on a stage for a bunch of government bureaucrats sitting in a small auditorium usually reserved for staff updates have anything to do with AIDS.

Nothing. Absolutely nothing.

We tried every antiretroviral in the book. Nothing worked. Antonio disappeared by inches.

The shitting and the vomiting and the pain in Antonio’s gut and the fungal infections and the delirium was a shroud’s common law House of Recantation.

Borderboy was a clandestine corpse. We all stood around. Cameron read a poem.

“I loved you,” he began. I did not hear the rest of it. To turn them into shapes that would apprehend some joy was more than I could do. I am an angry man. It cannot be undone.

Fucking Sex Slavery is everywhere. America The Moral sucks in young boys — and pimps them out where they are typically fucked in the asshole for whatever the going rate is for getting fucked in the hole — there is no island where none of this happens, but if you read the crime report of the LA Times, they will tell you that on Sunset Blvd., more boys than girls are busted for prostitution in an area that was previously, famously, primarily a province of Big Girl hookers, no one anywhere near the high end, here, but working the street is the lowest common denominator, again, it’s always a hierarchy, with working the phones and local paper gigs, to a lowlife pimp pimping your ass out to whoever, and there’s the high end pimp, who only takes credit cards, and markets its meat to men who can afford prime rib steak.

I want to, but I can’t publish the name of the country that has the current corner on high end ass.

I am followed by enough people from this country.

My typing in the name of it will only send off alerts and enough what with the alerts.

We all love vodka. You will need it if you are a whore trying to get out — there are the wrong people and the not so wrong people — who will offer to get you out; on this train, and usually students who are everywhere on this thing straight out of 1956 and Doctor Zhivago asleep in a bunk bed with Julie Christy while the train and all its gravity scrapes the ground — you cannot escape the pulling of the earth here — ice palace thrones in the phosphorescent shadows of the witching hour. A grave’s glass and farthing candle it is a universe of grasshopper swarm in the summer, and the hard carcassses of fozen wild animals in a winter’s testament of sleeping in a top bunk with this parhelion sundog and we only left the the little scartch room with its bunks and its army blankets of piss and all the vodka bottles like candelabrums of ashen glass when the gathering of the black steppe of clouds came screaming out of a tunnel of cadaverous lead as if blindness itself was a myopia peering out from one and wicked eye, ill-marked, and in the tundra some think it food.

The black eye is from fighting back which was a good idea or a bad idea whichever way you wanted to look at it. Sex work itself was dangerous whether it’s leaned up against a building or in the backseat of a parked car.

On a street in Moscow.

Stockholm is a major hub.

If you are trafficked from this part of the planet, chances are good you will will be trotted through Arlanda.

If your papers hold up to scrutiny, when you get off the train, you will be on your way to Helsinki by boat. Санкт-Петербург is a human trafficking port of call.

People ask me how to build this kind of safe place. You can’t. Not only is there nowhere safe, but even if there were, the insiders you need to support it have to be extraordinary, tenacious, patient, good at listening, willing to tackle any health issue, and aware that kids, do, indeed, engage in sex work, and while an adult might choose that life, The Life, which is fine, adults are adults, but kids who choose this are forced to choose this because you do not choose to see them. Silence equals death in more than one or two or three or a hundred ways. I can’t tell you what to do or how. All I can tell you is to keep your head up.

Today, a few are leaving the house with cameras.

I tell them. “No guns.”

Around here Black Lives Matter matters. Matters a lot.

This is the South. I can’t possibly imagine what African American young males with HIV face. And gay. I can barely go there. I do go there because I know what it’s like to be shot. You cannot imagine that either. All I know is anecdotal. Will a cop shoot you. Oh, in a minute. Why. Walking down the street is a felony.

So is having HIV.

North Carolina Community Health Center Association

4917 Waters Edge Drive, Suite 165 Raleigh, NC 27606–2459 Phone: (919) 469–5701 Fax: (919) 469–1263

wncchs@wncchs.org

POB 338

Asheville, NC

John A. Fagg, MD, Chairperson, Winston-Salem

NC Medical Care Commission

809 Ruggles Drive, Raleigh, NC 27603

Josh Childers

Minnie Jones Health Center

257 Biltmore Avenue

Asheville, NC 28801

Mary K. Wakefield, Administrator HIV/AIDS Programs Bureau Health Resources and Services Administration

5600 Fishers Lane

Rockville, Maryland 20857

UNAIDS Secretariat

20, Avenue Appia CH-1211 Geneva 27 Switzerland

Robin Gary Cummings, M.D., Acting State Health Director

1931 Mail Service Center, Raleigh, NC 27699–1931

Location: 5605 Six Forks Road, 1st Floor, Raleigh

Office of Rural Health and Community Care (ORHCC)

311 Ashe Ave Raleigh, NC 27606

chris.collins@dhhs.nc.gov

Sylvia Mathews Burwell

HHS Office of the Secretary

re: Region 4 — Atlanta (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee)

Jocelyn Samuels

Director of the Office for Civil Rights (OCR)

Francis S. Collins

Director, National Institutes of Health (NIH)

ACLU of North Carolina

Executive Director: Sarah Preston

contact@acluofnc.org

P.O. Box 28004

Raleigh, NC 27611

This letter is being written to inform you that the Western North Carolina Community Health Services, PO Box 338 Asheville, NC 28802 and the Minnie Jones Health Center, 257 Biltmore Avenue, Asheville, NC, 28801 are in violation of Federal statute and the Ryan White HIV/AIDS Program’s (RWHAP) core medical services requirement. In stating that they have no waiting lists for medications on the AIDS Drug Assistance Program (ADAP) formulary when the recently uninsured are prohibited from pharmaceutical access by the Minnie Jones Health Center essentially and administratively violates federal anti-discrimination clause in the Affordable Care Act. Western North Carolina Community Health Services has received funding from the Health Resources and Services Administration (HRSA), through Part C (then Title III-b) of the Ryan White HIV/AIDS Treatment Modernization Act (then Ryan White Care Act), to provide comprehensive HIV medical care to persons living in the 18 westernmost counties of NC.

The Minnie Jones Health Center and the Western North Carolina Community Health Services policy of requiring ADAP patients who leave pharmacy services and return — through losing a job and or the cancellation of job-related private health insurance — limiting their access to ARVs, and can only be readmitted to the program after a two year waiting period creates a defacto violation of the Ryan White HIV/AIDS Program’s legislative requirements (RWHAP). No waivers of core medical services would be appropriate for this agency as they have broadened the definition of who can and cannot be served. They have made it up on their own to save money through not treating HIV. This is health care rationing for people in Appalachia living with HIV. These agencies were financially invested with a mission to expand outreach in Appalachia, not restrict it. This is a flagrant violation of the law and the intent of the law and the funding increase to reach people — hard to reach — in regions with pockets of HIV. WNCCH’s mission is clear, and a matter of public record: “Treatment of common chronic diseases. And Provision of essential drugs (as defined by the World Health Organization).

This is to inform you these agencies are administratively discriminating against people who have lost their health insurance. Grantees, Part A Planning Councils, community planning bodies, and Part B- funded consortia may optionally define eligibility for pharmacy services in a focused way, but they may NOT arbitrarily broaden the definition of who is eligible for services by creating waiting periods not permitted under ADA policy, and these agencies have done exactly that. They have chosen to define client population by a formula based on a waiting period. It kicks out the very people they are funded to serve. The do not have the authority to redefine what an HIV Hard to Reach population is and then require a two year waiting period before medication can treat HIV. This is how HIV spreads. People do not stay in care because the cost of the drugs is so high. For the patient population for HIV services to preclude the recently uninsured is not allowed under the ACA statute.

This rationing has dire consequences for an Appalachian community the CDC describes as “Hard to Reach.” Appalachia and the 18 counties not well-served here endure pharmacy rationing, and the result is that the Hard to Reach are more hard to reach, and where is the kind of public health policy that facilitates, and they are receiving funding to facilitate, keeping this population in care. How can care be defined as a two year waiting period for services.

In a family HIV emergency, there is no help regarding medication for people who do, indeed, qualify. They qualify under federal law, and for the record, copies of this are being sent to foundations such as the ACLU and the NAACP where I am filing a request for a Class Action.

This policy regarding rationing HIV medication is in violation of ADAP legislation that defines discriminatory practices and any increase in the ability of the grantee to enlarge that definition delineating a subgroup in Appalachia where HIV numbers are double what they represent in other demographics. More funding was set aside for providers in terms of reaching the Hard to Reach and those funds cannot be used to restrict a subgroup’s access to HIV pharmaceuticals.

This policy clarification outlines the Ryan White HIV/AIDS Program (RWHAP) expectations for client eligibility assessment and clarifies the recertification requirements. Payments for incurred costs during coverage gap must be for covered Part D drugs and paid for by a TrOOP eligible payer such as a Part B ADAP under Part B of Title XXVI of the Public Health Service Act. These costs must be flagged as being from ADAP to ensure they are counted for TrOOP. These figures are inaccurate when grantees are of their own volition redefining eligibility as inherent to a waiting period as defined by the grantee. This new provision in the Affordable Care Act treats ADAP funds the same as assistance provided by SPAPs. To ensure ADAP expenses are accurately accounted for in the TrOOP calculation, the ADAPs must participate in data sharing with the CMS COB contractor. The proposed SON Index does not provide incentives for jurisdictions to redefine patient populations. The Severity of Need (SON) Index is a methodology under development by the Health Resources and Services Administration’s (HRSA’s) HIV/AIDS Bureau (HAB) to improve the way Ryan White HIV/AIDS funds are distributed. Discriminating against those who no longer have access to pharmacy services through the cancelation of services from the patient’s previous private providers defined under the Affordable Care Act is strictly prohibited. For an 18-county service area of western North Carolina included in Federal HHS jurisdiction for endemic poverty demographics defined as Appalachia to discriminate against patients eligible for ADA is the equivalent of enforcing eligibility within a time frame and not a epidemiological paradigm as required by law. As a federal Ryan White provider, the waiting period enforced is illegal, in violation of statute, punitive, in violation of HHS policy, at variance with the Alma Ata Declaration by creating a new subgroup definition of eligibility — the recently uninsured — which is, in fact, drug rationing for people with HIV. The Alma Ata Declaration specifically condemns such administrative rationing by health care systems as does UNAIDS. To wit:

“Far too often, discrimination, criminalization, punitive approaches and administration obfuscation that eliminates services eligibility are all limiting an effective HIV response for those in greatest need, especially key populations at higher risk of infection. Of particular concern is the emergence of new legislative initiatives to arbitrarily define and even criminalize certain key populations, which not only violates human rights but also drives people away from essential services. Experience has demonstrated that fear, blame and ostracism are not the ingredients for success in the HIV response. We have more tools than ever to address the epidemic and our response must be guided by science and shared values rather than by prejudice and denial.”

Such drug rationing for people living with HIV who do, indeed, fall into the federally defined administrative category as the Hard to Reach are patently absurd, and beneath contempt. I would suggest you end this waiting period discrimination immediately.

TP Barrus

The AIDS orgs are in denial. Who can understand a word they say.

It all boils down more or less that you’ve all been fucked. I’ve never been fucked in the ass in my life. But I know it when I see it I just do. The machine revs up to fully fucked alert.

I can only put less that one percent of one percent anywhere on the Internet — stuff. Just stuff. Just stuff I have either seen or faced or went through.

What I often see is pairing. Your friends and your lovers. Often, what I have seen are also tricks. What I also see is a community alarmed. I don’t even want to know what vile excrement comes out of the conservative churches of Appalachia. I already see the thing as if it were a car wreck of a hundred million tempests of drought and crawl on your knees cocksucker fucked in the mouth by churches, churches, churches down here they come with signs and many of them are crooked as a barrel of fishhooks ignorance and here’s what I will tell anyone and everyone: Everyone is armed. I just assume that the people I do not immediately know are armed and I wonder a lot about the people I do know.

I am not afraid of dying. There were no riots here. This is the hollows and the mountains. And the villages struggling there and racism and the history of racism goes back to the bones of the families who live here and make no mistake about it they run things.

The things I have seen are insane. Crazy as pig shit.

Police focus is never on me. I’m stupid, and harmless and white. I’m a white man who has no job. I know who the police focus on because I walk down the sidewalk with them. They are being hunted down by men with guns who use those guns and who do not hesitate to use them carelessly and they have enervated and itchy fingers. I have seen cops use their guns. You go into Oh Fuck Mode.

If I feel besieged, what do they feel. Walking down the street is jack fucking dangerous.

I do not want to be on the Cop Radar. We move very quietly around a lot.

It is also a war with animals. Pit Bulls versus German Shepherds. Guns I know what it is like to be shot. OMFG. Death is better than that mess. I truly do not know how many kids with colostomies do it. I don’t know or care what you see. I see so many young men with colostomies and we don’t talk about it because discussing shit is fucking rude and many males just aren’t going to go there. Since gun violence is a public health issue that public health does fucking nothing about in any serious way, a few posters in clinics is lame, it sucks white cock. It’s indifferent. What we really need to discuss is the reality that colostomies are often the result of a medical system that saves more and more lives in emergency situations (like with gut wounds) are being saved but the person shot wakes up in a hospital recovery room and, baby, you now shit into a plastic bag, and I do not care what they say, what the PR is, you will lead some other kind of life from now on — conceivably, you’re in a wheelchair with a plastic tube stuck up your cock — and all the tubing shit and the shit shit is going to run you like a shaggy dog.

Around here we were frozen in our tracks watching a le Tube kid (quite hot) get his stoma washed by a group of women in white. Why do they wear white I think they should all wear bee-keeper suits of black shrouds they have to drag around because spells and hexes have been sent their way (I volunteer to cast them) and I am so sorry but nurses are emasculating bitches and I hate them. I will n-o-t abide being touched or lectured to by women who in my opinion can go diddle themselves silly don’t even look at me because I cannot tolerate you and that attitude extends to doctors and they know it.

They hate me. And then the next one hates me. They usually just fire me.

I let lab techs take my blood. I don’t give a flying fuck how much people in white whine about it but I give them fucking blood and they can know more with that information that they can know through the humiliation they feel so fucking empowered to impart to the universe. They stand ten feet away from me, ask me a few stupid questions, consulting their notes whatever the fuck they consult but they do not look at me in the eye at any time and do not do it. This so unnerves lad techs. Babycakes, I do do not chat just do your fucking job.

They have a term they use: Survivor.

They have no fucking idea. Abuse survivor. Sexual Whatever Survivor. Survivor survivor. There is no surviving the process. The process will cut your balls off for breakfast.

Adolescent African American males — because they are adolescent — have no concept of what living with a colostomy means. And do not listen to the white bullshit that white people will push at you about how everything will be fine because these are the same cocksuckers who will tell you that one little pill a day makes HIV go away. Do you know what a humpback is.

I ended up with an allergic reaction from Abacavir that so changed my attitude about how dangerous antiretrovirals can be. I am here to tell you that these are POWERFUL drugs. Big Girl Drugs. Do not mess with them. I do not care what drugs you play with. Antiretrovirals can, usually not, the success rate is almost universal, kill you, and not suppressing the virus itself will kill you, too. You feel fine. You are not fine. If you are one of the Hard to Reach, the CDC is so scratching its ass about what with the truly bad numbers because suits can only reach so many people — and young black men know this — if you’re working for an AIDS org, you are not making shit they know this stuff. The car you drive is shit. You are a cheap shit motherfucker and why should they have to listen to your bullshit. This is how it works. Value is a cultural construction. It is not inherent. They cannot and I cannot and hardly any adolescent can understand what it would be like to be a gay young man with HIV who was shot in a bad drug deal that went down with guns and gangs now you shit into a plastic bag and your shit hole has been sewn up and you are paralyzed and live in a wheelchair with a tube stuck up your dick which will never for the rest of your life be hard and connect with another human being outside the medical witches who are now going to fuck with you far more effectively than any popping hungry gang crips and bloods your mother screamed at you about and now who do you think is going to take care of you asshole just put a sock in it because I want your attention if you are carrying around a gun I cannot know you even if I so do want to know you but I can’t ride your ass because I am stupid and angry that HIV can so slap you around like a rag. The stereotype that no gay men live here is exactly that. Your Baptist church will not save you now. I worked in a Los Angeles Hospital ER once. THE FUCKING NIGHT SHIFT. I have seen it all and it doesn’t matter what Esquire Magazine believes. THEY’RE SUITS, IN FACT, THEY’RE THE SUIT’S SUITS BECAUSE WHAT THEY SELL ARE SUITS CAN YOU GET IT. Everyone is going to smell your shit no matter what they say because people are going lie to you to spare you your feelings when you become Everything Is Up to Them because you will not be leaving the house to go get fucked by your secret boyfriend before you run down to You Know Where It Is to see what ships came in.

Just take a bottle of fucking pills because you can’t so much as shit in your mother’s toilet you are so irrelevant and you fucking know it’s true. Hard to Reach. Hard to Reach can go suck his Glock.

You will be whipped. Still. With whips. Most of them are economic.

You are now going to cost a mouthful of money, Sugar.

This is a toy gun you can buy for ten bucks on the Internet. Does it look real to you. I post it here because cops see this and they’ll have a cow.

Your life does matter. Glock 43 now has a holster. Your life has more value than that fucking gun. All those white men are armed to the teeth. By military issue they love that. Guns at funerals. What would a funeral be without ammunition for the next funeral. I am so fucking over it. Your BRAIN is more powerful than that fucking gun. You do not want to believe it. Believe this: they shoot children playing with Legos.

I have lived in the wilderness with big guns. This is different. My one bag can accommodate a broken down twelve gauge. It’s too fucking heavy to carry. The wilderness of the street is far more dangerous than a wilderness of bears. Been there done that.

OMFG. The pain from being shot. I became a Demerol addict by seventeen. Go live your life. All I can tell you is that HIV is like a fucking gun.

I am a white hypocrite.

I like killing people — I like it a lot — so shut the fuck up. You do it.

It’s weird how the Smash Street boys understand how to blend in, like great photographers, and no one sees them because no one knows how that — Seeing Them — works.

Many of them are ghosts among you.

A few have stayed behind to proof edit this monstrosity — Just Before the Cure — and at the moment, they’re also playing with the images they want to use as thumbnails for the video I will post below.

The last and final video for a while.

Close in on boys filming each other on the street.

The ones who stayed behind are arguing over the way they want to portray the yellow wristband.

“You don’t tell us too much about the bad times. The staying up all night in hospitals,” Mary said.

She was the only voice I had been hearing for a good while.

“Why bother. Where are the other voices, Mary.”

“They left.”

“Why.”

“They’re all writing books god help us.”

“There is no god.”

“I know that. And if there is god knows what religion he blongs to what a mess the whole world is a mess. Anton says you are unstable.”

“That and fifty cents get you on the bus. The world is a mess but not publishing.”

“Especially those cocksuckers.”

“There is no publishing.”

“Everything is publishing. Any fool can do it.”

“It’s the construction of stuff, of ideas, I want them to connect to and know as powerful.”

“It’s kinda like hope.”

“There is no hope.”

“So you say. I’m not sure I believe it.”

“What do you believe.”

“I believe I want to hug each one of them. They’re from everywhere. Literally. I believe I have to go now, too.”

“Even you.”

“Even me. I’m writing. I can’t help it. It’s what I do. Like clockwork like a ship in the night. I would love to stay to dance with them, but I have work to do. Stays Put Woman. I have work to do. You will find me by my window doing my work bearing witness because I have work to do.”

And then, she was gone.

How do kids at risk use the Internet. That would be another story. Another time. Another place.

Right now kids at risk are only hanging on.

What is past and what is yet to come is strewn with war and death and sex and love. And the House of Writing, a formless ruin of laughter and oblivion.

Run Credits.

Continued:

This is a work of fiction. Images and video via Show Me Your Life(Real Stories Gallery Foundation Non-Profit Initiative), Smash Street Art Program for boys at risk with HIV. Research Project: How Children at Risk Use the Internet. Non-profit Classroom Teaching Application: Fair Use: Multi-media Artistic Materials in an Instructional Setting. International Digital Millennium Act.

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