At 25, the AIDS epidemic shows little progress, except for erecting an expensive bureaucracy, a thriving ‘gay’ lobby and a war on abstinence
Warning: Graphic material follows
• How effective are current strategies in the U.S?
• Our teens: caught in a war against abstinence
• A close look at the “battleground” state of Ohio
• What’s with all the “unknown” HIV cases?
• Youth, HIV and corruption
In Part One of this article, we gave an overview of HIV/AIDS expenditures in the U.S., and the lack of verifiable progress achieved in lowering the incidence of HIV. We also outlined the recent aggressive campaign against abstinence-until-marriage education programs launched by the contraceptive distribution network (Planned Parenthood, SIECUS and others) in conjunction with HIV and AIDS groups.
The Ohio Example
To get a clearer picture about both abstinence education and HIV prevention efforts, let’s take a closer look at one state. I have chosen my home turf, the “battleground” state of Ohio.
Ohio’s 2000 census revealed that there are over 1.3 million school age children between the ages of 10 and 18 in Ohio.1 This age group is the primary target of abstinence- until- marriage education efforts. In 2005, 153,578 people, mostly students in this age range, were unduplicated clients of the largest abstinence network in Ohio, that of the Ohio Department of Health and its sub-grantee programs. With combined federal and state funding that year of over $2.1 million, that amounts to just under $14 per client. Many of these students were reached multiple times during the year.2 Another $8 million in federal funds is awarded directly to a number of abstinence groups in Ohio, who reach an even wider audience with the message of abstinence.
So slightly over $10 million per year of public funds is spent currently in Ohio to persuade the target-age audience of over 1 million students that abstinence until marriage, with no mixed messages, is the key to a healthy and productive sexual and social future. That is a mere $10 per person for this wide audience. Many if not most taxpayers would consider this a meager amount of funding for such an important job, yet it’s a start in working toward two major goals at once: reducing teen pregnancies along with the incidence of sexually transmitted diseases. Teen pregnancies have been trending downward in the past decade in Ohio, and many have noted that this tracks with the implementation of abstinence education.
Yet among HIV and AIDS activists and even some public health professionals in Ohio, these programs and expenditures are cause for great alarm. It’s odd that those who object seem to be speaking from the same talking points.
Teresa C. Long, M.D., who hails from San Francisco and Berkeley, now heads the Columbus (OH) Health Department. She had critical words for abstinence education in a recent newspaper interview. “The emphasis [on sex education] nationally has been on abstinence-only education, which does not seem to be working for some of the youth we serve....We continue to battle misinformation, lack of information and opposing social norms.” Concerning sex education, she said, “Young people seem to have much less access to health education and sex education than generations a few years ago.” 3
This astonishing position reflects both Dr. Long’s need to get out more as well as a misalignment with the facts. Teen pregnancy rates in the Columbus area have been heading downward since the late 1990’s, so there is some reason for celebration, not doom and gloom.4 One would think she might have mentioned this positive trend.
If one attributes the youth pregnancy rate decline in Columbus to better condom use, that would discredit the claim that youth “don’t have access to health education” (probably meaning explicit anatomical instruction on condom use). So—are kids getting the “needed” condom lessons—and that’s the reason for the better trends? If so, Dr. Long hasn’t been filled in and is wasting time criticizing the abstinence message. But if, as is more likely the case, abstinence- until- marriage lessons are the main cause for the decline, why the bitter if misdirected abstinence criticism? There’s a possibility we have public health officials who are more biased than objective.
Criticism from other quarters is similarly bold, biased and confused. A group of “gay, lesbian, bisexual and transgendered” Ohio Department of Health employees met “outside of the workplace on their own time,” and sent a complaint letter in 2004 to Dr. Nick Baird, director of the Ohio Department of Health, about the state’s abstinence program among a litany of other gripes.5 On the heels of this, Earl Pike, executive director of the AIDS Task Force of Greater Cleveland and Dr. Tracey Lind of Trinity Cathedral (an Episcopal church) in Cleveland, held a press briefing in February 2005 complaining about the state funding of abstinence programs. Rev. Dr. Lind reportedly bemoaned the funding of abstinence education, which he said left AIDS prevention programs without money, a wildly inaccurate assertion.6 After a flurry of other press releases during 2005 to make an issue out of a non-issue, their anger was aired in several major newspaper articles, courtesy of apparent allies in the media.
The Cleveland Plain-Dealer published an article in May 2005 reporting on Pike’s call for an end to the state’s funding of abstinence programs. The PD followed this with an article on August 13, 2005 entitled, “Speaker Choice is Controversial.” The PD gave ample space again to Mr. Pike to label as “extremist” and “offensive” a speaker being considered for the 2005 annual meeting of the Ohio Department of Health’s abstinence sub-grantees. She was “out of the mainstream,” Pike was quoted as saying in a long (and inaccurate) rant about conservative views on homosexuality. The director of the abstinence program for the state was not quoted in the article, nor was there any mention of attempts to contact her.7 The reporter, Regina McEnery, was given an award in December 2005 by the AIDS Task Force of Cleveland.8
So, who was this troublemaking speaker, this pariah and outcast from polite society? None other than Maggie Gallagher, nationally syndicated columnist, Yale graduate, co-author of The Case for Marriage (Doubleday, 2000). But with the Plain-Dealer and screaming activists at their throats, the beleaguered administration of Gov. Robert Taft caved under the pressure and the conference organizers un-invited Gallagher and scheduled a less-recognized alternate. Gallagher was said to be “out of the mainstream,” except possibly for the 62% of Ohio voters who passed a tightly-worded pro-marriage ballot initiative in 2004. The state’s “gay” lobby must have meant some other mainstream.
What could be provoking such vitriol? Again, we can follow the money and follow the sex.
Funding in Ohio for HIV prevention and AIDS treatment grows and thrives. In 2005, the combined federal and state expenditures for HIV/AIDS was between $35-40 million,9 roughly three to four times the amount spent on abstinence education. While this at first and even second glances may seem to be an outrageous amount to spend on a 100% preventable disease spread by a relatively few people, there are several ways to break this down. Around $16-17 million alone is spent on drugs for AIDS patients under ADAP, the AIDS Drug Assistance Program, to assist low income patients in the purchase of expensive antiretroviral drugs.
There have been nearly 14,000 total AIDS cases in Ohio since the start of the epidemic. In June 2005, the number of ADAP clients in Ohio was 1,371.10
Prevention of HIV accounts for over $7 million in state funds11 and over $10 million12 in federal funds in Ohio in recent years. This is distributed among state and local health departments and local HIV/AIDS groups for HIV education and testing. There’s also HIV testing at Planned Parenthood locations and other women’s health clinics, many of which receive funds under a huge federal program called “Women’s and Infant’s Care,” which includes Title X funds. A request to the Ohio Department of Health to provide a breakdown of the HIV prevention portion of the over $200 million pot of federal dollars allocated to this program annually resulted in a terse response: there was no way to account for the HIV portion alone.13
Some of the HIV education and testing activities take place in a clinic’s or organization’s offices. But much does not. There are “outreach” activities conducted by groups like the AIDS Task Force of Greater Cleveland, AIDS Volunteers of Cincinnati, and the Columbus AIDS Task Force. This outreach include visits to “gay” bars and bathhouses, “gay” pride parades and circuit parties to meet with men and distribute condoms and brochures. There are even outreach programs to youth, including talks at schools and testing at community homosexual youth clubs, like Columbus Kaleidoscope, which is open for kids as young as 11 or 12 with no parental notification or consent needed. And in and around all of these activities, condoms are distributed and detailed “safer sex” instruction is provided.
Enough latex to pave I-71 between Cincinnati and Cleveland has been spread over Ohio – yet still the HIV cases rise.
In Ohio as in most states, even young minors can consent to health care treatment, counseling and testing without parents’ knowledge or approval. When these health care providers, clinic counselors or HIV educators learn about sexual relationships between minors and adults, they are mandatory reporters, required by Ohio law to inform authorities. Is this being done consistently? Are such reports being filed? Are kids being protected? Or is there a tacit “don’t ask, don’t tell” policy? Are young teens, like the adult clients, being tutored in the intricacies of graphic sex, mostly homosexual, at taxpayer expense, all in the name of “HIV prevention”?
The Explicit Nature of Prevention
The web site of AIDS Volunteers of Cincinnati (AVOC) provides us with examples of how HIV is being prevented. AVOC’s “Men in Touch” program is described on the group’s web site: it’s a “six week discussion group for men who have sex with men, explores issues related to intimacy, sexuality and HIV/AIDS prevention.” AVOC also offers a follow- up program called “Keeping in Touch.”14
Additional advice from the AVOC web site says, “Gay men are still getting infected with HIV. Why? Because some men still don’t use condoms.” It goes on to say, “Your best weapon against HIV is your brain...With creativity and openness, safer sex can be sexual, sensual, erotic and fun.” There follows a detailed discussion of how to have “safe” oral sex, “fingering and rimming,” anal sex, how to use sex toys (cleaning them each time), and explicit anatomical instruction on condom use.15
Other innovative prevention strategies in Ohio emerge from the AIDS Task Force of Greater Cleveland (ATFGC), which has over 60 staff members and an estimated annual budget of over $4 million. One of their programs is called “Man 2 Man.” During 2004, among the Man 2 Man workshops held were “F-Him – A discussion that investigates the vast sexual behaviors and genres associated with gay men’s sex while reducing HIV/STI.” (STI stands for sexually transmitted infections). There’s also “To Cheat or Not to Cheat: A panel discussion centered around why men cheat and HIV/STI risk reduction for men who choose to cheat.” Man 2 Man also conducts private home “safer sex” parties for MSM (men who have sex with men) and had as a goal to conduct outreach to GSA’s (gay-straight alliances) in local high schools.16
Another AIDS/Cleveland series called “Positively Sexual,” is funded by a federal grant administered through the Ohio Department of Health. HIV positive clients attend workshops at ATFGC. Various titles of past workshops include “Ride ‘Em Cowboy” (2004), “Wood Pecker (2004)”17 and “KY Jellystone Park (2002.)” The latter two concerned men who have sex with men in bathhouses, public parks, sex parties and other public sex venues.18
Another Positively Sexual workshop at ATFGC in early 2004 was entitled, “Next Stop: Sodom and Gomorrah.” The report narrative described the session as follows:
This workshop examined gay and bisexual men relationship with the church [sic].Participants watched the video ‘All Gods Children’[sic] which examines the African-American church and homophobia. Participants shared their feelings and experiences and talked with a representative from a gay-affirming church in the Cleveland area. 19
Apparently, only one religious viewpoint is permitted under this particular federal grant.
Reducing HIV?
How successful are these and other prevention programs in reducing the incidence of HIV? Again, looking at Ohio, not very.
Little change has taken place in numbers of and newly diagnosed HIV and AIDS cases in Ohio in recent years, despite the millions of dollars spent
Numbers of new Ohio cases of HIV diagnosed in:
• 1999.....1004
• 2000.... 916
• 2001... 1033
• 2002... 967
• 2003... 1001 20
If one adds the total number of people in Ohio living with HIV and AIDS, it rose from 11,005 in 1999, to 14,477 in 2003.21
So despite fluctuations in some years, overall the problem is getting worse in many ways. Yes, it’s hopeful that people live longer after contracting the disease; however, with longer life comes the epidemiological reality of more HIV positive people who can expose others. With that in view, prevention efforts for “positives” take on tremendous importance. In reviewing the types of prevention programs taxpayers are funding at the AIDS Task Force of Greater Cleveland, the AIDS Volunteers of Cincinnati, and elsewhere, do we think these approaches could be problematic in any way?
One would think that the highest priority would be to reduce these numbers, to do everything possible to make progress. After all, we know what is causing this disease, right? Male to male sex, injection drug use and high-risk heterosexual contact are said to account for the vast majority of cases. High-risk heterosexual contact is first or second- hand sexual contact with someone in the first two risk groups. So it should be easy to target given behavioral populations and then implement effective—with the emphasis on effective—programs. And if you are carrying a potentially lethal disease, some of your freedoms may have to be curtailed. That’s always been true in epidemics.
Well, not so fast. Other issues surface. First, the special interests involved, most notably homosexual pressure groups, complain and even act like bullies just on general principle. From within taxpayer supported groups like the AIDS Task Force of Cleveland, there is generalized screeching about “discrimination” almost constantly. So—can public health principles be applied in such an environment? Yes, but only by the courageous.
Observing their unprofessional tactics, isn’t it prudent to wonder about the basics coming out of these local groups, like the reliability of the reported data? I’m not the first person to question this. Unreliable or missing information is a chronic problem.
The CDC just instituted an improved accountability tool to more carefully identify risk behaviors. It’s called “PEMS,” the Program Evaluation and Monitoring System. It involves much more detailed questions when HIV counselors interview a client, and the information feeds directly into the CDC for quicker impact and tracking of the epidemic. The HIV prevention personnel in the field, who see the suffering of these people everyday, must be thrilled, right?
Ah, but think again. The grumbling is everywhere. “It’s a violation of privacy,” “It will take too much time,” and so on, go the complaints circulating around the web. Perhaps less time spent on homosexual advocacy and attacks on abstinence programs might free up some staff hours. Whatever helps to actually track the epidemic and thus save lives, would seem to be worth shifting priorities.
And it’s not as if the grassroots couldn’t use some better methodology. If one looks closely at the HIV/AIDS stats,there are numerous inconsistencies and puzzles.
The Great “Unknown”
For instance, there’s a fat and ever-growing transmission category labeled “other/unknown.” In Ohio as elsewhere, this slot is, in some reports, the largest category for HIV causation. And in recent years, it seems to be growing.
Have you heard about this? Why are there not front page headlines about this trend?
Just to explain, at the first point of patient contact, each case of HIV and/or AIDS is assigned a transmission category signifying the known or suspected origin of the disease. The standardized categories recommended by the Centers for Disease Control are:
• Male/ male sex
• Intravenous drug use
• Male/male sex & IV drug use
• Heterosexual contact (high risk is what is meant here)
• Blood product
• Perinatal transmission
• Other/Unknown or Risk not reported
Where this practice gets really alarming is when one looks at “fresh” reports on new HIV cases. For instance, in looking at the Cleveland (OH) Consortium’s reporting from the years 1998-2000 compared to the years 2001-2003, here’s what was reported. We’ve only listed the two largest categories of risk for both males and females:
................................ Reported Cases of HIV Infection
....................................... Cleveland Consortium
.......................................... 1998-2000................2001-2003
Males
Male to male sexual contact......... 53% ................... 43%
Other/unknown........................... 31% ................... 47%
Females
Heterosexual contact.................... 36%.....................20%
Other/ Unknown ............................. 55%.....................73% 22
The accounting becomes even more troubling when looking at the numbers for the
Columbus area:
................................. Reported Cases of HIV Infection
....................................... Columbus Consortium
....................................... 1998-2000 .................... 2001-2003
Males
Male to male sexual contact.......... 43% .................... 23%
Other/Unknown............................. 49% .................... 74%
Females
Heterosexual contact..................... 32% .................... 14%
Other/Unknown............................. 57% .................... 83% 23
In the years 2001-2003, 83% of HIV cases among females and 74% among males in Columbus had an unknown origin??? What in the world is going on?
The Ohio Department of Health does not leave this unexplained:
Risk information is collected on the HIV/AIDS reporting form; however the number of reports lacking risk information is increasing and can be greater than 50% for some population groups. Reports of HIV without risk information receive follow-up investigation in an attempt to classify them into a transmission category; therefore cases reported in previous years have a higher proportion of cases with a known risk.24
I called the Ohio Department of Health and asked for clarification, but they basically repeated the above statement, saying, “There is no mode of transmission reported on many of our cases.” This is not helpful; they acknowledge it’s happening but can’t or won’t say why.
The Centers for Disease Control has become concerned about this trend. The number of cases across the U.S. without an assigned risk factor has been rising sharply in recent years. For the year 2003, over one-third of new cases were reported without risk information. CDC says the most probable causes are staff turnover, inadequate training, and non-standardized intake methods and terminology. 25 This may at least partially explain why the PEMS program has been implemented.
Even though this category includes the word “other,” it’s by far mostly “unknown.” In order to account for what this “unknown” category might be, the CDC has come up with a handy device. At the bottom of many Ohio reports is the following phrase:
Cases reported without risk information are redistributed using CDC models that are based on historical patterns of risk classification in the Midwest.
As time passes, it seems these unknown numbers resolve themselves by disappearing into the other established categories as one looks at tables of diagnosed AIDS cases, or in summary reports for all of Ohio. One could assume this is mostly by using the CDC’s handy “redistribution” formulas, which may not at all reflect reality.
These are the real headlines. Is there any newspaper in this state that dares to probe these questions?
There are only a few real reasons why this could be happening, and most of them are not good. It’s either gross inefficiency, outright fraud, they truly don’t know, or some combination of these. One can imagine what that response of the “gay” lobby will be the same as it always is when their behaviors are questioned: it’s “homophobia.” Oh. Well, we need to continue to throw millions of dollars at the situation and just shut up, I guess. Meanwhile, people are dying and we don’t know why.
If this kind of accounting turned up in the annual report of a major corporation, we’d be talking another Enron scandal and the media would park on the offending party’s doorstep. But since it’s only Ohio taxpayers, and the future health of citizens and even children, there’s no reason to worry about accountability, right?
Children, the HIV lobby, and Corruption
One of the major activities of local HIV and AIDS groups in Ohio, as elsewhere in the U.S., is to reduce the incidence of HIV among youth. The primary audience for these efforts is the age group 13 to 19, but some sex education activities target even younger ages.
It’s interesting that while there has been increasing outrage across the U.S. about child sexual abuse and molestation, few want to point a finger at the activities of the sex ed cartel which enables adult-child sexual activity from many different angles. In most states, children can consent to health care treatment without parental knowledge or permission, which essentially opens up doorways for predators.
Adults are provided increasing access to kids through groups that offer sex instruction, counseling or sex-related health services to children. Kids are given adult level, age inappropriate information in the guise of “protecting” them; they are led to believe that “everyone” their age is doing this and that they can be protected by condoms; and they are seldom informed that an adult who becomes one of their sex partners is committing a crime. Fueling all of this is, of course, pornography.
There is an ideology that seeks to “empower” teens and even children into making sexual “choices,” as if kids are capable of true consent, or as if there’s no harm involved. There’s also the inevitable outcry: “Well, if they are already sexually active, shouldn’t we help them to at least reduce their risk?”
There’s a simple answer: yes, but only by recommending the most humane approach, the one that actually works: abstinence. If one of our teens was driving drunk, it’s unlikely we would hand him or her a loaf of bread and say, “Since you are probably going to do this again, this will soak up some of the alcohol in your system and reduce your chances of having a car accident.”
In Columbus, there’s a youth organization called Kaleidoscope. It’s run by adults, mostly volunteers, and it’s for “GLBT” kids ages 11 to 22. Of those homosexuals who are attracted to kids, do we not believe many will volunteer for venues like this in order to gain access to kids?
This group offers drop-in hours and parent or guardian permission or knowledge is not required. There is no oversight of this organization by a school board or any group that supervises children. Many of the area high school “GSAs” (homosexual clubs) meet at Kaleidoscope to plan, receive training in activism, and socialize. Parents are currently not notified in Ohio if their 14- year- old at high school has joined such a group, either. And in Ohio as elsewhere, middle school homosexual clubs will soon be starting, since few parents have objected to anything homosexual activists have demanded, even regarding children.
Why is there not an outcry over this? HIV testing becomes a convenient excuse for this seamless web enabling youth to enter the homosexual lifestyle. At Columbus Kaleidoscope, as at a similar group in Cleveland and one in Cincinnati, the HIV/AIDS groups and Planned Parenthood are frequent speakers at these centers, teaching vulnerable kids all the intricacies of sex. And socializing, and role-modeling, all in the name of “health.” And when these kids quickly become sexually active—they are right there with the HIV test, just to prove the need.
Your tax dollars at work.
The Future: Some Ideas
What can we do?
- Emphasize abstinence until marriage programs and give them substantially more funding. These programs create self-respect in youth and respect for others. Any other approach is inhumane by treating our children as if they are animals and exposing them to possible abuse, disease and pregnancy. Abstinence programs do not disseminate “fear” unless one is scared of giving youth vital health information about the real risks of sexual activity. Abstinence messages do not make teens afraid of sex. It makes them take it seriously. When we are talking about damaged and destroyed human lives, throwing billions of dollars toward “party-time” programs is insane.
- Consider closing establishments that enable male/ male sexual activity and/or substance abuse, especially “gay” bathhouses, “gay” bars and circuit parties. If this is not feasible, at least force these establishments to share the tax burden of increased disease that they enable.
- Make non-reporting of child sexual abuse by mandatory reporters a felony with stronger sentencing guidelines, and publicize on the Internet the names of mandatory reporters who are convicted, to prevent them from getting another job in the youth services/health care field.
- Enact an Ohio law that prohibits any homosexually-oriented youth programs, either in schools (like homosexual clubs) or in the community. Kids must not be encouraged to engage in homosexual sex, or any sexual activity that’s outside of marriage. This is consistent with current Ohio law on abstinence education in schools, which is routinely being ignored.
- Conduct congressional investigations at the federal and state levels of the activities of AIDS groups that receive public funding. Any activities that enable behaviors in the highest transmission categories for HIV need to be eliminated, including pro-homosexual activism. Religious discrimination needs to be stopped immediately. Abstinence needs to be emphasized for all clients. This could get nasty, because AIDS activists have demonstrated over the years both in Ohio and elsewhere that they have few scruples about how they get what they want. Still, official investigation needs to happen.
- Brave reporters and researchers need to expose the unethical practices and conflicts of interest of the vast sex cartel. Who gives money to the foundations that fund Planned Parenthood, SIECUS, Advocates for Youth, ACT UP, and national homosexual advocacy groups? There is a profit motive here that is probably buried not too far back. Our neighbors, families, friends, and children are suffering. Who’s willing to ask the right questions and shut this death and disease industry down?
- Actually treat AIDS as if it’s an epidemic, not like it’s the inevitable outcome of benign human activity (like tooth decay). It’s the result of certain known preventable behaviors. Let’s get real, or else slash the wasted funding---one or the other.
Notes:
- Derived from data found at: http://www.nccic.org/
- From documents provided by the Ohio Department of Health, as a result of a Freedom of Information request in early 2005.
- Business First, Columbus, Ohio, May 26, 2006, p. B 7.
- Based on data for Franklin County from the Ohio Department of Health, available at http://www.odh.ohio.gov/healthStats/disparities/pregnancy.aspx
- Letter to Dr. Baird dated December 30, 2004.
- http://www.gaypeopleschronicle.com/stories05/february/0218056.htm
- Cached article available at http://64.233.167.104/search?q=cache:iJmntTYCrEQJ:www.cleveland.com/health/plaindealer/index.ssf%3F/base/news/1123925674284590.xml%26coll%3D2+Regina+McEnery+Maggie+Gallagher+Earl+
Pike&hl=en&gl=us&ct=clnk&cd=1
- http://www.gaypeopleschronicle.com/stories05/november/1125053.htm
- Estimate compiled from a number of sources including material supplied by the Ohio Department of Health, the state of Ohio’s budget, and Internet sources.
- http://www.kff.org/hivaids/hiv042005pkg.cfm
- Line Item 440-444 in the Ohio Department of Health budget found at http://www.lbo.state.oh.us/
- From Kaiser Health Facts, http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=HIV%2fAIDS&subcategory=HIV%2fAIDS+Funding&topic=CDC+Funding
- Several requests under the Freedom of Information Act for documents from the Ohio Department of Health were submitted by the author in 2005 and 2006. This was a response to one of the questions submitted.
- http://www.avoc.org/educonc.html
- http://www.avoc.org/edusexc.html
- Report on progress of federal grant program called "ManHealth” in July 2004 to City of Cleveland from ATFGC about workshops scheduled to be held in October 2004. Among materials mailed unsolicited to the author by Earl Pike of AIDS Task Force of Cleveland in March 2006.
- Ohio Department of Health AIDS Client Resources Section , Community-Based HIV Case Management Grant, Quarterly Narrative Report, July 1.2004---September 30, 2004, ODH Grants Number 1860031AT03. See also note 16.
- ODH Reporting for Positively Sexual Program, Quarterly Narrative Report, October—December 2002. See also note 16.
- Ohio Department of Health AIDS Client Resources Section, Community-Based HIV Case Management Grant Quarterly Narrative Report, January 1, 2004—March 31, 2004. Ohio Grants Mgt. Number 1860031AT03. See also note 16.
- “Overall Trends in HIV Infection in Ohio”, http://www2.odh.ohio.gov/data/Inf_Dis/HIVpf/EpiProf02.pdf, p.24. Statistics for year-end 2004 and forward were not available.
- Ibid., p.28.
- http://www2.odh.ohio.gov/data/Inf_Dis/HIVpf/EpiProf04.pdf, p.112.
- Ibid, p. 118.
- “Overall Trends in HIV Infection in Ohio”, http://www2.odh.ohio.gov/data/Inf_Dis/HIVpf/EpiProf02.pdf, p. 37.
- Centers for Disease Control report, HIV/AIDS Risk Factor Reporting Alarmingly Low
