Why I Left AIDS

I left AIDS in the mid-late 1990's.

I made a conscious decision to stop working on HIV/AIDS, and to stop referring to HIV/AIDS when talking about gay health.

In short, I was over AIDS.

I wanted to force myself into a new idiom, a new way of thinking. I had no idea what it would be, but I had come to the conclusion that continuing to work on HIV/AIDS would be detrimental to me personally, and might well not be helping anyone else either.

I wish I could say that I had some inspired moment, that I had some vision of the future of queer health, some goal in mind, some grand theory. But in truth I had none of those things. Gradually, I began to realize that working on HIV/AIDS felt increasingly distant from my personal experience I noticed that it was harder and harder to interest my friends to get active, it was even hard to know what to get active about.

But maybe I should start a little earlier.

I was a little fagling in 1987, a momentous year in queer history. In 1986, my freshman year of college it began to dawn on me that it was not a passing œdipal phase, that my attraction to other guys was not merely admiration of their physical form, to be replaced at some point in the future with an attraction to the voluptuous female form, marriage and children.
This was distressing to me, because my only image of an adult gay man was not what I wanted to become. Don't get me wrong, I didn't want to be "normal", I just didn't want to be lonely, depressed, and ridiculed for the rest of my life.
I quit the crew team, partly because I was not going to be competitive at the level required, but mostly because I just didn't see any possibility of being happy, healthy, and vibrant as a gay man.

I slowly began meeting other gay men, particularly Chris Bartlett and Stephen Gendin. Then in October 1987, Chris invited me to vanpool down to DC for a March on Washington. It totally blew my mind. For the first time in my life I saw happy, healthy, vibrant gay men. I kissed one of them, for about six hours, while driving around from one spectacularly lit patriot monument to another.

I came back to Providence transformed. I realized that I could do this gay thing after all.
My then (and current) roommate calls it my militant phase. I painted pink triangles on the back of my hands. I gave out "queer fries" at the snack bar to anyone who would publicly say they were gay or lesbian. I proselytized to anyone and everyone.

In early 1988, Stephen invited me to "come get arrested". I said "sure" and then it took me a week to ask "what for?" He told me it was about gay rights, and only during the civil disobedience training did I learn that it was really about AIDS, about trying to keep the Health Department from doing widespread mandatory HIV testing, and compiling a list of everyone who tested positive for some as yet to be determined intervention. I kinda freaked out. I had begun to come to terms with the gay thing, but I was scared to death of AIDS and didn't want anything to do with it.

But Stephen was inspirational, and I stuck with it, becoming one of six people arrested in H. Denman Scott's office on the fourth floor of the Health Department. I'm the one in the purple shirt with a green knapsack.


Thus began a long and industrious career with ActUp/RI.

We never needed to get arrested again, it just doesn't take much of a fuss to get on TV in Rhode Island. We disrupted Ed DiPrete's gubernatioral candidacy announcement, we protested the high price of AZT, we joined in national actions at CDC and FDA. I started writing a weekly summary called Bill's News Headlines, a 'zine about all things HIV/AIDS, with a few spicy pictures thrown in for interest.

Under the Reagan Administration, AIDS was largely ignored, until it wasn't. In the late 1980's all kinds of scary talk was coming down, including threats of quarantine. We had a clear and obvious enemy. Those of us young enough and pissed off enough rose up in anger and began a confrontational style of political action that the generation before us was too overwhelmed to undertake.
But when George the first took office, things began to lose traction. Many of our initial demands were being met (AIDS drugs cost less, mandatory testing and quarantine were mostly averted, some government resources began to flow into aid programs, some of the egregious ethical violations inherent to clinical trials of new medications were being abated). The newer issues we were grappling with (needle exchange, anonymous HIV testing) just weren't as sexy. We had a few more big demos (notably a big coalition bash at the Providence Journal, and a fun hootin' and hollerin' when Dan Quayle came to town), but things were starting to taper off. We started meeting with the Health Department, in addition to chastizing them. I even worked there on an internship one semester.
And by the time Clinton came along, all the air got let out of the balloon. Don't get me wrong, Clinton the first did as little as possible to advance the cause of people with HIV, and was arguably one of the worst presidents we've had on gay rights. But the community had had enough. It just wasn't possible to gather a crowd of pitchfork-wielding townspeople any more.

By this time, I was working in HIV/AIDS clinical research. Doing some statistical presentations of data from clinical trials, and medical record abstractions. I began keeping a list, for the medical researchers, of everyone that had been treated for HIV in Rhode Island, what major infections they had had, when they started treatment, etc. I felt pretty conflicted about that, and at the same time fascinated by the stories I was reading between the lines of lab reports and hospitalization records.

The job took me to an AmFAR conference in San Francisco. I fell in love with the city instantly, despite having an earthquake knock my hotel bed around the room my first night in town. I loved how it smelled. I loved the hills and the views. It seemed impossibly magical.

I vowed to move to San Francisco at the next opportunity, quit my job in HIV clinical research, and had all but bought the plane ticket when I got invited to take a job with the tuberculosis and HIV basic immunology lab at Brown. The pay was good, very good. And I figured, what the heck, I can do this for a couple years more, then go out to San Francisco. In the meantime, for several years I got in the habit of taking a month-long vacation in San Francisco every January, staying at the YMCA on Golden Gate & Leavenworth. Everything I needed to pack for a month fit in one bike messenger bag.

Well, I worked on that stuff for a few years, developed a mathematical algorithm for predicting amino acid sequences that would be likely to trigger an immune response, and had a lot of fun while doing it. Got to work with some very motivated and bright undergrads. Got to travel to a bunch of conferences. Even got a pat on the back from Tony Fauci at one point.

But at some point, I realized I needed a break from the frantic pace of HIV research.
HIV/AIDS was the most important thing in the world, or so it seemed. Everything was urgent. HIV/AIDS was an exception to every rule. But after the better part of ten years on the cutting edge, I got weary of being cut. I needed a break.

I began looking for another job, and quickly found it, in the much tamer field of gerontology. I got to work with incredibly bright, talented, and caring people. People who were interested in getting things done carefully, slowly, correctly, not living in a state of perpetual emergency. I had an amazing boss, who really helped me work much more effectively with other people (do you remember the 7 habits of highly defective people - I had probably 4 of them - I was not an easy person to manage).

So at first, I was just taking a break, not really thinking about HIV/AIDS, except about how futile it seemed to be to think about it.

At some point, though, I did make a conscious decision that I would not work on HIV/AIDS again. I wanted to force myself to think differently, to force myself to be more creative, to develop a new language and vocabulary, and whole new mindset.
As I was struggling to do that, I put together a forum at Brown about the Post-AIDS phenomenon. I invited Chris and Stephen as panelsits, after getting re-connected with Chris at the Boulder Gay Men's Health Summit, and also invited Justin Smith, a next-generation activist. It was a fantastic discussion, and there was plenty of passionate but respectful argument.
I made an analogy at the outset that Post-AIDS, in my mind didn't mean that AIDS was over, any more than Post-Modern means we are no longer modern. But the shock of modernity is largely over. The automobile has gone from being a bizzarre new sight on our city streets, crowding and running over pedestrians and cyclists, to being banal, a fact of life (though still running over pedestrians and cyclists - I've got the chronic pain to prove it - it's just banal and mundane now). Electric lights are no longer a showy extravance. It is not that modernity is done modernizing, but rather that the progressive development of wonderful, exciting, and dangerous new technologies is expected and welcomed.
My analogy to the term Post-AIDS was that the shock of AIDS was over, that we were now living in a world where AIDS is part of life, and that public health prevention efforts revolving around HIV as new, threatening, and catastrophic may have worked in the past, but would no longer work in the future. We needed to find new language, new ways of thinking about public health's role in prevention, because the tools of fear and hyperbole have run their course. We are in Post-AIDS now, but HIV prevention has yet to catch up to that reality.

Some ten years later, there are some exciting new developments on the gay health promotion front, such as Chicago's How are you Healthy? campaign, which is all about tying the three words "Gay. Sexy. Healthy." together in new and interesting combinations. The I Am Gay And... campaing in New York City is another one I like a lot. But these two are exceptions.
We're still bombarded with ad campaigns like this one, this one, this one, and this one that either play on fears and negative imagery, or treat us like we're just not knowledgeable enough to know what's good for us.

Well, I've wandered and rambled quite a bit here, and I'm not sure that I've adequately answered the original question - why I left AIDS. But it's a start.

I'm really curious about what some of the stories of the thousands of gay men who have left AIDS work - what did it feel like? What are you doing now instead? Do you, like me, feel conflicted about abandoning the AIDS work, even if what you're doing now is much more productive and forward-looking?

Quick Trip East

Went back East for a week to see my parents. Here they are walking through a small orchard of apple trees planted a very long time ago (probably about 100 years or so) that I've been pruning. The apples used to taste awful but now they're pretty good. They are varieties that are not commercially viable (too small and bumpy), so you can't find them in stores, even specialty markets.
My mother says that one of them is called a "banana apple" which she recognizes from her father's farm in upstate New York. It's true, it's an apple with a faint whiff of banana as you bite into it.

Also stopped into Providence to try to do some work on my house. Got a bit frustrated because the windows I wanted to replace I have to special-order, so mostly I frittered around with some electrical work and painting instead.

I've come to the solid realization (yet again) that I need to work tirelessly towards getting a full-time teaching job. Not only do I love teaching (and I'm getting pretty good at it if I may say so), but I need to be connected to the land in Vermont that I've put so much time and effort into, and the best way to do that is to have the summers off.

HPV Vaccine for Boys? No (and Yes)

The news about HPV vaccine for boys lately has been mighty confusing.

An FDA panel approved the use of an HPV vaccine in boys to prevent genital warts in September with a 7-0-1 vote.

Then an article came out in early October, sponsored by the CDC and others, suggesting that vaccinating boys to prevent cervical cancer in girls would not be cost-effective (more on that later).

And then today, a CDC advisory panel chose not to recommend HPV vaccination in boys. Apparently, the CDC-funded study weighed heavily in the committee's deliberations.

The upshot is that a doctor can write a prescription for HPV vaccination for a boy, but because it is not recommended, very few doctors will bring it up as an option, and no health insurance plan will pay for it.

Benefits of Vaccinating Boys Against HPV
1) The vaccine prevents getting genital warts. Sure, genital warts are mostly a minor nuisance, but tell that to someone who's had a few hundred warts cauterized up in his butt. Ouch!

2) The vaccine probably prevents anal cancer. No study is ever likely to prove that the vaccine prevents anal cancer. It is too rare, and takes too long to develop. But it doesn't take a genius to figure out that if the vaccine prevents getting the HPV strains that cause anal cancer, it will prevent anal cancers. Interestingly, this benefit is often dismissed as not a real problem, because most anal cancers occur in gay men (and nobody's son will grow up gay?).

3) The vaccine probably prevents a bunch of other, though rare, cancers - penis cancer (yes, there is such a thing), and cancers of the head and neck, primarily. Admittedly these are pretty rare. But if they can be prevented, why not?

4) Vaccinating boys prevents cervical cancer. Huh? But only people with a cervix (born female) can get cervical cancer. OK, but how are they getting HPV? From "Immaculate Infection"? No, from men and boys (for the most part). So, vaccinating boys is crucial to having a successful strategy for reducing the prevalence of these HPV strains in the population, thereby reducing the chances that a woman or girl will get infected, either because she didn't get the vaccine, or because it didn't work.

Lousy Vaccine Policy
The problem with contemporary U.S. vaccine policy is two-fold. Vaccination policy is strictly limited to worrying about individual risks and benefits, and vaccination policy is couched in terms of cost-efficacy, a framework that doesn't make sense.

Individual Benefits Only
So first, the individualized approach to vaccination strategy assumes that nobody else benefits from you getting vaccinated. So, if there is not an immediate benefit to you, don't get vaccinated. Because the individual, albeit miniscule, risk to you outweighs any potential benefit to others. And since men can't get cervical cancer, it is irrelevant that men and boys can infect women and girls with the virus that does cause cervical cancer in them.
That's not how vaccination policy has always been done. Smallpox vaccines were given to lots of people who had a next to zero risk of getting it, because the risk to society of having smallpox come back was too high. Same with polio. Today's vaccines are a lot safer than those vaccines were. The shift came with the HBV vaccine, when individualized risk-assessment was used to guide vaccinations, a policy that largely failed for the first two decades, and thousands of Americans are paying the price with HBV infections they didn't need to get, because a safe and effective vaccine was bottled up in a bureacracy of risk-assessment.

Cost-Efficacy. You're Worth $50,000 a Year.
Second, cost-efficacy is the wrong framework for evaluating vaccination strategy. For one thing, it is fairly arbitrary to say that a year of healthy life is worth $50,000, but not $100,000. By that logic, it wouldn't make sense to treat many forms of cancer, or advanced HIV infection, etc. Because if your treatment costs more than $100,000 in a year (which is not hard to do if you get surgery, chemo and radiation therapies), it exceeds the 'value' of your life for that year.
But that's exactly the logic of the CDC-funded article I linked to above. At $50,000 per year of healthy life saved, vaccinating girls is worth it. But at a little bit higher than $90,000 per year of healthy life saved, vaccinating boys isn't.
The study was also funded by the American Cancer Society, which recommends cancer screening programs that cost many times higher than that, and some of which (mammograms in women under 50, PSA tests), may well cause more human health harm than good, so could not be considered cost-effective at $10 billion per year of healthy life.

More fundamentally, cost-efficacy ignores any societal benefits acheived through reducing the prevalence of HPV infections. There is no space in the calculation for the benefits to society from reducing one's exposure to HPV because fewer people in the population have it. By the logic of cost-efficacy, if the vaccination strategy were somewhat effective, and reduced the prevalence of HPV infections by half, then the cost of a year of healthy life saved would rise to $100,000, and this logic would dictate that we should stop vaccinating girls at that point if the vaccinations are successful.
If we had pursued that strategy with smallpox and polio, we would have vaccinated people when the prevalence was high, but as soon as it got down to an acceptable annual cost to just let people get sick, we would have stopped the vaccinations, and we would not have eradicated smallpox from the Earth, or polio from almost everywhere.

Gloomy Predictions for HIV Vaccination Strategy
All the signs point to these forms of illogic being applied to the HIV vaccine, when it becomes available. First, vaccinations will be targetted only to "high risk" individuals, meaning that doctors won't think to ask if you want it, insurers will not pay for it, and you'll be hard-pressed to find it in-stock anywhere, meaning that you'll need to visit your doctor to get the prescription, go to a pharmacy to pick it up, and make another trip to the doctor's office to have it administered. Second, the logic of cost-efficacy will almost certainly exclude recommending any HIV vaccine - which will be expensive, require multiple shots, and be only partially effective (maybe 1/4 to 1/2 of people would be protected).
Getting a vaccine that works, my friend, is the easy part of this battle.

So forget what's recommended. If you can afford to get your boys vaccinated for HPV, please do it. For them, and for the girls.

Environmental Success Stories

Global warming. Air pollution. The ozone hole. Nuclear winter. Acid rain. Deforestation. Pesticides. Extinction. Industrial waste.

Poisons are everywhere, undetectable, and have unknown risks.

Everything you hear about the environment leaves you feeling threatened and helpless. Not only that, but usually you are personally culpable unless you spend a huge amount of money buying your share of the problem away with (insert environmentally chic and expensive food/clothing/transportation/lifestyle item here).
A pretty insurmountable trio of adjectives, threatened, helpless, and culpable.

Believe it or not, there are actually a lot of environmental success stories. Successes that are the direct result of the political action engendered by making us feel threatened, helpless and culpable.

Acid Rain
When I was a kid, everybody talked about acid rain, how it was killing the fish in the lakes, burning the trees. And it did. And it does still, but to a much lesser extent. Did anyone tell you that acid rain has gotten much better? That your outrage led to actions that severely curtailed the emission of the pollutants responsible for acid rain? That progress has been made even faster than what Congress anticipated?
Clap yourself on the back. We did it. Or, more correctly, we're doing it. Keep up the good work!

Air Pollution
You never hear about it, but the air is easier to breathe. Not everywhere, but in most cities, particularly in California and the Northeast, air quality has been getting better and better, thanks to some of the same measures that were taken for acid rain, but mostly because cars and trucks have become less polluting.

Deforestation
Deforestation is a huge problem worldwide. But not everywhere!
New England used to be about 80% de-forested. Now it is about 80% re-forested. Those new trees are a lot smaller than the old trees that got cut down. And the demand for wood in New England is largely met by exporting the problem to other parts of the world.
And yet, New England is rapidly re-growing a valuable renewable resource.
And nobody talks about what a huge success that is. How can we learn from what happened in New England and export that success as well?

The Ozone Hole
The ozone hole was first recognized in the 1970's, and by 1978, the main agents responsible were banned in most countries. We changed the propellants used in spray cans, and the refrigerants used in refrigerators. And although the ozone hole hasn't been shrinking, it has stopped growing quickly, and is expected to recover over the next few decades.
Problem caused. Alarm raised. Problem addressed. Let the healing begin.

Lead Poisoning
A huge success story is lead poisoning in children. You've probably heard about kids getting poisoned from lead paint. Too much lead causes brain changes that are not good. It's still a big issue in areas with older housing stock (but rapid progress is being made).
Not too long ago, virtually every child had potentially toxic levels of lead in their body, due to the lead additives used in gasoline that we all breathed in. That's gone now. And there's a huge generational shift in blood lead levels.

And there's more. The Nashua River used to stink to high heaven, it's banks were scorched clean. Now you can eat the fish you catch there. Bays have gotten cleaner. Alternatives to pesticides are gaining ground. Eagles are laying eggs that hatch. Wild areas are being protected. And so on and so on.

I remind myself of these stories now and again because I think feeling threatened, helpless and culpable is a pretty big waste of time.
I'd like to think that there's a way to motivate the public to address the serious environmental threats facing us that doesn't resort to backing us into that uncomfortable corner. And can we celebrate the successes, for once?

When faced with the newer threats - like global warming - and the old threats - like nuclear waste - I take heart in the fact that we've been able to make real progress on a lot of fronts in the past. I don't necessarily think that there's a technological fix to every problem, that there's a progressive inevitability to cleaning up after ourselves. But I also don't think we're living in a world that is on the verge of total collapse, either. And I vehemently disagree with the stance that the only real solution is to reduce the human population. We may cause the problems, but we're also the ones to fix them.
I think we can make a difference. We already have. Let's keep doing it.

redefinitions

retreat. v. Seconds on dessert. I had a light supper, so I retreated myself with ice cream.

revenue. v. To move an event from its original location. The unexpected douwnpour caused us to revenue the wedding ceremony.

predate. n. The period of time before a date when you can think about nothing else.

distance. adj. Holding both sides of an argument simultaneously. The senator distanced himself on the Health Care debate, hoping that whichever way it went, he'd be able to declare a victory.

promote. adj. Supportive of the political aspirations of dust particles.

reveal. v. Milk feeding the calf of a cow that never left its own mother's teat.

prevent. adj. The hot clammy slap in the face you get coming home to an apartment that's been shut up on a hot muggy day.

represent. v. see retreat above.

propound. n. (Br.) see anti-euro.

Research Worth Reading (3)

There's a myth out there that gay men are self-obsessed and narcissistic, and I for one don't buy it.
David Nimmons, in Chapter 3 of his book Soul Beneath the Skin claims that on the contrary, gay men are actually more likely to get involved in volunteerism and altruistic behaviors, in part basing that on the enormous outpouring of volunteer time and energy devoted to AIDS service organizations.

Well, this is the first quantitative random sample analysis that really tries to get to the issue of whether gay men (and lesbians) are more or less altruistic than straight people. And that goal is what makes it 'research worth reading', in my opinion.
This is one of the few analyses that examines assets, rather than risks; one of a very small number of quantitative analyses to do so. So regardless of the results, regardless of the methodologic challenges, this is an important read in terms of thinking about the health of sexual minority populations.

Self-reported altruistic and reciprocal behavior among homosexually and heterosexually experienced adults: implications for HIV/AIDS service organizations.

Susan D. Cochran, Vickie Mays, Heather Corliss, Tom W. Smith, Joseph Turner

AIDS Care 21(6):675-682. June, 2009

The authors used data already collected as part of the General Social Survey (GSS), a random-dialed telephone survey of the US population conducted annully since the 1960's, a staple dataset for the social sciences.
They looked at four potential measures of altruism across groups of people defined by whether they reported ever having had sex with someone of the same sex, or whether they reported only mixed-sex sexual relationships. The sample size of the GSS is fairly large (they combined 2 years to get 2,031 people), but the number of men and women reporting same sex partners in their lifetimes was pretty small (68 men and 51 women), so they elected not to divide that group farther, but lumped together men who were homosexually active and bisexually active together, and the same for the women.

The GSS asked a 7-item scale intended to measure empathic concern (other-oriented feelings), a 4-item altruistic feelings scale (similar idea, as far as I can tell), a set of 11 altruistic behaviors (things that one does for others that have no self-serving interest, like giving directions to a stranger, even at some risk to one's self, such as donating blood), and 4 reciprocal behaviors (things that one does for another, but do have self-serving aspects as well, like helping someone you know find a job, or lending a friend a considerable amount of money).

They found that gay/bi men (at least in terms of reported sexual behavior) were very similar on all of these measures, in terms of the average. Of course, the average is just the average, it doesn't really say much about the distribution of individuals in the population, meaning there might be a bunch of gay/bi men who are much more altruistic (for example: helped 7 people find jobs, not just one) but that wouldn't be reflected in the average.

The lesbian/bi women were also very similar across all four measures of empathy and altruism.

So, the results are pretty vanilla. Looks like we're about as caring and other-centered as everyone else.

Blood donations
One interesting side note is that they found lots of people in GSS reporting having given blood recently, over 20% of exclusively hetero men, and almost as many of the gay/bi men. That's similar to what I saw in the same dataset and reported on here.
I suspect that there's something wrong with that variable, not because it shows lots of men with same sex sexual behavior giving blood, but because it shows many many more people of all stripes giving blood than actually do.
I don't know what the problem in GSS is about blood donation. Maybe a lot of people are interpreting it to mean gave blood ever in their lives, rather than just in the last year. Maybe a lot of people are interpreting having given a tube of blood for medical tests as having given blood. I don't know.
But at any rate, there are more credible results on blood donation in the National Health and Nutrition Examination Survey, which I reported on here.

Study limitations
The General Social Survey (GSS) is an amazing dataset. They ask tons of questions, and repeat a lot of them year after year. But, it is also very general, and not necessarily designed for whatever analysis you or I might have in mind, so when re-purposing it, it is important to hold in mind that the results may not be what they seem for a variety of reasons.
As is typical for epidemiologists, I'll break them down into three large categories: errors in assessing sexual orientation; errors in assessing altruism; and other factors that may be associated with both sexual orientation and altruism.

errors in assessing sexual orientation
The GSS is a telephone survey, and it is a really long survey. And not everyone pays close attention the whole time they are on the phone. As a result, some people inadvertently give answers that don't actually represent their reality, and in very rare cases, the interviewer records something other than what the respondent said.
All that would be well and good if a little bit of error here and there gets swapped from one group to another, but it gets problematic when one group is much smaller than the other (like sexual minorities). In this sample, 5% of the women and 6.6% of the men reported at least one sexual partner of the same sex in their lifetimes (since age 18). It's possible that maybe 4% of the women and 5% of the men really did have same sex partners, and the other 1-1.5% represent people who were inattentive or miscoded for some reason (this is purely hypothetical, there's no way to know what the error rate really is). So, if that were the case, then gay/bi men and lesbian/bi women would look more like straight people than they should, because a bunch of the people we think are gay/bi/lesbian really aren't (Scout's Law of Fake Queers).
The GSS actually has more opportunity than most datasets to check on this kind of error, because at different points they ask about sexual partners ever in one's lifetime, in the last five years, and in the last year. And there's always people who say they have had no sex in the last five years, but they have in the last year. No way to tell which of those is correct, but they can't both be true, so you can get a sense of the error rate that way. I haven't done that analysis myself, but it could be done.
Another way to check is to see whether the queers identified in this study look like queers identified in other studies. Most demographic studies have found that people who describe themselves as LBG, or who report same sex partners, tend to be slightly younger, more highly educated, and especially less likely to be married. In this study, they were somewhat younger (much younger for the women), but not more highly educated. The LGB people identified in this study were less likely to report being married, but still about 30% reported being married, which is pretty high.
For those reasons, I'm a bit skeptical that the GSS sample has really accurately described the LGB population, I suspect that there's a fair amount of 'slop' from the heteros mixed in with us.

errors in assessing altruism
Another potential source of error is if altruism is not measured accurately. This is an area I'm much less familiar with, in part because I just don't trust scales. The known inaccuracy of the blood donation question gives me some cause to interpret this study cautiously, but that could be a problem mainly with that one question for whatever reason, and not reflect systemically on the other measures in the study.

other factors associated with sexual orientation and altruism
I don't know enough about how altruism is distributed in the population. They separated the population by sex, and that's probably the biggie. There weren't enough people to do stratified analyses across any other variable (like age, educational attainment), but they did do a mathematically smoothed model to try to partially adjust for these factors simultaneously, and found no big difference from the overall results.

Full disclosure: Susan Cochran, the lead author on this study, was also the external reader for my dissertation. She and I have never discussed this paper, though. I don't think seeing her name on the paper made me especially more likely to choose it, I was hooked by the word 'altruism' before I saw that she was associated with it. I do think that knowing that she and Vickie write good research is why I asked her to be my external reader.

Patricio gives a very moving account of his experiences at the Chicago LGBTI Health Summit here.