Positive Living Autumn 2013

PositiveLiving A mAgAzine for people living with hiv l Autumn 2013

The positive traveller PLUSuSEX C•TREATMENTS OF TOMORROW•MONOTHERAPY

PositiveLiving THENEWS Issn 1033-1788

Positive Living is a publication of the national association of People With hIV australia.

Positive Living is published four times a year. next edition: june 2013 Positive Living is distributed with assistance from

SuBSCriptionS free subscriptions are available to hIV positive people living in australia who prefer to receive Positive Living by mail. to subscribe, visit our website or call 1800 259 666. contributions are welcome. In some cases, payment may be available for material we use. contact the editor. aDDress corresPonDence to: Positive living Po Box 917 newtown 2042 tel: (02) 8568 0300 freecall: 1800 259 666 fax: (02) 9565 4860 emaIl: pl@napwha.org.au WeB: napwha.org.au

n Positive Living is a magazine for all people living with hIV in australia. contributions are welcomed, but inclusion is subject to editorial discretion and is not automatic. the deadline is 21 days before publication date. receipt of manuscripts, letters, photographs or other materials will be understood to be permission to publish, unless the contrary is clearly indicated. n material in Positive Living does not necessarily reflect the opinion of naPWha except where specifically indicated. any reference in this publication to any person, corporation or group should not be taken to imply anything about the actual conduct, health status or personality of that person, corporation or group. all material in Positive Living is copyright and may not be reproduced in any form without the prior permission of the publishers. n the content of Positive Living is not intended as a substitute for professional advice. coVer art PhIllIP mcGrath

treatments of tomorrow there are numerous new hiv treatments currently in development. A few are already approved overseas and likely to arrive in Australia soon. Some are exciting prospects. others look promising. All are quite hard to pronounce.

Adrian ogier reports.

Stribald, formerly known as the QUAD pill, is a once-a-day, multi-class, fixed-dose combination (FDC) pill.

Similar to the other FDC pills available in Australia (Atripla and Eviplera), Stribald contains the popular NRTI base: tenofovir and emtrictitabine. But unlike its sisters, who each also have an NNRTI — Atripla has efavirenz and Eviplera has rilpivirine — Stribald contains an integrase inhibitor, elvitegravir, plus a novel boosting agent called cobicistat.

Put up against regimens containing efavirenz or atazanavir, Stribald performed well in phase III trials.1, 2 People on this new four-drug combo seem to achieve undetectable viral loads quicker than those on the other regimens. Plus, it appears to have a better side effect profile, particularly when compared to the elevated lipid levels1, 2, 3 and neuropsychiatric effects some people can experience on Atripla.

Stribald was approved by the Food and Drug Administration in the US in August last year.

elvitegravir is a promising new integrase inhibitor. In phase III trials it reduced viral loads just as well as raltegravir, the only drug in this class currently approved in Australia. However, elvitegravir

appears to cause fewer liver abnormalities.4

BmS-986001 is a new NRTI in phase IIb trials that seems to be active against abacavir- and tenofovir-resistant strains of HIV. It also appears to be much less cytotoxic than some of the other NRTIs.

Cobicistat is a boosting agent designed to replace ritonavir, the protease inhibitor often incorporated in drug regimens to increase the potency of the combination. It performs just as well, but unlike ritonavir, cobicistat is not active against HIV. It is also less likely to elevate lipids. And, while it can elevate creatinine levels, it doesn’t appear to impair kidney function.5

gS-7340 is a ‘prodrug’ form of tenofovir. A prodrug is an original form of a drug that is metabolised differently in the body. It is more concentrated, requires lower doses and can be targeted better, causing fewer side effects.

GS-7340 is currently being trialled in an FDC with darunavir, emtricitabine and cobicistat and also in a new Stribald (#2) formulation.

Dolutegravir (or 572) is another new integrase inhibitor currently available in the US on expanded access.

In phase III trials, dolutegravir performed slightly better than raltegravir while sharing similar low-level side effects.6 But when combined with abacavir and lamivudine, it outshined Atripla, managing to bring viral loads to undetectable levels much faster (median 28 days compared to 84) and causing far fewer adverse events, particularly neuropsychiatric ones.7

Cenicriviroc is a CCR5

Photo julos

eDItor adrian ogier (adrian@napwha.org.au) assocIate eDItor David menadue contrIButors David anders, jae condon, loretta healey, Dr louise owen, jo Watson DesIGn stevie Bee Design

572-trii is an FDC pill containing dolutegravir, abacavir and lamivudine and was developed following the impressive results of the above phase III studies.

S/gSK1265744 is an integrase inhibitor (follow-on compound to dolutegravir) that appears to be effective at much lower doses.

Test tube studies indicate that it doesn’t appear to be crossresistant to other integrase inhibitors, raltegravir or elvitegravir. It also has a long half-life — remaining active in the body for up to 50 days — so development is focussed on administering it as a monthly injection and as a possible candidate for pre-exposure prophylaxis (PrEP).

lersivirine (UK-453,061) is a new NNRTI currently in phase IIb trials that appears to be as effective as efavirenz but may cause more headache and nausea.8

inhibitor which is also active against another receptor, CCR2, which plays a role in the inflammatory and metabolic pathways, the clinical implications of which are unclear, but may include a potential benefit in future studies. It showed good anti-HIV activity in phase II trials.

BmS-663068 is the first drug in a new class of attachment inhibitors, currently in phase IIb trails. This prodrug prevents attachment of gp120 to the CD4 receptor on T-cells. Because it targets a different step of the viral lifecycle than existing antiretroviral agents, it offers promise for individuals with highly drug-resistant virus.

rilpivirine-lA is a long-acting, injectable version of rilpivirine, the most recently approved NNRTI in Australia. Given its long half-life, it is currently another candidate for PrEP. references

1 study 236-0102 2 study 236-0103 3 study 236-0104 4 aIDs2012 abstract tuaB0105 5 aIDs2012 abstract tuaB0103 6 study sPrInG-2 7 study sInGle 8 aIDs2012 abstract tuaB0101 full references at napwha.org.au

ContriButorS (from left) David Anders discovers that monotherapy and a healthy lifestyle can work wonders l Jae Condon cautions us on the risks of sexually transmitted hepatitis c l loretta healey guides us through the grieving process l David menadue makes some well-researched travel plans l Adrian ogier tries to pronounce the names of the latest drugs in development l Dr louise owen advises the positive traveller on vaccinations and what to pack l Jo watson cooks up a superfood storm with beetroot PositiveLiving l 2 l autumn 2013

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THENEWS neW stuDy reVeals

good evidence for beginning treatment early . . . really early A new study has found that people who start antiretroviral therapy within the first four months of seroconverting have a far better CD4 t-cell recovery rate than those who don’t. the study, co-authored by monash university’s associate Professor edwina Wright, followed 468 PlhIV for four years.

‘In the four months after hIV infection the immune system mounts an immune response and starts to recover naturally before it subsequently progressively declines,’ associate Professor Wright says. ‘this observation tells us that there may be a narrow restorative window that could be targeted for recovery through earlier initiation of potent antiretroviral therapy.’ early treatment may also better position PlhIV to directly fight off infections, tumours and disease and also put them in good stead for future cure strategies, investigators believe. new us treatment guidelines released by the Department of health and human services (Dhhs) in february strongly support art being offered to those with early hIV infection.

Knowing what we now do about the harm in interrupting art, people who start this early are encouraged to stay on their therapy for the long term.

the smoking will get you before the hiv does while there is evidence that the inflammation and metabolic changes associated with hiv do increase our risk of developing things like cardiovascular disease and cancers, another risk factor plays a much more significant role in shortening lives.

By comparing the life spans of HIV positive smokers with nonsmokers, researchers in Denmark have calculated that while HIV shaves an average 5.1 years off people’s lives, a massive 12.3 lifeyears are lost due to smoking.

They found that smoking kills more people with HIV than the general population, and, in fact, that positive smokers tripled their risk of death.

An HIV positive 35-year-old who smokes has a median life expectancy of 62.6 years, they calculate, compared with 69.1 years for an ex-smoker and 78.4 years for someone who never smoked.

‘In a setting (like Denmark) where HIV care is well organised and antiretroviral therapy is free

of charge, HIV-infected smokers lose more life-years to smoking than to HIV,’ the study authors concluded.

These findings further emphasise the importance of smoking cessation among positive people. m helleberg, s afzal, G Kronborg, et al. mortality attributable to smoking among hIV-1-Infected Individuals: a nationwide, Population-Based cohort study Clinical Infectious Diseases December 18, 2012

continuing your dental care the Chronic Disease Dental Scheme helped many plhiv get some much-needed and, in some cases, very overdue dental work. it also got many of us back into the habit of seeing a dentist regularly.

Now that the scheme has ended, it’s important we still keep on top of our dental health.

If you hold a concession card,

you may choose to source free care from public dental hospitals.

Or, you might consider taking out health insurance to help cover the cost of continuing to see the same dentist you saw under the scheme. This way, you can ensure ongoing care plus show your support to those who were prepared to service PLHIV

under Medicare.

Log onto iSelect.com.au to compare prices and cover between different insurance companies.

Note that there is no legal requirement to disclose your HIV status when taking out health insurance. Most policies will not cover any pre-existing condition for 12 months.

like a friend dropping by with advice ‘get happy’ is a smartphone app that does just that.

Using techniques that are based on Acceptance and Commitment Therapy (ACT), the ‘Get Happy’ app was developed by clinical psychologist Dr Lisa

Patterson-Kane.

A message is delivered each day to your phone in one of four categories: relationships, personal growth, leisure or work and education.

It’s nothing earth shattering.

Simply good, practical, no nonsense advice with subject matter such as the grass is not always greener on the other side of the fence; laugh often, think less; and embrace change.

And at 99c, it’s worth every cent.

australian cure research at croI

last year, a small study was launched in melbourne to test whether a drug called vorinostat could force hiv out of cells where it is lying dormant. the hypothesis being tested was that if ‘resting’ hiv can be driven into the bloodstream, then regular Art may be able to clear it from the body.

Twenty PLHIV volunteered to try the drug for 14 days, and the first reported results have just been presented by Sharon Lewin (PICTURED RIGHT), Director of The Alfred Hospital’s Infectious Diseases Unit, at the prestigious CROI scientific meeting in the US. Her presentation looked at safety and tolerability, and also what effect the drug has had on HIV in the blood and on tissues.

She and fellow investigators found that the multiple doses of vorinostat were safe and that taking the drug did result in an activation of HIV. However, the results did not show any change in HIV DNA and latently infected cells were not eliminated as was hoped.

Additional strategies will need to be found for that next step.

This and other studies presented at a special session at CROI have been hailed for their significant efforts to progress a real HIV cure strategy.

The study report, ‘Safety and effect of multiple doses of vorinostat on HIV transcription in HIV infected patients receiving combination antiretroviral therapy’, and other information can be found by following the links at napwha.org.au

You want that wrapped? nsW campaign to end hIV the sort of sex that positive men do together is not something that gets talked about too often.

But positive life nSw wants to change all that.

Their new-look ‘Wrapped or Raw’ website includes videos where gay men with HIV talk frankly about the sort of sex they have. The stories are real and while you may not always agree with them, the guys are honest

and upfront when talking about their sexual lives and relationships.

We recommend viewing the video stories and digging through the other information on the campaign website. There’s some good stuff about decisionmaking and information on taking care of your sexual health and dealing with STIs, such as syphilis, hepatitis C, gonorrhoea and LGV (lymphogranuloma venereum). check it out at wrappedorraw.org.au

PositiveLiving l 3 l autumn 2013

in early february, nSw health minister Jillian Skinner launched ACon’s ending hiv campaign.

‘On World AIDS Day Minister Skinner launched the NSW HIV Strategy 2012-2015, which includes a plan to reduce HIV transmission among gay men in NSW by 80% over the next 10 years,’ says ACON president Mark Orr. Encouraging gay men to ‘test

more’, PLHIV to ‘treat early’ and everyone to ‘stay safe’, the campaign is a rallying cry and ‘marks an historic turning point in the response to the HIV epidemic,’ Orr says.

The promotion joins in an international movement focussed on a community response to help eliminate HIV. to view the inspiring video, go to endinghiv.org.au

Mailbox

getting on the DSp Dear positive living I gave up my career several years ago to care for my mother. I received a carer’s pension and together with her aged pension we were able to live in a semi-comfortable manner in country NSW. Sadly, she passed away in March last year and I attempted to find employment. But at 63 years of age, I found it impossible to obtain an interview, let alone a position.

I have a severe, untreatable form of muscular myopathy which has resulted in approximately 70% loss of muscle bulk and mobility. I am able to walk short distances with difficulty but have had four falls in the past three years, caused simply by turning too quickly, or tripping over uneven objects. As well as HIV, I also have hepatitis C and angina.

In early May, I applied for a Disability Support Pension (DSP), provided the required medical assessment forms completed by my doctor, and was placed on ‘New Start’ while awaiting a decision. For a person my age, New Start pays $656.20 per fortnight including rent assistance.

After a psychological assessment (by phone) and a medical assessment (also by phone), I was denied the DSP. I appealed, was again medically assessed over the phone and denied.

From what I can determine, there is now a seemingly magical, 20-point ‘table’ system for determining a person’s medical condition. These tables are extremely rigorous and appear to have been compiled to prevent almost anyone from successfully qualifying for a DSP. It was now early August. Another appeal and I was then referred to a Centrelink Area Review Officer — a process with a supposed waiting time of another 3-4 weeks. So, I contacted my local Federal Member of Parliament and wrote several e-mails to the Minister for Human Services and to the Prime Minister.

I also appealed to the Social Security Appeals Tribunal (SSAT) and underwent a video link-up with them in October. The SSAT eventually ruled in my favour and stated that I did in fact qualify for a DSP from my original application in May. I had a further wait of 28 days so that Centrelink’s Legal Department could decide whether or not to contest the SSAT decision.

But there has been a resolution to my situation. In November, I was informed that I will be receiving a DSP backdated to June when my carer’s pension ceased.

My message to others who may be

Photo jamesBrey

why did this reader have to go through such an ordeal to get on the Disability Support pension?

suffering under the same distressing and depressing process is to not give up. This application and appeals process took me 6½ months. The tables are simply unjust, and the process is intended to make people give up. Both must be reviewed as a matter of urgency. name withheld by request

we asked the Department to comment . . .

Dear positive living We cannot comment on individual cases; however, the following provides information on the application process for a Disability Support Pension.

As with any payment, when a person is assessed for Disability Support Pension (DSP), the Department of Human Services (the Department) follows a thorough and fair process to make sure the applicant meets eligibility rules and receives the right level of support.

Assessing the impact of medical conditions on a person’s work capacity can be very complex. No two cases are the same.

It is important that the Assessor has all

the relevant information available to them — especially medical documentation — in order to make an informed decision.

When an assessment is conducted for a DSP claim, the Department looks at the person’s physical, intellectual or psychiatric impairment and their ability to work.

The functional impact of a person’s impairment is assessed using the Impairment Tables. A person needs an impairment rating of at least 20 points to be eligible for DSP. The person must also be unable to do any work of at least 15 hours a week at or above the relevant minimum wage, or be re-skilled for any work for at least the next two years.

The Impairment Tables have been reviewed recently and the revised Impairment Tables were introduced on 1 January 2012.

An Advisory Committee made up of medical and allied health professionals and disability stakeholders oversaw the review and provided expert advice on the revised Impairment Tables to bring them up to date with current medical and rehabilitation practices.

The Impairment Tables are designed to focus on a person’s ability, not their

PositiveLiving l 4 l autumn 2013

disability.

The descriptors in the Impairment Tables do not list specific medical conditions; instead they assess the functional impact caused by the conditions.

Advances in technology, medicine and rehabilitation techniques now make it possible for many people with disability to work in some capacity. We want to ensure that people with disability who have some capacity to work get the assistance they need to help them prepare for and find work.

DSP is designed to provide support for people who have a permanent disability that prevents them from working.

If it turns out someone is not eligible for DSP, we can discuss other options available to them such as applying for an alternative income support payment such as Newstart Allowance or Sickness Allowance, as well as other support options to find work.

If a person’s claim for DSP is rejected, they can request a review of the decision by a Centrelink Review Officer or make a new application.

If they are not happy with the decision of the Review Officer they can appeal to the Social Security Appeals Tribunal (SSAT) and we encourage people to understand their right to appeal.

The SSAT is an independent review process and the reason a decision could be changed may be because new evidence becomes available during the SSAT review that was not available when the Department was making the original decision, for example, new medical evidence.

For more information on DSP eligibility and other payments available, visit humanservices.gov.au, call 13 2717 or visit one of the Department’s Service Centres. a spokesperson for the Department of human services

to improve your chance of a successful application, make sure: n you understand the criteria n you have the full support of your primary doctor n your documentation is impeccable.

having a support worker to help you through the process is also a good idea. contact your local aIDs council or PlhIV organisation for a referral.

THENEWS

once upon a time, hiv was viewed as too much of an insurance risk. But these days, some Australian companies are offering full policies for people living with hiv.

As with any pre-existing condition, they do require medical underwriting to assess your risk. For example, insurers prefer to see a good level of control that includes being on treatment, a low or undetectable viral load, a CD4 count above 350 and no significant comorbidities.

As part of the application, an insurer will request a report from your doctor to confirm treatment and ongoing control of your condition. The insurer will also request a ‘confidential lifestyle questionnaire’ to assess any additional lifestyle risk factors.

Coverage is generally limited to $250,000 and offered on a 10year term — meaning the policy expires after 10 years and you have to reapply. Policies like these are usually offered with a higher premium, however, lower-cost accidental-death-only policies require no medical underwriting.

If you’re interested in life insurance but not sure where to go next, contact NAPWHA on (02) 8568 0304 for more information.

ashm calls for review of treating criteria Currently, Art is only subsidised through the pharmaceutical Benefits Scheme for plhiv commencing treatment with a CD4 t-cell count of less than 500 or who are symptomatic.

The Australasian Society for HIV Medicine (ASHM) has called for a review of these criteria.

In talks with the Pharmaceutical Benefits Advisory Committee (PBAC), ASHM has asked that the decision on when to start treatment be changed so that doctors are free to decide on a case-by-case basis.

Criteria could then allow for people who want to start earlier in order to avoid disease progression and also to reduce their risk of transmitting HIV to others.

Jae Condon investigates the sexual transmission of hepatitis C there is a growing concern that hepatitis C (hCv) is more easily transmitted sexually among hiv positive gay men than previously thought.

Since 2000, rates of hepatitis C among PLHIV have been steadily rising in Europe, the USA, Asia and more recently Australia. The rise in rates coincides with the availability of effective HIV treatment and is probably also related to a decrease in condom use.

Having both viruses is problematic, as it can increase liver complications and cause other health issues. Plus, treating both conditions becomes more of a challenge.

Hepatitis C is transmitted via blood through sharing needles and other parenteral (injecting) means, as well as through sharing swabs and tourniquets.

It is also transmitted by sharing sex toys, fisting and other activities where bleeding is more likely.

The biological science related to the sexual transmission of hepatitis C is not fully understood. That said, hep C is detectable in semen,* and having HIV probably makes transmission easier.

Participating in group sex or having lots of sexual partners increases the risk of acquiring sexually transmitted infections (STIs) that cause sores — especially syphilis, gonorrhoea, and LGV (Lymphogranuloma inguinale). These sores make it easier for HCV to be transmitted.

The use of recreational drugs can make people more likely to try new sexual practices and forget their own safe sex rules of play. Using drugs and having sex for prolonged periods can dry out the lining of the ass, leaving it more prone to bleeding and making transmission of hepatitis C more likely.

Sharing drug-snorting

Sex C

transmission of HCV during anal sex. If you share toys, cover them with a condom and always use gloves when fisting. Remember to change condoms and gloves between partners.

Having regular full sexual health checks is important for your own health and reduces the risk of transmitting HCV and other STIs. There are different types of hepatitis C, some of which respond to treatment differently than others. If you already have HCV, it is possible to acquire a different strain. If you have cleared the virus, it is possible to acquire it again.

So, talk to your sexual partners and make informed decisions about the type of sex you have.

Photo acon

life insurance now an option

equipment, including plastic and metal straws or rolled up notes, can ‘in theory’ promote the transmission of HCV. Shafting drugs (intrarectal use) can irritate the lining of the ass, also making it easier for the virus to pass from one person to another.

There is no vaccination for hepatitis C and while some types can be cured, not everyone responds as well to treatment.

And while treatments are improving, they can carry the risk of serious side effects.

HCV rarely causes a seroconversion illness and so many people are unaware they have it. Routine HIV blood tests do not regularly test for it, so you may need to ask your doctor to test for it specifically. Depending on the type of sex you have, your doctor may recommend that you test for it on a regular basis.

Because hepatitis C is not classed as an STI, there is no legal obligation for people to disclose their status and there are many reasons why people may not want to. People with hepatitis C, people who inject drugs and people who enjoy ‘esoteric’ sex practices often experience stigma. This stigma can prevent people from talking to their friends and clinicians and prevent them from accessing important information to protect their health. But it is important to talk about the risk of hep C with sexual partners, as you would about HIV or other STIs. Condoms and water- or silicone-based lube are an effective means of preventing

PositiveLiving l 5 l autumn 2013

for more information about hepatitis, go to hepatitis australia.com/about-hepatitis.

If you live in nsW, call the hepatitis nsW helpline on (02) 9332 1599 or freecall 1800 803 990. hepatitis nsW also hosts the ‘c me project’ and is looking for ‘local champions’ throughout nsW. contact dpieper@hep.org.au or visit hep.org.au/c-me *If you are living with hepatitis c and currently not on treatment, consider contributing to some important research. st Vincent’s hospital in sydney is currently looking at levels of hcV in semen. Both hIV positive and hIV negative volunteers are needed. contact Dr Daniel Bradshaw on (02) 8382 3825. note:

Vaccinations for hepatitis a and hepatitis B are available, so talk to your doctor. If you have been vaccinated, a simple blood test can confirm whether you are still protected.

Jae Condon has recently joined naPWha as the treataware Project officer. In his spare time, jae enjoys meditating, good movies and taking long walks along King street.

Listening to those not on treatment

in this current climate of protreatment, people who are not taking antiretroviral therapy (Art) can feel like a minority whose voice is not being heard.

This is why NAPWHA has partnered with researchers Limin Mao and Henrike Körner from the National Centre in HIV Social Research to conduct interviews with people who are currently not on ART. ‘We thought we had set ourselves a very difficult task,’ says Limin. ‘But to our surprise, people from a range of backgrounds have come forward.’

They have included gay men, heterosexual men and women, people born in Australia and those who have migrated here from overseas.

Both Limin and Henrike are impressed by the courage shown by many who have contacted them. Interviewees have opened up about many aspects of their lives: about how they cope day-today; their experiences with HIV disease progression and with health service providers; and, of course, their reasons for not taking ART. ‘Their stories are giving a collective voice to this minority group,’ says Limin.

‘But we would like to gather more to help us better understand how people living with HIV make decisions about treatment.’

HIV treatment has changed considerably over the years. New generation drugs are less toxic, easier to take and more effective in suppressing the virus.

However, treatment still requires a high level of adherence and a life-long commitment — two significant reasons why some people delay starting.

If you would like to share your story, please contact Brent at NAPWHA on (02) 8568 0300 or Freecall 1800 259 666 or email brent@napwha.org.au. You must be over 18, proficient in English and currently not taking ART. The interview can be done by phone or in person in Sydney and will take one to two hours. And you will receive a $30 Coles gift voucher for your time.

ImaGe mIGhtyIslanD

O

ne of the first overseas trips I took after being diagnosed with an AIDS-defining illness was to the USA. The ban on people with HIV entering the country was in full force at the time so, needless to say, I was nervous as the plane touched down in New York.

Not looking particularly well and tired and drawn after a long flight, I was visibly anxious as we lined up at Customs. A friend had been deported back to Australia after US officials discovered she was HIV positive, and I didn’t want the same fate to befall me.

Can they hear my pills rattling in my carry-on luggage? This is what I was thinking as a large Customs official made a beeline towards me. He raised his arm as if to remove me from the line . . . and then curiously lifted it again to let it rest on an older woman standing behind me.

Even today, many countries discriminate against the positive traveller. Some threaten immediate deportation if HIV status is declared or discovered. I don’t believe that these laws should stop you travelling to these countries, but I do believe that you should take adequate precautions to limit the chance of your status being discovered.

The website plwha.org suggests the following tactics to try to get through customs in a country which may otherwise be problematic: n Carry your prescriptions and a doctor’s letter with you. The letter should include a list of the medications and the words: ‘These medications have been prescribed for a medical condition’, without mentioning HIV. n Keep your HIV medications in their original bottles and do not attempt to hide the containers. If you do, Customs officials may think they contain contraband. n Don’t advertise the fact that you are HIV positive. Even a red ribbon might alert a Customs official to follow up on a suspicion. n Be discrete and polite. Don’t draw any attention to yourself that could cause Customs officials to pull you aside. n If you are taking injectable medications (such as Fuzeon, insulin or testosterone), you must have the medication with you in order to carry any empty syringes. art PhIllIP mcGrath

With a little pre-planning and a dash of adventurous spirit, travel can do wonders for your health and wellbeing.

n If you encounter problems, it can be worthwhile asking for a private screening to protect your confidentiality or to ask to speak to a supervisor. n Take the attitude that it’s not really an issue unless it is presented as one.

The good news today is that an increasing number of countries are removing barriers to HIV positive travellers.

When the USA lifted its travel ban early in 2010, China followed suit later in the year. One of the reasons it did so was probably to counteract the negative publicity it received when it refused a visa to HIV positive Australian writer Robert Dessaix in March of that year. Advocacy efforts by the Australian government, writers’ groups and HIV advocacy organisations were thought to have helped change the Chinese government’s attitude.

The

positive traveller

by David Menadue

PositiveLiving l 6 l autumn 2013

Travelling wiTh TreaTmenT We know that taking a break from treatment or missing doses is not a good idea, so always pack more pills than you’ll need in case you are held up.

For short trips, carry double the number of tablets. Put half in your carry-on luggage and checkin the other half, in case either bag goes missing.

Some people avoid carrying their drugs through borders by posting them to their destination ahead of time. This strategy can be problematic, as Customs have been known to intercept such packages; plus, mail can get delayed or not arrive at all.

Other people try to obtain medications in their destination country. This too can be fraught and, unless you are sure of the procedures, can also turn out to be very expensive.

The best idea is to take enough treatment with you. And remember to pack your doctor’s prescriptions as well. This will not only verify that your medications are bona fide, it will also make it easier to obtain more should the need arise.

Six months is the maximum amount your doctor can prescribe at any one time. But for this amount to be dispensed, you may need your doctor’s help to negotiate with your dispensing pharmacy. If you are away longer and are unable to return to Australia to refill your scripts, you may wish to purchase cheaper generics through a reputable online website such as

Time ZOne Changes Most people like to take their HIV drugs at the same time every day and this can prove difficult when crossing time zones. You may want to set an alarm as a reminder.

If you are on a particularly complicated regimen, ask your doctor if it can be simplified.

While adherence is important, it is also true that missing one dose because of a time zone is unlikely to cause any problems.

Travel insuranCe Another tricky area is travel insurance. Fortunately, a few companies have caught up with the fact that people with HIV, particularly those on treatment, are unlikely to present with HIVrelated conditions while travelling.

However, it is still common for travel companies to refuse to provide cover for HIV-related conditions, although some will provide cover if you pay an extra premium — usually a reasonably substantial one. A few will even refuse to pay out for anything if you have not declared your HIV status upfront — on the grounds that you have misled the company about the risk (even if you are not claiming for an HIVrelated condition).

Many of the travel companies I spoke to, in preparation for this article, were prepared to offer travel insurance at normal rates, even if you disclosed your HIV status to them — provided you did not intend to claim for HIVrelated conditions. A consultant from Columbus Direct Insurance suggested that there would be no problem granting insurance cover if you disclosed your HIV status over the phone but you would not be covered for anything related to it.

Another company I spoke to, Covermore (associated with Flight Centre), said that it did not need you to disclose pre-existing illnesses as long as you didn’t

want to claim for them. The exception to this was if you were travelling to the Americas or Africa, where you must disclose any reduced immunity (present or past) or cover may be denied.

The company also said it could usually provide extra premium cover for people with HIV with a phone call to their medical consultants — and that if the HIV was well controlled, coverage would not be a problem.

Other companies require an assessment form to be filled out by your doctor regarding your current state of health and treatment before they will provide extra cover for HIV-related conditions.

There may still be a risk with some of the promises given above.

One policy, for example, states that the company does not automatically cover claims arising from, or exacerbated by, some existing medical conditions.

If I did not apply for HIVspecific cover and was to suffer a heart attack while overseas, could an insurance company regard my higher risk of that happening to be ‘exacerbated’ by my HIV medications or the virus itself? If I was to suffer a fall and break a leg, could the insurance company argue that the HIV wasting in my legs was a contributing factor in my accident?

It’s difficult to say and would probably rely on a treating doctor’s report. However, many insurance companies have a history of avoiding payments if they can get out of them on a legal technicality.

Here is one salutary lesson about an insurance company which shows they are not always your best friend when things get tough.

Bruce was travelling through South America when he was struck down with a respiratory illness so severe that he needed to be hospitalised. He was diagnosed with PCP and the doctors asked if they could test him for HIV. To his surprise, the results came back positive.

Although the standard of medical care was excellent, Bruce knew he had to get back to Australia as quickly as possible to start HIV treatment.

‘Don’t worry about the hospital bills,’ one of the doctors assured him. ‘You have travel insurance.’

But it was not to be so simple.

The insurance company was quiet for the first few days after it was established that it was dealing with an HIV-related

illness. It then took over a week to decide if it would cover the substantial cost of Bruce’s return to Australia. The company’s online product disclosure stated no cover for anything HIV/AIDS related — which didn’t bother Bruce when taking out the policy, as he was unaware of his status — but he was reassured by medical staff that he would be covered because it was not a pre-existing condition.

Bruce was devastated when the insurance company told him it would not cover his expenses. The only support it offered was contact with an Australian Embassy in another country 4000

action and even talking to the media, but eventually he was refunded his costs.

‘It was a highly traumatic experience,’ he says.

The lesson from this story and from others I’ve heard is to read the fine print of insurance policies and ask questions if you are uncertain. Ring up their customer service lines and ask the hard questions. There is no need to disclose your personal details. reCiprOCal healTh agreemenTs The Australian government has Reciprocal Health Agreements with the following countries:

If you are travelling to the Netherlands, you need to apply for an eligibility form before you travel there.1 Doctors in the United Kingdom do not have to accept a patient for treatment under their National Health Scheme (NHS) and can request a private consultation fee. However, coverage in the UK includes treatment in a hospital (as an inpatient or outpatient), ambulance and NHS prescription medicine if your doctor treats you as an NHS patient.

To check HIV travel and residence restrictions for particular countries plus

ImaGe PlWha.orG

AiDSdrugsonline.net.

Talk to your doctor about vaccinations or prophylactic medications if you are travelling to areas where malaria, yellow fever or other bugs may be prevalent. People with HIV should not take live vaccines, such as those offered by some clinics for yellow fever.

Anti-diarrhearals are also a good idea, particularly if you are visiting developing countries.

See What’s your problem on page 8 for more advice.

the website www.plwha.org has an extensive site on travel for hiv positive people, including this map showing the countries with excluding policies. kilometres away.

‘I was at the lowest ebb I had been physically in my life,’ he says.

Feeling alone and very sick, he spent his holiday savings on a long series of connecting flights back to Australia.

Back home, Bruce put the insurance company in contact with all his doctors over recent years. He wanted to prove that he didn’t know his HIV status before taking out the policy.

‘I considered their behaviour to be negligent and failing in their duty of care to me as an insured client,’ he says.

Bruce considered taking legal

PositiveLiving l 7 l autumn 2013

New Zealand, the United Kingdom, the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway.

This means that Australian residents can receive help with the cost of essential medical treatment while visiting these countries and visitors from these countries will receive the same service if they visit Australia.

You need to show your passport and your Medicare card to medical staff in the country you are visiting and tell them you want to be treated under the Reciprocal Medical Agreement with Australia.

treatment information and support services, we recommend the search engine at hivrestrictions.org. The travel tips available at smartraveller. gov.au are also useful.

Finally . . . please don’t let all these considerations put you off your overseas trip. With a little pre-planning and a dash of adventurous spirit, travel can do wonders for your health and wellbeing.

1 see www.humanservices. gov.au/spw/customer/forms/ resources/application-form-foran-a111certificate-of-eligibiitynetherlands.pdf

fit to travel

pedro from queensland writes: I’m thinking of going on a fiveweek holiday. First stop Bali, followed by Singapore, Malaysia and Thailand, then back home. Do you have any special advice about avoiding overseas bugs? Should I get all the relevant vaccinations? What else should I do to stay well?

Dr louise replies: First and foremost, Pedro, it is important that you visit your doctor well in advance to discuss your general health and to plan what to do before visiting those specific destinations.

Some vaccinations need to commence a few months before your trip to be effective.

Also, the type of travel you are doing, the style of accommodation and whether it is rural or urban will influence

which vaccinations are recommended.

You can do some research yourself by entering each of your destinations in the travel health planner at traveldoctor.com.au/ travelhealthplanner There are some other simple things you can do to avoid getting sick.

Hand washing is important (and not even just while you’re away), as this simple act reduces the spread of common respiratory and tummy bugs. Carry a bottle of antibacterial hand sanitiser with you and use it often.

Water precautions are well known. Some countries recommend that you avoid drinking the local water, so don’t forget this when you’re brushing your teeth (use bottled water) or ordering a drink (no ice, thanks).

Carry a tropical-strength insect repellant. Choose one that contains diethyltoluamide (DEET) and one that can be

what’syourproblem? is usually lower in towns and cities and higher in country areas, so discuss with your doctor as some places call for malarial prophylaxis.

Pack a personal first aid kit. Include paracetamol (or another pain killer), antiinflammatory medication (check for allergies or contraindications), a nasal spray (in case of a cold), some basic dressings, anti-diarrhea tablets and perhaps some specific antibiotics for diarrhea (you’ll need a prescription for this).

Remember to pack more than enough of your HIV and other regular medications. Ask your doctor to list them in a letter, along with any complex medical issues you may have in case you Photo Pushlama

DoCtor louiSe AnSwerS Your queStionS

sprayed on both clothing and skin. Malaria and other infections are transmitted by night-biting mosquitoes. The risk

need medical help while you’re away.

Do you need an STI checkup before you go? Remember that an untreated STI can increase your risk of acquiring another STI or transmitting HIV, so take a supply of condoms and lube so you are always prepared. Some STIs are more common overseas than in Australia, so it’s worth mentioning that you have been overseas when having your return STI checkup.

Apart from this: use your commonsense, chat to others who have travelled to the places you plan to go, and have a great time.

Keep your questions under 100 words and email them to pl@napwha.org.au. n Dr louise owen’s advice is not meant to replace or refute that given by your own health practitioner, who is best placed to deal with your individual medical circumstances.

SUPERfoods most of us know Jo watson as the executive Director of nApwhA, but away from the office Jo displays a passion for cooking. So, we asked her to share one of her favourite recipes using a ‘superfood’. She chose beetroot.

Beetroot and goat cheese tart photo by rafal Gaweda

the beetroot in this delicious tart is a rich source of antioxidants, including betacyanin, the pigment that gives beetroot its colour.

Beetroot also contains magnesium, manganese, sodium, potassium, phosphorus, soluble fibre, calcium, iron, vitamins a, B and c, folic acid and betaine — a powerful compound, which, among other things, enhances the production of our body’s natural mood-enhancer, serotonin.

But it is beetroot’s high level of nitrate that helps lower blood pressure and earns it the title of a superfood.

4 l 1 bunch beetroot (about 400g), trimmed l 30g unsalted butter l 1 tablespoon olive oil l 2 red onions, thinly sliced l 1/4 cup (60ml) balsamic vinegar l 2 teaspoons thyme leaves, plus extra sprigs l 1 tablespoon caster sugar l 150g soft goat’s cheese l 2 eggs, lightly beaten l 150ml thickened cream l 1/2 teaspoon nutmeg serVes

Pastry l 1 1/3 cups (200g) plain flour

5mm thick and then use to line the tart pan. chill for 15 mins.

l 100g chilled unsalted butter, chopped l 1 teaspoon thyme leaves

3 Preheat oven to 180°c. cover pastry with baking paper and fill with pastry weights or uncooked rice. Bake for 10 mins. remove the paper and weights and then bake for 5 mins or until dry and pale golden.

method 1 Place beetroot in a pan of cold water and bring to the boil. reduce heat to medium-low and simmer for 1 hour, topping with water if necessary, until tender.

Drain. refresh under cold water and leave to cool. Peel and coarsely grate. set aside.

4 heat the butter and oil in a frypan over medium heat. add onions and 1 tsp salt, then cook, stirring occasionally, for 6-8 mins until softened. add beetroot, vinegar, thyme and sugar, then cook, stirring, for 5 minutes or until thickened and syrupy. spread beetroot mixture over the tart base and then crumble over cheese.

2 meanwhile, for the pastry, place flour, butter, thyme and a pinch salt in a food processor and whiz until the mixture resembles breadcrumbs. add 1/4 cup (60ml) chilled water, then process until the mixture comes together in a ball. enclose in

PositiveLiving l 8 l autumn 2013

plastic wrap and chill for 30 mins. lightly grease a 30cm loosebottomed tart pan. on a lightly floured surface, roll out pastry to

5 Whisk egg, cream and nutmeg together and then pour into tart case. scatter with extra thyme.

Bake for 35 mins or until set.

6 cut tart into slices and serve warm or cold.

stateOFMind the Column where therApiStS reCommenD teChniqueS we CAn emploY to DeAl with the SYmptomS of AnxietY or DepreSSion

In this issue, loretta healey offers some practical wisdom to help those

Coping with loss&grief

Photo 3DstocK

it iS SAiD thAt the eminent pSYChiAtriSt eliSABeth KüBler-roSS leArnt A lot ABout grief from the CleAner in the hoSpiCe where She worKeD. She hAD notiCeD thAt Some of the Young men in her CAre woulD DiSCuSS their impenDing DeAth with the CleAner But not with her. wonDering whY, She ASKeD the CleAner one DAY, who reSponDeD with the worDS: ‘DeAth iS no StrAnger to me.’

While a normal part of life, it is true that loss and grief do not distribute themselves fairly across the population and affect some groups more than others. This is particularly true for people living with HIV, many of whom have lost partners, friends or relatives to the virus before effective treatment came along.

Elisabeth Kübler-Ross is important because she challenged the Western response to death, where grief was swept under the carpet and people maintained a ‘stiff upper lip’. We now know that this approach is unhelpful and can cause more harm than good.

Many people find themselves struggling with emotional problems related to unresolved grief and counsellors spend much of their time with people who have previously buried grief in the hope that it will go away. Grief does not disappear because we wish it wasn’t there. However, acknowledging and dealing with grief will shorten its duration.

It is natural to experience grief with any significant loss in your life. Grief can be overwhelming, even if our relationship with the person who has departed was poor. A common and major loss for many people is the death of a pet. But grief can also encroach on our lives when it is not related to a life lost but rather to the loss of health, life goals or dreams. Do not minimise the potential impact of this type of grief.

It is important to first recognise that you are grieving and what you are grieving for.

This is the first step in working

through the process.

In the 1960s, Kübler-Ross revolutionised our understanding when she developed the five stages of grief: denial (this can’t be happening), anger (who can I blame for this?), bargaining (if

only I do this, it may be okay), depression (overwhelming sadness), and acceptance (I didn’t choose this, but I can accept that it has happened to me).

Some people may not experience all these stages and

PositiveLiving l 9 l autumn 2013

many move in and out of different phases at different times. Kübler-Ross’s theory was never meant to be a step-by-step process. Nor is there a timetable for recovering from loss. The length of grief and the way in

which a person grieves will differ from person to person and are dependent on personality and normal coping methods.

During the grieving process some people become retraumatised by previous losses in their lives, and are sometimes shocked to find they ruminate over past emotional pain.

Grief may also manifest itself in physical symptoms and some people find themselves visiting their GPs more often.

Ignore people who tell you to ‘get over it’ or ‘man-up’. You have a right to your feelings.

Remember that we tend to move in and out of stages, so don’t be shocked if you find yourself crying when you thought the tears had finished.

While it may be tempting to use alcohol and other substances, they can only bury your grief. The relief they offer is very short term and will not help you deal with your loss.

It may sound trite or boring, but taking care of your body by eating well, sleeping and exercising will help considerably.

Don’t wait to feel motivated to exercise; put it in your routine and just do it. Go for a walk in the morning or practise some simple yoga poses in the evening.

Regular, gentle exercise will help you sleep, improve your mental health and make you feel more in control of your life.

You may feel like isolating yourself, but try to maintain your connection with family and friends.

That said, there is no need to put yourself through demanding social engagements just so you won’t offend someone. If you tend to say ‘yes’ to people at your own expense, make a special effort to say ‘no’. Simply explain that you are not up to it at the moment.

If you feel stuck, it may help to speak to a counsellor. Make use of services available to you in your area.

Give yourself time to recover from your loss.

Trust that you will gradually feel better. n loretta healey is senior counsellor at the royal Prince alfred hospital sexual health service in sydney.

monotherapy is not for everyone. my treatment officer and doctors took pains to caution me that this approach is well outside standard treatment guidelines. But i was keen to simplify my regimen. And surprisingly, my immune system has responded in leaps and bounds.

But, first a little background.

I seroconverted and was diagnosed during overseas military service in 1992. Under today’s treatment guidelines, I would have been encouraged to start treatment immediately. But there was little on offer back then. Plus, I didn’t really want to treat. In fact, it wasn’t until the beginning of 2009 — sixteen years after first being diagnosed — that I reluctantly began ART for the first time.

By this time, comprehensive treatment protocols and an army of new drugs with lowered side effects had been developed. Triple combination therapy worked beautifully and within three years, my CD4s had climbed from 20 to 490.

But, I wasn’t satisfied. I felt over-treated and wanted a lighter maintenance regimen.

So I consulted my treatments officer at Queensland Positive People (QPP) and my medical team at the Brisbane Sexual Health and HIV Clinic.

What followed was months of negotiating and fact-finding while we waited on the latest results from experimental research using a single protease inhibitor as maintenance therapy. As a class, protease inhibitors (although not all of them) seem to have a much higher barrier to resistance when used as monotherapy. This is miles away from the early days when single-drug approaches to HIV failed miserably.

Eventually, we settled on the MONOI trial protocol and in February 2012 I made the transition to boosted darunavir monotherapy. The dosage is one 600mg darunavir boosted with 100mg of ritonavir at breakfast and the same again at dinner time. Note: ‘boosted monotherapy’ means that ritonavir is used to boost the concentration of the darunavir.

In the first few months, we tested monthly. Our aim was for viral suppression of less than 200 copies/ml, with failure defined by two consecutive tests above 200. Additionally, any test above 200 copies/ml would be followed by another viral load test two

A little can go a long way

David Anders

Gone are the days of multiple daily dosing and battling horrendous side effects to achieve viral suppression. Newer generation drugs can achieve much with a lot less effort.

Armed with this knowledge, David Anders made the transition from standard triple combination therapy to a lighter regimen of boosted darunavir monotherapy.

David complements his radical treatment regimen with a range of healthy pursuits including marathon running weeks later. My immune indicators (such as CD4 counts and percentages) were measured after the first month, the third month and then at threemonthly intervals.

There were extra supports I put in place to give this new drug regimen its best possible chance of success. I sought encouragement from friends, family and QPP. I maintained a meditation program. And I began training for an upcoming marathon.

The naturopaths at the Endeavour College of Natural Health also gave me some personalised dietary and lifestyle advice. They had a detailed brief. I wanted the nutritional supplements and herbal formulations to do a number of things: n to support and regulate digestive function in order to achieve optimal nutrient absorption

n to address oxidation of cells — which in HIV infection can cause systemic inflammation and nutritional deficiencies n to provide relief to any symptoms experienced from drug therapy n to stabilise mood and energy levels and to improve sleep quality and the body’s ability to cope with stress.

As soon as I began my lighter drug regimen and the complementary supports, I felt an immediate rise in energy. After my first month of treatment, my CD4s rose slightly from 490 to 510 and my percentage rose from 35% to 37%. After three months, the virus stayed undetectable, my CD4s rose sharply to 700 and my percentage to 41%.

I discovered there was no glass ceiling to my immune system’s recovery. Three and a half years ago, I had a CD4 count

PositiveLiving l 10 l autumn 2013

of 20. But my health-care team encouraged me to keep working at my health, with the result that I avoided any negative selffulfilling prophesy.

My next step is to sustain these great results and, with my doctor’s guidance, I am currently deciding whether to switch to a lower 800mg dose of darunavir.

This is the MONET trial protocol, where patients with an undetectable viral load switched from standard combination therapy to a single daily dose of 800mg of boosted darunavir.

I figure: why use a large hammer when a smaller hammer will do the job?

But timing and precision are everything. My results show that with good management, the immune system can truly rebound. For me, boosted darunavir monotherapy far outstripped my previous triple

combination regimen — where my immune system seemed to stall or reach a plateau. Within the first three months on montherapy, with the support of complementary therapies, I experienced a 42% rise in my CD4 count.

This leaves me with huge confidence in my Brisbane healthcare team and in all the cuttingedge researchers in the field of HIV medicine. New generation treatments are emerging more powerful and more efficient.

Triple combination therapy saved my life. Now, monotherapy is giving me the quality of life I want. These days, a little appears to go a long way.

David Anders lives in Brisbane, completed his first marathon in august 2012, and switched to the once-daily 800mg dose of boosted darunavir monotherapy in january 2013.

How do you like us?

How do you read Positive Living and what do you like about it? We’d like to know so we can keep the magazine relevant. please answer the questions below by ticking the appropriate box or boxes. Alternatively, you can complete the survey online by following the links at www.napwha.org.au. queStion 1 are you? n male n female n other ............................................................. queStion 2 What is your age? n under 30 n 30-39 n 40-49 n 50-59 n over 60 queStion 3 What is your postcode (or country if outside australia) queStion 4 Which of the following best describes your sexuality? n Gay n lesbian n Bisexual n heterosexual n other ............................................................. queStion 5 What is your hIV status? n hIV positive n hIV negative n Don’t know/untested n Prefer not to say queStion 6 Do you work in the hIV sector or an allied health field? n yes n no queStion 7 Positive Living comes out four times a year. how many editions do you read? n every edition of Positive Living n most editions of Positive Living n some editions of Positive Living n few editions of Positive Living

queStion 8 how long have you been reading Positive Living? n less than a year n 1-2 years n 3-5 years n 6-8 years n more than 10 years

queStion 15 In general, do you think Positive Living is written in a way that makes it easy to read and understand? n yes n no If no, why not?…………………………………….....

queStion 9 how difficult is it for you to access or obtain a copy of Positive Living? n never difficult n sometimes difficult n often difficult Please outline any difficulties

queStion 16 Do you think the look of Positive Living (including its graphics, layout and design) is appealing? n yes n no If no, why not?…………………………………….....

queStion 10 how do you read Positive Living? (tIcK one or Both If they aPPly) n In hard copy (paper version) n electronically (via computer) queStion 11 how do you get your hard copy? n as an insert in the Star Observer n Personally mailed to me n from a clinic/hIV service/ community venue n In QPP alive n other ............................................................. queStion 12 how do you like to read it online? n Via email with links n as separate items on the naPWha website n as a PDf n In ‘flip-book’ format n Via facebook queStion 13 how many people read your copy of Positive Living? n1 n2 n 3+ queStion 14 as a general rule, how much of Positive Living do you read? n all of it – cover to cover n the headlines and most of the articles n about half n I just scan it and read what is of interest

queStion 17 What do you most like to read in Positive Living?

(Please tIcK uP to fIVe Items) n Information about hIV treatments n health advice n Personal stories n news pages n conference highlights n the latest cure research n Drug and alcohol issues n Women’s issues n calD issues n atsI issues n What’s your problem (doctor’s advice) n tales from the network (case studies) n state of mind (anxiety and depression) n Gentle exercise (yoga poses) n superfoods (recipes) n PlhIV Directory (back cover) n other …………………………………….................. queStion 18 Is there anything you don’t like to read about in Positive Living?

queStion 19 When you have read Positive Living how do you generally feel? (tIcK all that are releVant) n Informed n Intimidated n challenged n confused n stimulated n anxious n entertained n Bored n other .............................................................

PositiveLiving l 11 l autumn 2013

queStion 20 have you ever recommended Positive Living to someone living with hIV? n yes n no queStion 21 Positive Living tries to strike a balance between articles written on health and treatment issues and articles on other lifestyle issues, including relationships, welfare, work, leisure and politics. What do you think of the balance? n the balance is about right n there should be more health and treatment articles n there should be more lifestyle articles queStion 22 are there any final comments you would like to add about Positive Living or how it might be improved?

If you would like to receive Positive Living via electronic or postal subscription, please go to www.napwha.org.au/subscribe.

If you are already a subscriber to Positive Living and would like to change the way you receive the publication or the address to which it is sent, please call naPWha on 1800 259 666.

THANK YOU FOR YOUR TIME please mail your completed survey by friday 19 April 2013 to: readership Survey, nApwhA reply paid 917 newtown nSw 2042 no StAmp requireD

nAtionAl l ¢ Australian federation of AiDS organisations (AfAo) ) 02 9557 9399 ø afao.org.au ¢ hepatitis Australia)02 6232 4257 ø www.hepatitisaustralia.com ¢ national Association of people with hiv Australia (nApwhA) ) 02 8568 0300 or 1800 259 666 ø napwha.org.au

ACt area code (02)l ¢ ACt hepatitis resource Centre ) 6230 6344 or hepline 1300 301 383 ø hepatitisresourcecentre.com.au ¢ AiDS Action Council of the ACt (m) (V) Information, referral, support. Westlund house, 16 Gordon st, acton ) 6257 2855 2 mandi.collins@aidsaction.org.au ø aidsaction.org.au ¢ positive Support network monthly social + educational night for PlhIV. free dinner. tue 6-8pm ) 6257 2855 ¢ positive living ACt (m) (V) social dropin centre Westlund house. free internet, holistic bodywork, positive speakers’ bureau, women’ n’s group, financial help, social networks, advocacy, referral, support, counselling, info, dietician’ n’s clinic + workshops.

16 Gordon st acton ) 6257 4985 2 positiveliving.act@aidsaction.org.au

new South wAleS area code (02) l ¢ ACon (m) (V) hIV prevention, health promotion, advocacy, care + support for PlhIV, glbti, atsI, IDu, sex workers. sydney (head office) 414 elizabeth st surry hills ) 9206 2000 /1800 063 060 hearing impaired 9283 2053 ø www.acon.org.au ¢ counselling 1800 647 750 ¢ hunter 4927 6808 ¢ southern nsW 4226 1163 ¢ northern rivers 6622 1555 or 1800 633 637 ¢ mid-north coast 6584 0943 ¢ Ankali (V) Volunteer support for PlhIV, partners, family, friends. referrals, counselling. ) 9332 9742 ¢ Blue mountains plwhA Drop-in centre.

Peer support, advocacy, health promotion.

10 station st Katoomba ) 4782 2119 2 ¢ Bobby goldsmith foundation (Bgf) (V) financial help with hIV medications, nointerest loans, financial counselling, accom. support for people returning to work or study.

111-117 Devonshire st surry hills ) 9283 8666 or 1800 651 011 ø bgf.org.au ¢ Community Support network (CSn) (V) transport + practical home help for PlhIV. ¢ sydney ) 9206 2038 or 1800 063 060 ¢ hunter/mid-north coast ) 4927 6808 ¢ Illawarra ) 4226 1163 ¢ csn volunteers (training provided) ) 9206 2038 ¢ hepatitis nSw helpline ) 9332 1599 (nsW country 1800 803 990) ø hep.org.au ¢ hiv/AiDS legal Centre free hIV-related legal services. Wills, super, immigration, discrimination 414 elizabeth st surry hills ) 9206 2060 or 1800 063 060 ø halc.org.au

plhivDIRECTORY KeY to SYmBolS ) Phone ø Internet 2 email 2 limited hours (m) membership organisation (v) Volunteer opportunities

¢ Karumah (newcastle) social + peer support for PlhIV, carers, friends, family. lunch tue, thu; monthly BBQ. ) 4940 8393 ø karumah.com.au 2 ¢ multicultural hiv + hepatitis Service Bilingual/bicultural support, advocacy for people from calD backgrounds. ) 9515 5030 or 1800 108 098 ø multiculturalhivhepc.net.au ¢ positive Central counselling, dietetics, occupational therapy, physio. Individual + group sessions, home visits.

103-105 redfern st redfern ) 9395 0444 ¢ positive life (nSw) (m) (V) advocacy, publications, speakers’ bureau, events.

414 elizabeth st surry hills ) 9206 2117 or 1800 245 677 ø positivelife.org.au ¢ positive Support network (Central Coast) care + support, referral, counselling, education+advocacy m-f 8am-4.30pm ) 4323 2905 2 posnet@tpg.com.au ø positivesupportnetwork.com ¢ pozhet (hiv positive heterosexuals) (m) freecall counselling for positive straight people and partners. Women’s officer avail. annual calendar of activities. ) 1800 812 404 ø pozhet.org.au ¢ the western Suburbs haven social support, convalescent + respite care. meals, massage, classes, cheap groceries, workshops, internet access. ) 9672 3600 ø thewesternsuburbshaven.com.au ¢ tree of hope Pastoral + practical support services for PlhIV and for their primary carers. 2c West st lewisham ) 9509 1240

northern territorY area code (08)l ¢ nt AiDS and hepatitis Council (ntAhC) 46 Woods st Darwin ) 8944 7777 ø ntahc.org.au ¢ alice springs ) 8953 3172 ¢ plwhA/nt (m) Po Box 2826 Darwin 0801 ) Bill Patterson or Daniel alderman 8941 1711

queenSlAnD area code (07) l ¢ hepatitis queensland (m) education, support, info, advocacy, counselling. ) 3846 0020 or 1800 648 491 (country) ø hepqld.asn.au ¢ queensland positive people inc (qpp) (m) (v) Peer support, advocacy, info. 21 manilla st east Brisbane ) 3013 5555 or 1800 636 241 2 info@qpp.org.au ø qpp.net.au ¢ queensland Association for healthy Communities (qAhC) (m) (V) Promotes health of lesbian, gay, bisexual, transgender people, as well as sexual health and Indigenous health.

30 helen st newstead 4006 2 info@qahc.org.au ø qahc.org.au ¢ Brisbane + s-e Qld ) 3017 1777 ¢ cairns ) 4041 5451 ¢ statewide ) 1800 177 434

¢ Spiritus positive Directions communitybased, client-centred, wellness approach to hIV with experienced hIV care coordinators + client support workers. services incl. mental health, diet, support to diverse social groups. ø positivedirections.org.au ¢ Brisbane ) 3028 4730 ¢ cairns ) 4051 1028 ¢ townsville ) 4721 1384 ¢ sunshine coast ) 5441 1222 ¢ Gold coast ) 5576 8366

South AuStrAliA area code (08) l ¢ AiDS Council of South Australia (ACSA) (m) (V) counselling, financial + practical assistance, individual advocacy.

2 eton rd Keswick ) 8334 1611 or 1800 888 559 ø acsa.org.au ¢ Cheltenham place (centacare hIV services) respite care for PlhIV and their carers based on assessed needs. ) 8272 8799 ¢ hepatitis SA ) 8362 8443 or 1300 437 222 (regional) ø hepccouncilsa.asn.au ¢ hepatitis SA library free online catalogue of resources covering treatment, tests + procedures, lifestyle (nutrition, mental health), risk factors, discrimination, information for different cultures + interest groups, educational, policy and statistical documents. ø www.hepsa.asn.au/library. ¢ hiv women’ n’s project (women’ n’s health Statewide) Peer support group, info, advocacy.

64 Pennington tce north adelaide ) 8239 9600 or 1800 182 098 2 health.line@health.sa.gov.au ø whs.sa.gov.au ¢ mosaic hiv and hepatitis Services (relationships Australia) confidential, free service for those affected by hIV or hep c.

192 Port rd hindmarsh ) 8340 2022 ø socialrelations.edu.au ¢ positive life (SA) (m) (V) Provides various health promotion activities for PlhIV and those closely affected. runs Positive living centre, offering referrals, treatments info + other services.

16 malwa st Glandore ) 8293 3700 ø hivsa.org.au

tASmAniA area code (03) l ¢ Sexual health Service 60 collins st hobart ) 6233 3557 or 1800 675 859 (hobart, launceston, Devonport, Burnie) ¢ tasmanian Council on AiDS, hepatitis and related Diseases (tasCAhrD) (V) 319 liverpool st hobart ) 6234 1242 or 1800 005 900 ø tascahrd.org.au

PositiveLiving l 12 l autumn 2013

viCtoriA area code (03) l ¢ AiDS housing Action group (inner South Community health Service) statewide confidential housing service.

240 malvern rd Prahran ) 9417 4311 or 1800 674 311 ø ahag.or.au ¢ the Centre Clinic community health service for PlhIV + GlBt community but open to all. rear 77 fitzroy st st Kilda ) 9525 5866 ¢ Country Awareness network 34 myers st Bendigo ) 5443 8355 ø can.org.au ¢ education and resource Centre (hiv, hepatitis and Sti) at the Alfred community resources on hIV, hepatitis, stDs, health research. ) 9076 6993 ø hivhepsti.info ¢ hepatitis victoria ) 9380 4644 or 1800 703 003 (V) for info, support and referrals. hep c positive volunteers welcome, full training given. ø hepcvic.org.au ¢ hiv and Sexual health Connect line (V) Info, support and referral regarding hIV and sexual health. ) 1800 038 125 ø connectline.com.au ¢ living positive victoria (m) (V) support, advocacy, representation. speakers’ Bureau, treatments officer newsletter, events.

111 coventry st southbank ) 9863 8733 ø livingpositivevictoria.org.au ¢ positive living Centre free tea/ coffee/brunch, complementary therapies, massage, naturopathy, yoga, low-cost meals, food pantry, emergency financial relief, peer support, legal centre, social/educational/ self-development courses + activities, community support, outreach, computer/ internet training, fitness classes. (tues-fri) 51 commercial rd south yarra ) 9863 0444 or 1800 622 795 ¢ positive women victoria (m) statewide peer support + advocacy for positive women. confidential support, info, advice, publications. 111 coventry st southbank ) 9863 8747 ø positivewomen.org.au ¢ Straight Arrows (m) support, services for hIV+ heterosexuals + families. suite 1, 111 coventry st southbank ) 9863 9414 ø straightarrows.org.au ¢ victorian AiDS Council/gay men’ n’s health Centre (vAC/gmhC) (m) (V) 6 claremont st, south yarra ) 9865 6700 or 1800 134 840 ø vicaids.asn.au

weStern AuStrAliA area code (08) l ¢ hepatitis wA ) 9227 9800 (enquiries) 9328 8538 (support, info) 1800 800 070 (Wa country) ø hepatitiswa.com.au ¢ wA AiDS Council (wAAC) (m) (V) support, events, courses, wellbeing programs, life coaching.

664 murray st West Perth. ) 9482 0000 ø waaids.com

Are Your DetAilS CorreCt? the PlhIV Directory lists services, programs and events of interest to hIV positive people. It appears once a year in the autumn edition. to enquire about a free listing or to update your details, email: pl@napwha.org.au