Dallas Buyers Club, HIV/AIDS, and Harm Reduction

Dallas Buyers Club. Advertisement. imdb.com. 2013.

Dallas Buyers Club. Advertisement. imdb.com. 2013.

I had initially posted this next entry as a longer than expected comment on facebook. As it turns out, a few friends and friends-of-friends ended up sharing it, which is more than I expected to happen with an early morning rambling. Because it seems to have gotten a bit of interest, and because it was informed by my research, I decided to put it up here as well (with a few minor changes).

I watched Dallas Buyers Club last night (a bit late to the game, I know). It got me to thinking about a three-hour interview I did for my dissertation. It was with a gay activist who has been involved in gay activism since the early 1970s. Even though he’s lived through a lot of stuff, he stayed pretty positive throughout our entire discussion. The one time when he got visibly upset was when we talked about AIDS. I knew that a lot of people had died, but I didn’t really get a sense of the pain and anger that some of the people who lived through went through. An eye-opening moment was when he told that in one year, 1987, he went to 26 funerals of friends that had died as a result of AIDS. That’s one funeral every two weeks. I don’t think any of us can relate to what losing 26 friends in the space of one year can do to us.

It also reminded me of another interview I did with an AIDS activist. I asked her if she remembered people losing their jobs as a result of being diagnosed as HIV positive. She answered by saying that “when I started doing AIDS work, people who were in hospitals were not even being fed.” Some doctors and nurses refused to be in the same room as people with AIDS, for fear that they would get sick themselves. So when friends and activists would visit the hospital, they would have to do everything for their friends: feed them, fix their sheets, clean them, and even change diapers that had been soiled for hours because nurses and doctors refused to help. “So, yeah” she said, “Lose your job? How about you’d almost die in the hospital from lack of care.”

I knew that it was bad. People got sick. People died. A lot of people got sick and died. However, before speaking to people that survived a plague (to borrow a phrase by AIDS activists), I had no idea exactly what it was like. How could I? When I was a kid, HIV and AIDS were just things that made you wear a condom. HIV and AIDS were what made me ask my mom what a condom was and why you had to wear one (which is the question that led to “The Talk”). It was something that people I didn’t know died from. It was an abstract. Meeting people who lived through it and watched as dozens of their friends died while governments either ignored them or messed around with potentially life-saving drugs because, who cares if a bunch of fags and junkies die, right?

I was also reminded of the kind of discourse that is used today against harm reduction initiatives, such as safe injection sites, as well as needle and crack pipe distribution services. Studies conducted on the impacts of these types of services have proven, time and time again, that they save lives. Despite these results, people and government still oppose them because the people they serve are drug addicts. Like the communities afflicted by HIV/AIDS, they’re often deemed to be less than worthy of support and help that has already saved hundreds, if not thousands of lives by preventing overdoses and transmission of infections. Yes, drug users deserve access to safe, free, and adequate detox programs, but anybody who knows anything (and I don’t, but I’m going on what people who do have already said), people can’t really be forced to kick their addictions, and that it doesn’t always hold, that can people slip and go back a few times. In the meantime, and when they do slip, harm reduction services are there to make sure they don’t overdose or get infected by sharing needles or pipes. When people say they oppose harm reduction services, this is what they’re opposing. Don’t give them potentially life-saving goods and services because, who cares if a junkie gets sick and dies, right? They brought it on themselves. Opponents of harm reduction services rarely stop to consider that, as the California punk band Fifteen in their song My Congressman, “there’s needle users sleeping with your children, with your daughters, with your sons and with your husbands.” Drug users are members of our communities, whether some people like it or not, and if we want to keep our communities safe and healthy, then we need to provide services and resources to make sure that these members of our communities are can stay free from infection and protected from overdoses until they are able to enter rehabilitation programs to help them to kick their addiction.

When people in the 1980s went around the law to make sure that people who were dying could have access to life-saving medication, the government went after them. Today, as people are working to provide drug users with access to life-saving and harm-reducing services and resources, the government is still going after them. Luckily, this time the Supreme Court of Canada had enough sense to listen to the numbers and saw that these services save lives, but that’s not always the case. Sometimes, people are denied access to life-saving drugs and services. Then that happens, those who deny them that access become responsible for the deaths of those whose lives were lost as a result of their refusal to provide life-saving services and medication.

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No Longer Dependents: Unions, Benefits, and Relationship Recognition

Last week, CBC reported the story of Della Wolf, a BC child whose birth certificate lists three parents: her two mothers and their male friend. The story of Della’s birth certificate made the news because hers was the first birth certificate in British Columbia to list more than two parents, something made possible by the province’s new Family Law Act, which allows up to four parents to be listed on a child’s birth certificate.

This news story got me to thinking about something that I came across in my research. In 1990, the Canadian Union of Public Employees (CUPE) published a series of reports titled Employment Benefits for Lesbian and Gay Workers and Their Families. The reports outlined a number of potential measures that the labour movement could adopt to help with efforts being made by lesbian and gay activists to obtain greater recognition for same-sex relationships. The reports dealt with issues such as bargaining, insurance policies, legal decision, and discrimination. Although they could at times make for some dry reading, some of the arguments made within the reports provide a fascinating insight into a time when the fight for relationship recognition was beginning to heat up.

One particular section in the report about ending discrimination stood out. The section dealt with the manner in which eligibility for benefits was determined by employers and insurance carriers. The report argued that, although the term “dependent” was often used to describe those who could be included on a worker’s benefit plan, actual dependence had very little to do with it. As the report stated, a “dependent” was not defined by actual dependency, but by their relationship with the worker. More specifically, someone was defined as a dependent one if they were a child or spouse of the recipient of a benefits package. In other words, someone could only be a dependent and therefore eligible to access a worker’s workplace benefits, if they were that worker’s child or spouse. The report continued by pointing out an obvious flaw in this manner of determining eligibility, stating that using biological and spousal relationships as the determining criteria did very little to meet the needs of many workers, gay or straight. Rather, it argued, this system was “devised to answer the needs of the traditional, one-income nuclear family.” In other words, it was tailored to meet the needs of a very particular family model, one in which one adult, usually the man, worked outside of the home, while his wife and children (dependents) stayed at home. The system, the report argued, was therefore not designed to meet the needs of a majority of workers, regardless of their sexual orientation, whose families and intimate relationships did not fit this model.

(Our Times, December 1989)

Despite these flaws, CUPE nevertheless admitted that the “most immediately attainable” approach to obtaining recognition of same-sex relationships and expanding benefits to same-sex partners was to simply expand on the current definitions of ‘dependent’ to have them include same-sex partners. Although there was recognition by the report’s authors that the current method of determining eligibility was limited, and that there was a desire to challenge these limits, they nevertheless recognized that doing so would be an uphill battle. The decision to move forward by redefining spouse to include a same-sex partner instead of attempting to challenge the limits inherent in this model of sharing workplace benefits and insurance coverage was therefore a deliberate strategic decision.

What does this have to do with the recent story of Della and her three parents? When I read the story, it reminded me of CUPE’s report and their criticism of the system of eligibility used by employers and insurance carriers, often with the consent of unions, to grant coverage based on criteria rooted in familial relationships.* Despite the advances made in the areas of women’s rights, as well as lesbian and gay rights, many of the benefits outlined in collective agreements still rely on an outdated system of criteria and use language, such as ‘dependent,’ that do not reflect the reality and relationships of an increasing number of people. This is the case with my own employer and union, whose insurance provider continues to define a “dependent” as a spouse or child.

Almost a quarter of a century has passed since CUPE issued the report critiquing this model of granting benefits. With the legal recognition that families often assume different shapes, it would be to the labour movement’s benefit to push for benefits packages and insurance coverage that also reflected this. One way of doing this, as suggested by CUPE’s report, would be to allow workers to designate one or more people as recipients of their coverage, regardless of the nature of their relationship, or what the report referred to as a “designated beneficiary” system.

In addition to allowing the labour movement to provide greater recognition of different relationship and family models, a designated beneficiary system would also provide those who are not married or in a common-law relationship to grant coverage to other members of their communities who may be in need of greater health care. This was something that was brought up by a number of people I interviewed for my research. One interviewee stated that he currently cares for a neighbour dealing with hepatitis C. The interviewee does not have any children, nor is he in married or in a common-law relationship, yet he would like nothing more than to be able to provide his neighbour, with whom he has a close friendship, with the type of coverage that could greatly improve his access to health care. A similar argument was made by another interviewee who stated that his inability to include friends who had been diagnosed with HIV/AIDS in his insurance plan meant that he was unable to help and care for them as much as he otherwise would have liked to.

So, while redefining the definition of ‘dependent’ to include same-sex relationships was a much needed and important step forward in terms of allowing lesbian and gay couples access the same benefits as their straight counterparts, doing so under the same set of criteria that relied on parental or spousal relationships to determine eligibility to employer insurance programs and union benefit packages unfortunately perpetuated the exclusion of certain workers whose relationships did not fit the mold of the nuclear family model. Unions are in a position to lead the charge on this. If the province of British Columbia can recognize that families come in various shapes and sizes, surely organized labour can help workers whose relationship models currently exclude them from accessing and providing the benefits to their own loved ones, however they may be defined.

*Those familial relationships that are recognized by most insurance providers are limited, as parents, siblings, and extended relatives are often excluded from insurance coverage and benefit plans.