Thursday, September 3, 2015

ACT UP Chelsea STD Clinic Town Hall! #Activism, #ActUp, #ActUpNY, #ActUpTownHall, #Chelsea, #DOHMH, #ENDAIDS, #FIGHTBACK, #healthcareisaRIGHT, #HIV, #HIVJustice, #newyork, #NYC, #‎Solidarity, #STD





There is nothing like the energy at the Center when ACT UP and company put on a community forum.  The forums over the sex wars and debates over new infections in New York two decades ago were legendary.  For years now ACT UP has been railing about the blunders by the New York Department of health. 

James Krellenstein and Jim Eigo zap the NYDOH in August of 2013.

But when the city shut down an std clinic in the epicenter of the HIV epidemic this spring, the group realized we were back to the old days with HIV prevention. 

 "Back in the bad old days, ACT UP and its allies were used to expecting the worst from the NYC Department of Health”, said Mark Harrington, the Executive Director of TAG and a member of Governor Andrew M. Cuomo’s End the Epidemic Task Force. “Fast-forward three decades and AIDS activists are deeply disappointed that the ostensibly progressive new Mayoralty of Bill De Blasio and his lead public health official Mary Bassett have exhibited poor leadership and defective decision-making when it comes to addressing some of NYC's most pressing health needs, such as the combined threat posed by the intertwining HIV and syphilis epidemics.

Closing clinics feeds the epidemic, noted a sign at the June demo over the issue. Yet the city failed to act or correct itself.  Three months later, I got an invitation from ACT UP:  

On behalf of ACT UP\New York and Treatment Action Group (TAG), we would like to invite you to a town hallmeeting regarding the closure of the Chelsea STD Clinic, the state of the sexually transmitted disease (STD) and HIV epidemics in New York City, and the indifferent and incompetent response of Mayor Bill de Blasio and his health department to these crises.

Following the sudden closure of the Chelsea STD Clinic in March 2015, ACT UP and TAG began to investigate the STD control and HIV testing policies of the New York City Government--what we have found is deeply concerning. 

Briefly:
- After closing the Chelsea Clinic--the busiest public STD clinic in the city-- in March, with no announcement and no plans to replace the lost testing and treatment capacity, the city Health Department has refused to build a temporary clinic facility onsite, despite being offered funding by the City Council to do so. Since the Chelsea clinic have been closed, the number of visits to city STD clinics have decreased by 18%.

- In order to save money, starting in 2010, the Health Department began severely reducing services at the City STD clinics, shutting down clinics, and losing visitors. By 2014, the number of patients seen at the clinics dropped by a third, while the number of gonorrhea cases in men citywide increased by more than 40% and the number of syphilis cases in men increased by a third. In May, the Health Department admitted it had no strategy to deal with the rapidly worsening STD epidemics.

- Starting in 2011, the City reduced the number of HIV tests that it funds by a third-- a loss of over a hundred thousand tests a year. The City never restored HIV testing to its 2010 level--potentially resulting in the delayed or missed diagnosis of thousands of HIV positive individuals. 

We are inviting members of the community, the Health Department, City and State Local government to discuss and questions these policies on September 1, 2015, at 6:30 PM at the LGBT Community Center on 208 W 13th St (between 7th Avenue and Greenwich Ave).

This is an important opportunity for community to speak out about our sexual health and wellbeing; we sincerely hope you are able to attend and also pass this invite along to others.

Thanks.

In Solidarity,
Jim Eigo (ACT UP)
Mark Harrington [All Tag] (TAG)
Jeremiah Johnson (TAG)
James Krellenstein (ACT UP)
Peter Staley


When I walked in, ACT UP’s long-time facilitator Ann Northrop was sitting on the floor reading the paper, as she has been known to do.


Ann Northrop, top.  The Mayor was absent from the standing room only event. Black and white photos by Erik McGregor.

Jeremiah Johnson (TAG)

Jeremiah Johnson (TAG) was reviewing the data about access to testing in New York now that the Chelsea STD Clinic has been closed.  This year’s numbers are starkly lower than last year, he pointed out pointing to data from a large graphic.   And the problem with this, of course, is that means those in need of care and preventive services are not getting them.  Those in need of PEP and PrEP or early treatment are not getting them.  Instead, HIV goes untested or treated and grows exponentially.  Rather than primary and secondary prevention designed to slow the growth of the virus and the epidemic, the Chelsea STD Clinic closure fuels the growth of HIV.  This is the policy of the NYDOH.


Standing room only, the room was crackling with energy.  Legends of aids activism, including Jamie Leo and Larry Kramer were attendance, as were members of the TAG gang Mark Harrington and Peter Staley. Annette Gaudino and Kenyon Farrow were moderating. 

I greeted my friend Reginald, who took a few shots of the forum.

Johnson reviewed what has happened in New York since the city shut down the Chelsea STD Clinic without warning and reduced HIV tests. He explained that,
starting in 2010, the City Government and its Health Department have significantly reduced vital services for the screening, treatment, and control of sexually transmitted diseases (STDs). This has included a drastic reduction in the number of HIV tests the City funds and performs. The cuts resulted in a total of over 400,000 HIV tests being eliminated between 2010 and 2014, possibly resulting in the missed or delayed diagnosis of thousands of HIV-positive New Yorkers.

Jim Eigo speaking. Happy birthday Jim!
ACT UP veteran Jim Eigo, whose birthday was the day of the event, was the next to speak. 

The title of this session is, New York City’s Bureau of STD Control Takes a Long Vacation, noted Eigo.

I have a dream, and I’m not the only one. The activists, service providers and local health officials who recently drafted the Blueprint for Ending the AIDS Epidemic in New York State share that dream. We have great plans for the STD Clinics of New York City. We envision their transformation into one-stop hubs of HIV care. Here everyone receives an HIV test unless they are living with HIV. Anyone who tests HIV positive is offered immediate care, including antiretroviral drugs. Anyone who tests HIV negative is offered appropriate prevention services and drugs, including PEP, an emergency drug for a possible very recent exposure to HIV, and PrEP, the pill-a-day for people at risk from possible repeated exposure to HIV. At least as important, a navigator at the clinic links everyone who needs it to long-term, affordable healthcare. Using these STD Clinics as the model, every testing site in New York State could—and in the vision of the framers of the Blueprint, one day would—become a portal to long-term care for all. Thus Ending-the-Epidemic becomes a broad public health measure, and the simple HIV test the best hope for linking many individual New Yorkers from the state’s underserved communities to a lifetime of the kind of care that improves lives.

But hold on. Having just delineated the vision, I’m afraid I’m going to have to snatch it away. You see, in the real world visions remain visions until people make them happen. And even though New York State has recently awarded New York City a million dollars to upgrade its STD clinics to one-stop hubs of HIV care, I can’t see that happening anytime soon. Back in the real world, New York City’s STD clinics are operated by the Bureau of STD Control of the city’s Department of Health & Mental Hygiene, and the Bureau has amassed a solid record of failure that dates back many years.

Here is some of what I mean. Over the past several years New York City has closed one STD clinic after another for two to five years for renovations. Only once did it replace a shuttered facility. In part because of these closings, between 2010 and 2014 the number of visits to the city’s STD clinics plummeted from 123,000 a year to 83,000. Add to those closings cuts in services at the clinics and we find that between 2009 and 2014 the number of HIV tests at the clinics plummeted from 150,000 to 68,800. Most of this loss, 73,000 tests, occurred over 2010 and 2011 alone, the years of the severest cuts. In that same time frame, from 2010 to 2014, cases of gonorrhea in men increased by more than 40%. Again from 2010 to 2014, diagnoses of syphilis in men increased by a third. This is an HIV issue as well. Studies show that syphilis is highly predictive of future HIV infection. Yet the head of the city’s STD Bureau recently declared that the city has no plan for dealing with syphilis. And when we asked her why, she looked at us as if the question had come from another planet. To top it off, as you have heard, this past March the city shut down its busiest clinic for renovations, the Chelsea STD Clinic, effectively snuffing out that dreamed-of hub of care at the center of the city’s HIV epidemic. After this latest closing, sexual health visits to city STD clinics dropped by another 18%. Little wonder that this moribund Bureau has trouble attracting qualified personnel and holding onto them.

If we are ever to trust the Bureau of STD Control with an important piece of Ending-the-Epidemic, here is some of what has to happen. NYC has to restore to its clinics the essential STD services and HIV testing that it cut early in the decade. In other words: Bill de Blasio, take public health in NYC off of the starvation diet that Mike Bloomberg put it on. Within DOHMH, the Bureau of STD Control will need the kind of dynamic leadership that can galvanize the Bureau and start to redeem its recent legacy of failure. The Bureau of STD Control needs to be integrated with the Division of HIV so the city’s STD clinics can smoothly assume positions as hubs of care in Ending-the-AIDS-Epidemic. The Bureau has to marshal its forces in support of its important position within the historic Ending-the-Epidemic effort. And the Bureau should exploit its place in that mission, using it as a magnet to draw and keep the best personnel.

The Bureau of STD Control will have to develop an action plan for dealing with the principal sexually transmitted infections. This is more important than ever. Patterns of condom usage may change with the uptake of PrEP, and patterns of STD testing most certainly will. The Bureau has to be sensitive enough to catch these changes, and flexible enough to deal with them. Here are a few important subsidiary issues. State law has led the city to introduce a sliding fee for services at STD clinics. City health officials have privately voiced a fear that this almost certainly presents an obstacle to testing for the most vulnerable New Yorkers. At the very least, DOHMH has to monitor for the ill effects of clinic fees and develop programs to mitigate those effects. Community testers have found success in reaching more people when they test beyond business hours. As the state endeavors to test all New Yorkers, NYC’s STD clinics need to follow the community’s lead in this. And finally, given the Bureau’s record of failing the community, the Bureau has to invite community oversight and participation as it works to undo this record of failure and realize its mission in Ending-the-Epidemic.

New York City’s Bureau of STD Control has been a public health backwater for far too long. If we hope to use our STD Clinics as vehicles for Ending-the-Epidemic and for achieving wider public health goals, we will have to whip the Bureau into shape. We cannot waste our historic opportunity to end the AIDS epidemic. And if, as we revitalize NYC’s bureau of STD Control, we also manage to humanize it, we might actually succeed in making the city’s STD clinics true centers for our sexual health & wellness. And what a bonus that would be!

The room roared with applause when Eigo finished his last line.  For decades, Eigo has worked to link the related concepts of sexual health and wellness. And it is still a central part of his work with the group.

Eigo came back to the group two and a half years ago, after a long hiatus.  In June, he summarized his efforts with the group since his return.

“This morning, while working on a draft of a flyer that ACT UP will hand out on Gay Pride Day, I drew on a list I’ve been compiling for a couple of weeks: What are the significant campaigns ACT UP has embarked on since I returned to work with the group two-&-a-half years ago. The list now stands at 32 items, too many for a flyer! So here are the dozen I came up with:
ACT UP IS FIGHTING—
To end the epidemic in New York State by 2020!
To lower the cost of outrageously priced drugs for Hepatitis C & HIV!
To support comprehensive HIV prevention including access to the prevention drugs PrEP & PEP & linking people at risk for HIV to healthcare!
To overhaul the HIV/AIDS Services Administration (HASA) to meet the housing needs of people living with HIV & at risk for HIV!
To protect the rights of people living with HIV as organ donors & organ recipients!
To reform HIV criminalization laws & end HIV stigma in all its forms!
To give long-term survivors of HIV the means to deal with their special challenges!
To prevent a new HIV epidemic in queer youth!
To enact single-payer healthcare in New York State!
To end the use of condoms as evidence of prostitution!
To support education in harm reduction & syringe exchange for people who inject drugs!
To fund & support research in HIV prevention, treatment, care, vaccines & a cure!”

HIV treatment, prevention and sexual health have long been at the core of his efforts as an AIDS activist.  Here, treatment and prevention overlap in mutually reinforcing ways.  The closing of the Chelsea Clinic by the NYDOH flies in the face of this logic.


James Krellenstein

James Krellenstein, of ACT UP, followed: “Eliminating a hundred thousand HIV tests a year” he explained, “is a decision that could directly result in excess HIV infections citywide.”  He summarized his report, “Trends in DOHMH Funded HIV Testing and Sexual Healthcare Provision V3: A Very Short Report.”
The City’s cuts to STD services also resulted in 40,000 fewer patients being seen at the City’s nine STD clinics each year. At the same time, the City’s gonorrhea and syphilis epidemics have been spreading out of control—syphilis diagnoses in men increased by a third from 2010 to 2014 and gonorrhea cases in men increased by more than 40%.
The city says it wants more tests and less infections, so it cuts the tests in Chelsea, he explained, to loud applause.  The end is in sight.  Science says we can end this.  But we cannot do so without an action plan, which the city implements. As of now, the city is dropping the ball.  We need the city to act.  This is a demand.  We need to push the city to act. We elected this mayor.  We need him to know our health counts, queer bodies count. The audience gave him a rousing ovation.
The town hall opened for an open mike q and a.
Several followed including Terri L Wilder, noting the Ending the Epidemic Taskforce will need to respond.  Everyone is invited to the session today.

So what do we do, noted members of the crowd.  Where do I go to get tested, wondered a man from Texas?



Andrew Velez
Andrew Velez stood up paraphrasing Frederick Douglass.  We learned long ago, power concedes nothing without a demand.  Power is never transferred voluntarily  in the epidemic.  Health care is a right.  We are not talking clothes for a party here.  We are talking life and death.  So join ACT UP, he explained.  ACT UP needs you.  Join us.

James Krellenstein followed noting that while marriage equality was a huge win, our sexuality needs to at the center of discussions of HIV prevention. Who we have sex with matters. I think we need to band together and address this problem.



Ken Kidd, Jim Fouratt, this writer, and Mark Milano in line.
Photo by Reginald Thomas Brown.
Several members of the crowd asked about the Rentboy.com raid, noting that it all feels like an attack.  (Several planned to attend the noon rally today at Cadman Plaza denouncing the raid).

“Cut to the chase, when is the demo?” asked Larry Kramer, to a loud round of applause.

So the crowd planned to march to the site of the closed Chelsea STD Clinic after the town hall.

Marriage is not a condom, noted another speaker.  We need to be demanding the city acts, he screamed with rage and frustration in his voice.

 Jim Fouratt, Ken Kidd, and Mark Milano followed, asking tough questions to the city. 



And Public Advocate Tish James stood to speak.  A master of moments like this, she let all the others have their say, explaining, “Indifference equals death.”  The city is neglecting public health, she continued pointing to the rash of hospital and clinic closures taking place in her borough of Brooklyn.  “The clinic in Ft Green is close to closing.  The clinic sits on expensive real estate.”  This is certainly an underlying dynamic.  Just blocks from the Center, St Vincent’s hospital is now a condominium.  “Why would you close a clinic like this without planning anything?” she asked.

The crowd became more and more fired up.  “How many the fuck more?” asked someone in the crowd.

“That’s another way of saying it,” Tish responded.

“Let her speak!”

“I don’t mind.  I like community forums where people speak their minds. Its ok, I love town hall meetings.  We have seen too many funerals.  Black lives matter. But so day gay and trans lives.  If you are serious about ending the epidemic, this is not the way to do it.”

By the end of the evening, ACT up descended on the clinic placing signs there, asking what the city planned to do.

Post forum march to the site of the Chelsea STD Clinic. Photo by Social Diarist


ACT UP / Action Tours veteran Jamie Leo reflected on the event pointing to the social media push needed to get the word out about the problems at the DOHMH.

Such great leadership. There were so many powerful moments of clear articulation, from the statements (and tireless efforts) of Eigo, Johnson, Velez, Krellenstein and others, to the BRILLIANCE and articulate suggestions from Ken Kidd, Jim Fouratt,, and of course Farmer Ebert – we are all indebted and can't help but be motivated by their vision. Hope to see more tweeting about the #DOHMH situation: #CitiesForLife @nycgov @BilldeBlasio #OneNYC @nychealth” 

The next morning the signs ACT UP lay at the Clinic site were still there. 

Scenes from a clinic closing. Photos by marcelo maia
After the forum, many who participated talked about the arrests at Rentboy.com, suggesting the city is once again attacking queer bodies. The mayor was elected, promising to decriminalize such level offences.  Now he is increasing charges, allowing his police to support these raids on sex workers.

 LGBT and Civil Liberties Advocates Denounce Arrests of Rentboy.com Staff ,
Call for Dropping Charges and Decriminalization of Sex Work

RALLY: Thurs., Sept. 3rd, Noon, Federal Court in Brooklyn

New York--LGBT activists, civil rights organizations, the HookUp Collaborative and supporters will hold a demonstration this Thursday, Sept. 3rd, at Noon outside the U.S. Eastern District Courthouse in downtown Brooklyn to demand that the U.S. Attorney stop the prosecution of Rentboy.com and drop all charges after the raid on them by Homeland Security and NYPD.

We are outraged at this latest example of the abuse and selective prosecution of sex workers. We are sick and tired of this misuse of government time and money to persecute members of the sex industry. This unrelenting harassment and persecution endangers the health and safety of these workers and their clients, and disproportionately targets the poor and people of color.   We demand an end to this system of criminalization.

BACKGROUND: With offices near Manhattan’s Union Square, Rentboy.com, a nearly two-decade-old website for male escorts, was raided on Aug. 25, 2015 by Homeland Security agents in concert with NYPD.  The US Attorney for the Eastern District of New York, Mr. Kelly T. Currie, is prosecuting seven individuals for felonies in a high-profile case that quickly drew criticism around the country including from the New York Times editorial board. The call for the decriminalization of sex work has just been made by Amnesty International, Lambda Legal Defense and Education Fund, Gay and Lesbian Advocates and Defenders (GLAD), the National Center for Transgender Equality (NCTE), the National Center for Lesbian Rights (NCLR), and the Transgender Law Center.   Decriminalization has previously been called for by Human Rights Watch (HRW), the American Civil Liberties Union (ACLU), the World Health Organization (WHO), the Global Commission on HIV and the Law, the UN Special Rapporteur on the Right to Health, the UN Development Programme, UN Women, and UNAIDS.

WHAT: Demonstration to protest Rentboy.com prosecutions and criminalization of sex work

WHEN: Thursday, September 3, 2015 at 12 noon
WHERE: United States Court for the Eastern District, 225 Cadman Plaza East (on Cadman Plaza Park near corner of Tillary Street; take A or C to High Street or 2 or 3 to Clark St. in Brooklyn Heights). See map here

Between the raid and the closure of the Chelsea STD Clinic, the city is still far from where it needs to be.

The ACT UP fact sheets on the Forum, tell the story.

NEW YORK CITY FUELS THE AIDS EPIDEMIC
IT PROMISED TO END!

WHAT HAPPENED?
• Five-and-a-half months ago the de Blasio administration blew a hole in its efforts to prevent HIV and sexually transmitted infections.
• Without warning, the city shuttered the Chelsea STD Clinic for 2 to 3 years of renovations.
• The Chelsea Clinic, the city’s busiest, was the site of 20,000 sexual health visits a year.
• Chelsea is the epicenter of the city’s HIV and STD epidemics.
• The Chelsea Clinic has been a place of care for high-risk, vulnerable New Yorkers from across the city, often young, poor, immigrant, gay, gender non-conforming and of color.
• The city’s original replacement plan: put up a sign directing people to a clinic 70 blocks away.

WHAT’S GOING ON NOW?
Under community pressure the city’s Department of Health & Mental Hygiene (DOHMH) has applied one band-aid after another to its self-inflicted wound. Nothing has yet stopped the bleeding.
• 3 months after it closed the clinic, the city began to redeploy a mobile testing van to the area, 5 days a week. It tests few.
• A DOHMH staff-person at the site can now refer people to 3 local non-city clinics. These over-worked facilities hope to, one day, add testing capacity. Right now, referrals are few.
• Chelsea Clinic once hosted 350 sexual health visits a week. Now the number of visitors to the site—fewer than 60 a week—has plummeted. People seeking testing have disappeared.
• DOHMH maintains that all these New Yorkers are magically showing up at other STD clinics. In fact, since the Chelsea Clinic closed, visits to city clinics have dropped by 18%.

THE CITY BLEW IT!
Local elected officials promised to find funding for a cost-effective, pre-fabricated unit on the Clinic site that would have replaced lost services for a large number of New Yorkers. Too embarrassed to admit its blunders, DOHMH put public relations ahead of public health and chose to apply its band-aids instead.

ACT UP DOES NOT ACCEPT THE STATUS QUO! ACT UP DEMANDS THAT THE CITY:
• Speed up the renovation process so it’s completed ahead of schedule.
• Provide all possible support to neighborhood clinics and community organizations for expanded testing and prevention services.
• Convene a community board right away to oversee the clinic renovation and restoration of services.
• Put a pre-fabricated unit on the Clinic site to replace lost services. Combine it with an information campaign that lets New Yorkers know there’s now an adequate onsite facility.
• Figure out how many people have been lost to testing and why. Then ask what measures the city needs to take to engage them in care and commit to taking those actions.


What’s Wrong with this Picture?
The community members who drafted New York State’s Blueprint for Ending the AIDS Epidemic had great plans for New York City’s STD Clinics:
 Test everyone for HIV. Depending on test results, offer everyone treatment or prevention drugs and services and a link to affordable long-term healthcare as needed.
• With STD Clinics as a model, every testing site in the state could one day become a portal to long-term care for all. Thus Ending-the-Epidemic becomes a broad public health measure, the best hope for linking many individual New Yorkers from the state’s underserved communities to a lifetime of the kind of care that improves lives.
• To help realize this vision, New York State recently awarded New York City a million dollars to upgrade its STD clinics to one-stop hubs of HIV care.

Say What!
Back in the real world, NYC’s Bureau of STD Control, which operates the city’s STD clinics, has amassed a solid record of failure that dates back many years. How can we trust the Bureau to oversee such an important piece of Ending-the-Epidemic?

A Bill of Particulars:
 Over the past several years the city has closed one STD clinic after another for renovations, replacing a shuttered facility only once.
 Between 2010 and 2014 the number of visits to the city STD clinics plummeted from 123,000 to 83,000 a year.
 Between 2009 and 2014 the number of HIV tests at the clinics plummeted from 150,000 to 68,800. Most of this loss, 73,000 tests, occurred over 2010 and 2011 alone.
 From 2010 to 2014 cases of gonorrhea in men increased by more than 40%
• From 2010 to 2014 diagnoses of syphilis in men increased by a third. This is an HIV issue: studies show that syphilis is highly predictive of future HIV infection.
• Yet the head of the city’s STD Bureau has declared that the city has no plan for dealing with syphilis.
• In March the city shut down its busiest clinic for renovations, the Chelsea STD Clinic, snuffing out that dreamed-of hub of care at the center of the city’s HIV epidemic. After the closing, sexual health visits to city STD clinics dropped by another 18%
• Little wonder that this moribund Bureau has trouble attracting and holding onto personnel.

How do we fix it?
 NYC has to restore to its clinics the essential STD services and HIV testing that it cut.
• The Bureau of STD Control needs dynamic leadership to reverse its recent legacy of failure.
• The Bureau of STD Control needs to be integrated with the Division of HIV so the city’s STD clinics can smoothly assume positions as hubs of care in Ending-the-AIDS-Epidemic.
• The STD Bureau has to marshal its forces in support of the historic public health mission of Ending-the-Epidemic.
• The Bureau should exploit its place in that mission, using it as a magnet to draw and keep the best personnel.
• The Bureau of STD Control must develop an action plan for dealing with the principal STDs.
• Patterns of condom usage may change with the uptake of PrEP. The Bureau must be sensitive enough to catch these changes and flexible enough to deal with them.
• State law has led to the introduction of a sliding fee for services at STD clinics, a potential obstacle to testing for the most vulnerable New Yorkers: DOHMH has to monitor for the law’s ill effects and develop programs to mitigate them.
• Community testers have found success in reaching more people when they test beyond business hours. NYC’s STD clinics need to follow the community’s lead.
 Given the Bureau’s record of failing the community, the Bureau has to invite community oversight and participation as it works to reverse a record of failure and realize its mission in Ending-the-Epidemic.

New York City’s Bureau of STD Control has been a public health backwater for far too long. If we hope to use our STD Clinics as vehicles for Ending-the-Epidemic and for achieving wider public health goals, we will have to whip the Bureau into shape.


DON’T WASTE AN HISTORIC OPPORTUNITY TO END THE AIDS EPIDEMIC
REVITALIZE NYC’S BUREAU OF STD CONTROL
MAKE NYC’S STD CLINICS CENTERS FOR SEXUAL HEALTH & WELLNESS




HELP ACT UP END THE AIDS EPIDEMIC!
ACT UP MEETS EVERY MONDAY AT 7 PM AT THE LGBT CENTER, 208 WEST 13 STREET



actupny.com / info@actupny.com /
 @actupny

ACT UP! FIGHT BACK! END AIDS!


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