One Year in SF

Well, here it is, one year since I moved here.
Just finished teaching a summer class on "The Development of Sex and Gender" and I think it went pretty well. I'm up to my eyeballs in grading at the moment, so hopefully I'll have more time to ruminate on the year anniversary soon.
Turning 41 went smoothly. A few friends in Providence had a little celebration for me last time I was back there, which made me miss it terribly (Providence, not 40, that is).
Tuna continues to be an amazing companion, she is far too tolerant of my bouts of fatigue that prevent her from getting the full walks she deserves.
Hopefully, we will be moving in with Paul and his fiancee soon, at Haight & Divisadero. That will be a lot more affordable, and Tuna will have the nearly constant company of Sascha, which will be quite a blessing for the both of them. Given the location, it will be a lot easier to get them out to the park for a romp, as well. The house is conveniently located smack-dab between Alamo Square (our current haunt, about 8-9 blocks from the Fox Plaza tower), Buena Vista Park, and the Panhandle. And Duboce is nearby too. So she'll be sitting pretty.

Weddings.
I had fun taking pictures of the resumption of similar gender weddings in San Francisco. Took the morning off work and wandered around City Hall, took extensive pictures of two couples. I was able to get ahold of these two later, it felt nice to be able to give them a little momento of their moment in the limelight.


Went to a lovely wedding in San Diego, and took the opportunity to walk over the Mexican border and back. It was very smooth in both directions. Definitely a huge transition over such a line in the sand.

Routine HIV Tests, the Class' First Test, and the Blue Angels

So, I had my first doctor's visit since I got here today. Here's the front door and elevator bank. Nice building! Especially for a doctor who takes HMO insurance.
My new doctor (physician's assistant, actually) seems like a nice enough guy. Now that I've gotten my back pain under control, there really wasn't anything pressing to discuss, just getting a prescription for my anti-depressant medicine.

This will be the first time I get a 'routine' HIV test. I wouldn't have gotten one under normal circumstances, since there's no reason to be concerned (oh, and I wish there was!). But the CDC has come out with a new policy suggesting that everyone get an HIV test every once and a while on a routine basis.
After some initial hesitation, I have come around to strongly supporting that policy, so I would look a little hypocritical if I supported routine testing on the one hand, and didn't do it on the other.
In the late 1980's and 1990's, while I was active with ActUp/RI, we strongly opposed routine testing, mainly because it would be happening in doctor's offices, and we felt that that was one of the worst places to try to learn anything useful about HIV. Partly because most doctors at the time were extremely uninformed, but mostly because if you got a positive test, the results would be part of your medical record, which despite what it looks like is a very public set of documents for anyone with the slightest incliniation to find out more about you.
Having such a public record would also make you ineligible for health insurance at all. At the time, there was even a fairly widespread policy of denying any HIV-related care even for people with insurance, especially if they fit one of the 'classic' risk factors.
So we strongly advocated for people to get anonymous testing, at one of the specialized HIV testing sites, run either by the Health Department, or by a reputable non-profit agency.

I think that was definitely the right strategy at the time. But circumstances have changed. For one thing, it is not as devastating to learn that you have HIV these days. It's also not anywhere near as hard to find competent care. And also everyone, including doctors and the general public, has gotten much less paranoid and reactionary about people with HIV. And, although it is still legal, and common practice, to deny HIV+ individuals any health coverage at all, at least it is illegal to deny coverage to someone for HIV-related care once they are already insured. So at this point, it makes more sense to offer HIV testing as a routine part of care, while still maintaining the capacity to offer anonymous free HIV testing sites, especially for people who currently have no health insurance.

But here's the big difference in my shift in opinion. Selective testing for HIV just doesn't work. For the same reason that virtually every strategy designed to work only on a high risk population is inefficient, and often counter-productive.
In this case in particular, having a conversation about whether to get HIV testing used to be about having a sexual and drug use risk behaviors. Essentially, several hurdles that have very little to do with whether you should get an HIV test or not had to be surpassed - First, your doctor had to think you were "at risk", which is a strange way to think about someone you care about. Second, you yourself had to think (or be convinced) that you were "at risk". That's also not a fun state of mind to be in. That's probably why the best definition of "promiscuous" is "anyone who has more sex than me". Third, you had to set aside time in the doctor's visit to have that conversation. And these days, with 10 minute appointments, can you really afford to spend 5 talking about an issue that isn't on the top of your priority list?
The other thing that making a big deal out of HIV testing did was re-inforce the idea that having HIV was a dangerous thing, and makes you a bad person. After all, if only high risk people should be tested, that sets up the notion that the risk itself is essentially a disease.
With routine testing, the conversation about getting tested didn't make me defensive about whether I considered myself to be "at risk", that was a non-issue in the process.


EPIDEMIOLOGY CLASS TEST
Well, I gave my students the first mid-term on Tuesday, and my initial reaction on leafing through them was that it had been a bloodbath. Several hadn't put any answers down at all for large parts of the exam, and others had scribbled things that didn't make any sense at all. Only a handful really "got it". I was despondent the next day, because that meant that 1) I wasn't teaching well, 2) they just didn't prepare, and/or 3) the test was not fair, in that I didn't allow enough time to complete it. I had long chats with some of the important teachers in my life (Rachel, Dad, & Kate) about what to do. I think there's a degree of all three involved, so my strategy now is to cut back somewhat on the scope of the class to make sure we can get through everything, adjust the grading system so that if they bombed, they can learn from the error of not preparing, and recover without a significant "drag" from the first test, and to set up office hours. I've given them my email and cell phone, and encouraged them to call many times, but it hasn't worked. I'm hoping that having drop-in times will help people get over their hindrances about asking for help.

Anyway, a few days later, as I have begun grading them, I'm not nearly as pessimistic. There's a lot to be happy about in their performance, and a lot of the stuff that just looked like random scribblings before is starting to fall into place, there are aspects of it that I can give credit for, so I think they are going to do better overall than I initially thought. So, it's not necessarily even going to be a bad experience overall. But, I'm still going to implement those changes right away.

BLUE ANGELS
The Blue Angels were flying over the city today, which was very disconcerting. They were flying right on top of the buildings. Suddenly the sky would rip open, and you couldn't tell where it was coming from because everything was echoing off the buildings. I was downtown, and went home to see if I could head out to the Golden Gate Bridge, so I could at least see them. But by the time I got home, they were done, so no pictures, I'm afraid.

Thursday, August 30

I can't believe its been over a week since my last update.
Each day, it doesn't seem like that much has happened, but looking back, it feels like ages ago.

Well, I had my first class at SFSU on Tuesday night, and I think it went very well. Things started out a bit rocky. I had spent the afternoon trying to get an ID so that I could access various campus services, an effort that so far has failed. At any rate, I was distracted by that and the pain in my back (more on that later), so I was a bit disoriented at first.

I introduced myself to each student who came into the classroom, and promptly forgot all their names. Every last one of them! Then I went through the enrollment to see who was there and who wasn't, and I still didn't latch onto their names at all. By the end of the class, I had maybe 3 of the 50 down.

After going through the syllabus (a deadly boring task, but one that must be done), we took a stretch break, and then the fun began. I asked them to get into groups of three people that they didn't know already, and asked them to write down on a piece of paper an answer to the question "In the broadest sense possible, what causes disease(s)?" and then give three specific examples. Then I asked them to compare notes within their groups and talk about whatever came up.
Within minutes, the room completely changed. From a row of mildly bored, even perturbed, faces sitting in rows all facing me, there was a riot of animated conversations. It worked!
I actually left the class for a few minutes to go get a drink of water. It was a great sound hearing the babbling of a dozen voices sharing and learning from one another. Brought a big smile to my face.
After that, I got them to come back to a more traditional setting, and we went through the room and discovered that with no formal training, they had already covered the main topics of epidemiology. The answers to the first question "What causes disease?" constitute epidemiologic theory. And we had begun to answer the crucial questions like "How do we know that X causes Y?", and "When should we trust scientists who say that X causes Y?" (causal theory and epistemology), which lead also into exploring various study designs, and beginning to thing about the role of bias and error in scientific investigation. So, in a half hour of barely structured conversation, they had laid out all the important principles that we'll spend the rest of the semester elaborating. I just put fancy words to what they already knew. That part was really fun.
Then, I wrapped up with a 10 minute lecture on who I am, my academic and professional background, and when the clock hit 6:55, released them like rockets off to various points around the city.

I was waiting for the MUNI M train to take me back home (it still doesn't feel right calling it that). A train came, but it was already packed with people, and with my back (more on that later) it was just going to be impossible to find a seat, at least a seat where I wasn't staring at three people's crotches. So, I waited for the next one, which seemed like an eternity, but was probably no more than 20 minutes. Anyway, good thing I waited, because at the next stop, a guy carrying a big box sat down next to me, and we just hit it off right away, he and his friend are Brazilian nursing students at SFSU, and we had the most pleasant conversation on the train. We talked about going out to one of the Brazilian restaurants in town, and I left my number, so we'll see what happens.

And speaking of my slowly burgeoning social life, I had dinner over at Paul's place (college roommate), which was a great deal of fun. We were going on non-stop for at least three hours. It was great to reconnect. And tonight, we're planning to get together again, at the Asian Art Museum across the street from my apartment (apartment, that sounds much more accurate than 'home').

So, my back.
Well, about eight years ago or so, I was biking home late at night, and when I started out across an intersection, a car raced through the red light, plowed through me, and sped off into the night. As it happens, there were several witnesses, but the car had had it's lights off, and nobody got the plate number. Anyway, my hip and elbow got banged up pretty good, and my hip has never fully healed from the accident (accident makes it sound unintentional, I wish there was a word in English that expressed the willfully reckless nature of the event).
As a result of having the hip injury, another injury has slowly evolved, involving the joint where the bottom of my spine connects to my hip. Normally, the ligaments in that joint have very little wiggle room, like laces on a hockey skate, but my joint has either loosened up somewhat, or gets inflamed for some reason, or something. Anyway, when this thing acts up, it is painful to sit. It is painful to stand. It is especially painful to walk, and it is painful to lie down. So relief comes in brief flashes that are hard to hold on to. The only things that don't hurt much are riding my bike, and lifting weights. Go figure!

Driving is no good for this injury, and neither is lifting lots of boxes. So, when I drove across country for 11 days, I took relatively high doses of naproxen sulfate, ibuprofen, and aspirin to hold things in check. That worked. I felt essentially no pain, and the swelling of the joint didn't have a chance to start up. But, because of all those drugs, I was not healing from minor bruises, and bruises were starting to show up on my body in places I didn't remember hitting anything. A considerable proportion of my body had a greenish cast. So, once the move was over, I went cold turkey off the pain killers. The bruises took a few days to go away, but in the meantime, the stresses and strains of moving began to catch up with me, and things got progressively worse, to the point that I started using a cane, taking frequent breaks at benches, grimacing and tearing up, etc. So on my second day at Berkeley, after walking from one office to another trying to get things set up here, I couldn't take any more, and found listings for a massage therapist. He gives a "Thai massage" which I'd never had before, but I was desperate to have anything, so I hobbled home, and then went over to his place. It was a very intense massage, and lasted almost two hours. It was at times painful for my back, but by the end, I was considerably relaxed, and actually felt well enough to stop at the supermarket to pick up some food to carry home on my bike.
In the week or so since, it has slowly gotten better, but there is still a ways to go. I'm trying to spend a lot of time stretching every morning, and I'm still trying to figure out how to access my health insurance through Berkeley, but no success with that, yet.

On the whole, despite the pain to my back, and the flood out of my wallet, I think it was the right move. Hearing those students babbling excitedly just made the whole thing worth it.