Positive Living Magazine by Positive Living Magazine

I N S I D E

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PAC’S FIGHTING WORDS

Housing rights for BC’s HIV community

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COVER STORY How people power is keeping Argentina’s health care system afloat

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LET’S GET CLINICAL

New study addresses bone density mass in women

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SEX NOW GOES VANILLA We probe deep into the research on the sex lives of gay men

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 positivelivingbc.org

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THE CANADIAN COALITION COME ALIVE TO REFORM HIV Volunteers’ voices CRIMINALIZATION from History Alive How to right a flawed law and end stigma for good

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THE POSITIVE GARDENER THIS BUILDING IS ROCKIN’ BACK TALK A stroll through the native Details emerge as the foliage of Vancouver opening of the new building nears

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

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VOLUNTEER PROFILE Volunteering at Positive Living BC

A first look at a new column exploring 30 years of activism

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LAST BLAST This is one pussy that grabs back, Donald

HEALTH PROMOTION PROGRAM MANDATE & DISCLAIMER In accordance with our mandate to provide support activities and prejudice. The program does not recommend, advocate, or endorse facilities for members for the purpose of self-help and self-care, the the use of any particular treatment or therapy provided as information. Positive Living Society of BC operates a Health Promotion Program The Board, staff, and volunteers of the Positive Living Society of to make available to members up-to-date research and information BC do not accept the risk of, or the responsiblity for, damages, on treatments, therapies, tests, clinical trials, and medical models costs, or consequences of any kind which may arise or result from associated with AIDS and HIV-related conditions. The intent of the use of information disseminated through this program. Persons this project is to make available to members information they can using the information provided do so by their own decisions and access as they choose to become knowledgeable partners with hold the Society’s Board, staff, and volunteers harmless. Accepting their physicians and medical care team in making decisions to information from this program is deemed to be accepting the terms promote their health. The Health Promotion Program endeavours to of this disclaimer. provide all research and information to members without judgment or P5SITIVE LIVING | 1 | MARCH •• APRIL 2017

Message The Positive Living Society of British Columbia seeks to empower persons living with HIV disease and AIDS through mutual support and collective action. The Society has over 5700 HIV+ members. POSITIVE LIVING EDITORIAL BOARD Earl Sunshine (co- chair), Neil Self (co- chair), Tyler Chudday, Ross Harvey, Joel Nim Cho Leung, Elgin Lim, Jason Motz, Adam Reibin MANAGING EDITOR Jason Motz DESIGN / PRODUCTION Britt Permien FACTCHECKING Sue Cooper COPYEDITING Maylon Gardner, Heather G. Ross PROOFING Ashra Kolhatkar CONTRIBUTING WRITERS Lorenzo Cryer, Paul Goyan, Cécile Kazatchkine, R Paul Kerston, Tom McAulay, Taylor Perry, Neil Self, Sean Sinden, Hope Springs, Alan Wood PHOTOGRAPHY Britt Permien DIRECTOR OF COMMUNICATIONS AND EDUCATION Adam Reibin DIRECTOR OF PROGRAMS AND SERVICES Elgin Lim TREATMENT, HEALTH AND WELLNESS COORDINATOR Brandon Laviolette SUBSCRIPTIONS / DISTRIBUTION John Kozachenko Funding for Positive Living is provided by the BC Gaming Policy & Enforcement Branch and by subscription and donations. Positive Living BC | 803 East Hastings Vancouver BC V6A 1R8

 Reception 604.893.2200  Editor 604.893.2206  living@positivelivingbc.org  positivelivingbc.org

Permission to reproduce: All Positive Living articles are copyrighted. Non-commercial reproduction is welcomed. For permission to reprint articles, either in part or in whole, please email living@positivelivingbc.org

from the chair

NEIL SELF

Surveys of faith and devotion am writing this after an intensive strategic brainstorming where board and staff members assessed Positive Living BC’s key goals and how we work to attain them. Members at-large and volunteers also played a strong role today via their responses to a survey distributed earlier this year. PLHIV have the brightest future when it is shaped by our collective contribution to Positive Living BC. I am happy to report that our future looks brighter than it did just a few, dark months ago. I give high praise to all of our members, volunteers, board directors, staff and other supporters for seeing us through 2016—one of the most tumultuous years in our Society’s history. Your unyielding loyalty has revived my faith in our vision of a future wherein “PLHIV/ AIDS in BC are healthy and free to lead purposeful and actively engaged lives in an accepting, inclusive community.” Much about the landscape of HIV has changed since members jointly crafted that vision statement in 2010. The goals they set for Positive Living BC remain valid: r Grow an empowering, relevant, collaborative organization r Advance the Society’s membership engagement and member services r Promote innovative HIV/AIDS education, access and assistance, health promotion and outreach programming, policy and evaluation.

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Many of you know that dire funding cuts in the past year forced the Society to layoff our Access and Assistance Coordinator, and our Director of Community Based Research who played an important role in policy and evaluation. That’s why strategic planning is essential—Positive Living BC operations must evolve to ensure our survival in a changing world. Results from the survey show that funding is a major concern among many of you whose good health depends on sustained, active engagement in our programs and services. I guess respondents got the message from all the noise the board has been making about our Society’s fiscal circumstances. Indeed, the cover story I wrote for Issue 18.6 laid out just how much PLHIV in BC stand to suffer in the wake of massive cutbacks in government funding. These are scary times for our community—but there is hope. Our defence of the needs amongst PLHIV seems to be reviving our government’s commitment to HIV health. Since our last issue, Positive Living BC and many of our partners in community-based HIV care have been promised transitional funding from the Public Health Agency of Canada (PHAC) for the next fiscal year. That means we can continue to offer Prison Outreach, Positive Gathering, and other essential programs as we pursue alternative funding streams and lobby for a greater commitment from PHAC. 5

HIV intasome puzzle solved?

pSalk Institute scientists have solved the

atomic structure of a key piece of machinery that allows HIV to integrate into human host DNA and replicate in the body. The findings describing this machinery, known as the “intasome,” appear in the January 2017 edition of Science and yield structural clues informing the development of new HIV drugs. “HIV is a clever virus and has learned to evade even some of the best drugs on the market. Understanding the mechanisms of viral escape and developing more broadly applicable drugs will be a major direction in the future,” says the study’s senior author Dmitry Lyumkis. Currently, a class of drugs called integrase strand transfer inhibitors (INSTIs) targets the intasome and are already approved to treat HIV in the US and Europe. Despite being some of the best drugs available, scientists have only gained a limited understanding of the precise mechanism of action of INSTIs, and how the virus mounts resistance, by the inference of structures of a similar retrovirus (called the prototype foamy virus, or PFV). That’s because the HIV intasome itself has been notoriously difficult to study at the atomic level. “Now we have the very first native blueprint in the context of HIV for studying the mechanisms of INSTIs,” says Lyumkis. In the new study, Lyumkis and colleagues used a cutting-edge imaging technique called single-particle cryo-electron microscopy (cryo-EM), which has allowed scientists to image large, complex, and dynamic molecules. The team attached a specific protein to improve the intasome’s

ability to dissolve in liquid and bathed the intasome in a syrup-like liquid called glycerol, with loads of salt added to prevent it from clumping. These are extreme conditions for a cryo-EM sample, but they were necessary in the case of the HIV intasome. Then, building upon novel technical advances in the field, the scientists cranked up the cryo-EM machine to spray even more electrons at their sample than usual. Lyumkis says the HIV intasome’s complexity hints at how nature has shaped its evolution from simpler retroviruses, which are considerably smaller, yet still use the same core pieces of enzyme. HIV can perform functions that its relatives can’t, such as gain access to the cell’s nucleus through active transport rather than having to wait for the cell to divide. “HIV is like the luxury car whereas other retroviruses are the economy models—they’re both cars, but the HIV intasome contains important upgrades to do different jobs,” he adds. Based on the different structures present in the samples, the team thinks that the HIV intasome could take multiple routes for assembly. “That’s speculative at this point, but it’s an intriguing possibility and would build upon mounting evidence that certain macromolecular machines take different routes to assemble the final product,” Lyumkis says. Source: www.eurekalert.org

Access to kidney transplants a challenge for PLHIV

pPeople living with HIV (PLHIV) who suffer kidney disease face longer waits for a transplant organ, this according to a new study.

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HIV-positive kidney patients were 28 percent less likely to receive a living donor than an HIV-negative organ recipient. Of the 1.2 million PLHIV in the US, more than 30 percent also have kidney disease. As a result, the chance of kidney failure are made greater. Kidney transplantation reduces the risk of early death by almost 80 percent over kidney dialysis. (Patients with HIV and kidney disease are 19 times more likely to die on dialysis than patients without the complications of HIV.) The study, published in February by the Clinical Journal of the American Society of Nephrology (CJASN), combed through donor-related data collected between 2001-2012 by the Scientific Registry of Transplant Recipients. In total, the study found 1,636 HIV-positive people had appeared on waiting lists for a new organ. In contrast, over 70,000 HIV-negative people sought new kidneys. “The supply of decreased donor organs remains limited,” said Dr Jayme Locke, the study’s lead author, so “living kidney donors have become a critical source for organs.” “No HIV-positive person has ever been a living donor, likely because little is known about risks HIV-positive persons may incur from donating a kidney. We see this study as the foundation for demonstrating the significance/need for identifying a subset of (PLHIV) who are both willing and healthy enough to be living kidney donors (so such procedures) can be done safely.” Source: http:cjasn.asnjournals.org

Role of vaginal bacteria in HIV transmission studied

pSpecific bacteria living in the human

vagina may play a previously unrecognized role in the sexual transmission of HIV, according to a study published in the January edition of the journal Immunity Ragon Institute researchers, working with young, healthy, South African women, found that individuals with vaginas dominated by pro-inflammatory bacterial species were at a four-fold higher risk of acquiring HIV than those with “healthy” vaginal bacteria. Meanwhile, viruses in the female genital tract showed no correlation with HIV risk. Participants with high-risk bacterial communities, which are commonly found in the population of women studied, also had increased numbers of genital CD4+ T cells—white blood cells that are HIV’s primary target. Furthermore, the researchers saw that the intravaginal introduction of pro-inflammatory species of bacteria found in the volunteers could increase the presence of mucosal CD4+ T cells in a mouse model. The research suggests that specific genital bacteria can increase HIV risk by making it easier for the virus to find a foothold. They now want to pursue probiotic or prebiotic therapies to reduce HIV acquisition in women living in vulnerable communities. “There is a direct translational application that comes from this work. By identifying bacterial species and communities associated with HIV risk, we provide specific targets that may be leveraged to develop new preventive strategies and to improve the effectiveness of existing preventive measures,” says first author Christina Gosmann.

Senior author Douglas Kwon was drawn to the community because of the high burden of HIV among women in KwaZulu-Natal and its potential link to genital inflammation. It has been shown that certain sexually transmitted infections, such as chlamydia, can cause inflammation and increase HIV risk, but that would not have accounted for all of the cases. Based on a paper his group published in 2015, Kwon knew that certain bacteria present in South African women are a major instigator of vaginal inflammation , and he thought this new work could connect some dots. “We think of a healthy microbiome as being Lactobacillus dominant—that’s what we are taught in medical school—but those studies are mostly based on white women in developed countries. When we did our first study we found that less than ten percent of the women in our South African cohort had this classically ‘healthy’ community,” he says. “Seventy percent of our volunteers had diverse bacterial communities with low Lactobacillus abundance. Here we show that not only are those more diverse communities associated with higher levels of genital inflammation but also with significantly increased HIV acquisition.” There are still questions around why differences between vaginal microbiomes exist. Despite looking at several factors, Kwon and his team could not identify any behavioural or environmental associations. However, the work does identify a new mechanism to potentially reduce vaginal inflammation and thus HIV risk by helping women with diverse bacterial communities in their genital tract become more Lactobacillus dominant. Sources: www.cell.com P5SITIVE LIVING | 4 | MARCH •• APRIL 2017

US HIV infection rates drop for some groups

pHIV prevention is making moderate

gains in the US as HIV infection rates have fallen, according to the Centers for Disease Control and Prevention (CDC). The annual number HIV infections over a seven-year period (2008-2014) dropped 18 percent. In hard numbers, the CDC estimates only 37,600 new infections occurred nation wide during that time frame. This, after HIV rates had been steady since the mid-1990s. Speaking at CROI in Seattle this February, Jonathan Mermin of the CDC revealed the findings show the “success of collective prevention and treatment efforts at national, state, and local levels.” Among the key areas where a decline in infections was noted: injections drug users (down 56 percent), heterosexuals (down 36 percent), gay and bisexual males 35-44 age groups (26 percent) and young gay and bisexual men (18 percent). An increase in the use of PrEP could explain this drop in infections. (In 2012, PrEP was approved for prevention by the Federal Drug Administration.) However, the gay and bisexual male community did not see a related drop in new infections. For example, Latino gay and bisexual men (20 percent increase) and gay and bisexual males aged 25-24 (35 percent). Annual infection rates held steady for gay and bisexual men (26,000). Sources: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB prevention; www.cdc.gov/nchhstp/newsroom

By Neil Self

HIV and Housing: A Basic Human Right and Election Issue

researching this article, the author has come to three critical conclusions that serve this process: 1 housing is the top concern for many our members here in BC 2 there is a plethora of data on the importance of housing for the health of PLHIV, and 3 housing is a basic human right that cannot be addressed by the market forces alone. In other words, the Government needs to be involved in the development of housing. From homelessness to home ownership, housing has been foremost on our collective consciousness for years now. Positive Living BC members are no different and, as reported in the 19.1 Fighting Words column, housing was the main area of concern among our membership. The geographical realities (lack of usable land) of BC and the Lower Mainland, combined with the current housing market, the high cost of living, and the lack of funding for housing has created a “perfect storm” and spawned a housing crisis in BC. Housing has been identified as the foundation of all of the social determinants of health. PLHIV that do not have safe, secure, and affordable housing have poorer health outcomes. To that end, Positive Living BC and the Positive Action Committee (PAC) are developing a position paper that will guide the organization when we advocate for housing on behalf of our members. The core of the position paper will be that all PLHIV should have access to long-term housing, regardless of socioeconomic status. PLHIV should have access to a variety of housing across the housing continuum—subsidized social housing, low-income market housing subsidies, and first-time home ownership assistance—throughout BC, with the full range of our diverse community represented. PAC attempts to stay informed about the housing challenges of our members and then responds where we can influence those with the power to change things. We attend community consulta-

tions on major housing developments. We write to politicians and bureaucrats to push for development of more social housing. We work with sister organizations that provide housing to our membership. We support other advocates for the development of social housing (Raise the Rates, BC Poverty Reduction Coalition, ACORN). In the spirit of the empowerment model of our organization, and with the BC Election coming up, we ask our members to inform themselves about the need for social and affordable housing in BC. We also ask you to contact the candidates and have them commit to: 1 Raise the Shelter rate of Income Assistance and Disability Assistance substantially (from $375 to at least $750 per month) 2 Work with the Federal and Municipal governments in developing and building 10,000 units of social housing in BC per year 3 Work with the Federal and Municipal governments in developing and building 10,000 units of affordable rental housing in BC per year. 5 Neil Self is the co-chair of Positive Living Society of BC.

VANCOUVER HOUSING CRISIS IN NUMBERS 5 Latest Homeless Count for Metro Vancouver (2014): 2,777 5 Current BC Housing Waiting List: 10,000 (average wait of 5-6 years) 5 Current Metro Vancouver Vacancy Rate: < 0.6% 5 Average Rent of Bachelor Apt: $1,900 5 Average Cost of Detached House: $1.4 Million

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Sex Now goes vanilla

By Paul Goyan he findings of the latest Sex Now survey from Community Based Research Canada (CBRC) have been released in a report entitled, “Gay Generations: Life Course and Gay Men’s Health.” In a noble effort, the report attempts to tie life course theory with gay/bi men’s health. Alas, the result is a 50-plus-page report that overwhelms with its length but underwhelms with its depth. Life course theory focuses on “where gay men were in their lives at key moments in the course of the [AIDS] epidemic.” The findings are presented using five “gay generations,” or age cohorts: Generation Gay Legal (Age 60-71, Baby Boomers), shaped by New York’s Stonewall riot and decriminalization of homosexuality in Canada Generation Gay Pride (Age 45-59, Late Boomers to Gen X), coming of age in the mid-70s to late-80s, and

r r

shaped by the 1981 Toronto bathhouse raids and the mass protests which followed, leading to the creation of Pride Week; Generation Safe Sex (Age 35-44, Gen X to Gen Y), from the late-80s through the 90s, condoms “represented sexual liberation.” Generation ART (Age 25-34, Gen Y to Millennials), coming of age in the late-90s and 2000s. In 1996, HAART became a game changer. Generation Gay Marriage (Age 15-24, Millennials), from 2009 to the present. Treatment as Prevention (TasP) gained momentum and in 2005, and gay marriage became legal in Canada.

r r r

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The survey was conducted across Canada between October 2014 and May 2015. Only 8,000 people completed the survey out of 15,000 that had at least taken a look at it. Although the number of respondents is similar to the last survey, the poor completion rate is a problem that requires further investigation. The overall length of the survey and its increasing reliance on technology presents a barrier to completion for those with do have not access to technology and lack the functional literacy skills to read and complete a lengthy survey. Unfortunately, there is no breakdown of the number of respondents by province or city.

Gender and Sexual Identity

r As a survey of gay/bi males, it is no surprise that 94-98%

of all cohorts identify as male. There is greater gender diversity among the youngest cohort (under age 25), with 11% identifying as transgender, four% genderqueer, and one% two-spirit. Only 70% of respondents identify as gay, ranging from a low of 64% (>60+) to a high of 79% (age 25-34). The proportion of bisexuals overall is 27%, ranging from a low of 19% among those 25-34 to 33% among those 60+. Straights make up five% of respondents. In the youngest cohort, 11% identify as queer. When asked about latest their latest HIV test results, the proportion responding that they were HIV-positive went from two% (<25), 5% (25-34), 12% (4559) and 10% (60+).

r r r r r r

Sexuality and Coming Out

Respondents were asked how old they were when they first had sex. Surprisingly, in the youngest cohort, only nine% had sex before age 14, compared to 27% in persons 60+. About one quarter of respondents over age 45 didn’t have contrast sex until they were >25. When asked about how old they were when coming out “to other guys,” the results ranged from 16% (25-34) to 40% (60+). A majority of those <45 came out before they turned 25 (from 78% of those <25 to

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53% of those 35-44). Only 34% of those between 45-59 and 20% of those 60+ came out before age 25. A significant proportion of older respondents did not come out until 40+: 11% of those 45-59 and 20% of those 60+.

What about Sex?

The survey reports fairly high levels of dissatisfaction about social participation, whether social groups/events (41% among those 25-34), gay bars (52% among those 25-34), Internet sites like Squirt (45% among those >25), and social location apps like Grindr and Scruff (40% among <25). When looking for sexual partners, younger guys tend to use social location apps while older guys use Internet sites. When the survey asked “what kind of action” a person had over the past year, it was really trying to determine how people found their partners. All cohorts found sexual partners in the same three ways: roughly one third by hooking up, rone third from friends with benefits, and one third from a primary partner. About 30 percent overall had group sex. Younger (13%) and older (12%) men were more likely to be inactive. About one third of those under 35 listed “dating” as a type of sexual activity, compared with only nine % among those 60+. The report views “the rise of dating to find a partner as a cultural shift among gay men,” which may be nothing more than speculative poppycock. A simpler explanation is that people date less as they get older, consistent with a life cycle rather than life course lens. The survey doesn’t tell us how much sex people are getting, although it asked respondents to indicate how many sexual partners they had in the past year. Just less than one quarter had either zero or one. The report claims that “large majorities of all age groups reported two to nine partners over the year,” which is simply untrue based on the data presented. Slightly less than half of respondents in all cohorts had two to nine partners. Between one quarter and one third of respondents had 10+ partners, ranging from 25% among <25 to 35% among those 35-59. After 26 pages, the report finally gets around to talking about the kinds of sex respondents had on their last encounter. It all comes down to lots of oral, anal, masturbation and rimming.

r r r

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r About 80% of all age cohorts had oral sex, r Half to two-thirds had anal sex (from a high of 65%

of those <25) to 48% of those 60+). Masturbation was also popular, but declined from 68% of those <25 to 43% of those 60+. About one third of all cohorts got into rimming.

r r

Sex Now reads like an academic paper, presenting a picture of gay sex that is exceedingly vanilla, if not downright dull. If it doesn’t change, future Sex Now surveys may lose much of the intended audience. The survey is simply too long and too opaque. By trying to offend no one, the sex becomes bland and boring. It is as if the gay men’s health movement in Canada has embraced a version of the

 Unlike the last survey, there is no mention of leather, spanking, dildos or the esoteric arts. Finally, we are left with the eternal gay paradox: how is it that in describing their last sexual encounters, all age cohorts had more bottoms than tops? In terms of relationship status, a slight majority overall were single, ranging from a high of two thirds of those <25 to less than half of those 60+. Approximately one quarter and one third of respondents in all age groups were partnered with a male, whereas the proportion partnered with a female ranged from five% (<25) to 28% (60+). The desire (or reality) of marrying a man is highest among the young (62% of gay males <25). Less than 20% of those 60+ indicate the likelihood of marrying another man. Millennials are most likely to become parents in the future, although 42% of the 60+ group already have children.

By trying to offend no one, the sex becomes bland and boring.

old Clintonian “Don’t ask, don’t tell” mantra. This may be politically savvy, but it is hardly liberating. What stands out most is the fact that despite defining a gay generation by a cohort’s coming of age experience as it related to the HIV/ AIDS epidemic at that time, the survey questions largely ignore PLHIV, and in the findings we are nearly invisible.5

Paul Goyan is a contributing writer for Positive Living Magazine.

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The Canadian Coalition to Reform HIV Criminalization An update on HIV & the law By Neil Self and Cécile Kazatchkine

LHIV can be charged and prosecuted for not disclosing their HIV-positive status to their sexual partner in some circumstances. That’s how it stands in Canada … for now. In 1998, in R. v. Cuerrier, the Supreme Court of Canada (SCC) decided that PLHIV have a legal duty to disclose their HIV-positive status to sexual partners before having sex that poses a “significant risk” of HIV transmission — or risk being charged with aggravated (sexual) assault. In 2012, in R. v. Mabior, the SCC ruled that this means that there is a legal duty to disclose before having sex that poses a “realistic possibility of HIV transmission.” The court stated that “as a general matter, a realistic possibility of transmission of HIV is negated if: (i) the accused’s viral load at the time of sexual relations was low and (ii) condom protection was used.” The decision leaves people open to prosecution in a wide range of other circumstances, including those which scientific evidence indicates do not pose a realistic chance or significant risk of transmission. PLHIV who face criminal charges related to HIV non-disclosure are typically charged with aggravated sexual assault. PLHIV have been charged even if they had no intention to transmit HIV, engaged in behaviours that posed little or even no risk of transmission, and did not in fact transmit HIV to their sexual partners. Some have been charged and prosecuted for spitting or biting, when transmission is unlikely to occur. The overly broad use of the criminal law increases stigma and discrimination against PLHIV, spreads misinformation,

undermines public health initiatives and leads to human rights violations. By equating HIV non-disclosure with aggravated sexual assault, Canadian law harms both PLHIV and survivors of sexual violence. In line with international recommendations, Positive Living BC and the HIV/AIDS Legal Network call for limiting HIV criminalization only to cases of intentional transmission. The Legal Network, Positive Living BC, and its partners (the Team) have spent years working to oppose the wide use of the criminal law against HIV. The Legal Network monitors criminal prosecutions across the country, provides support to PLHIV and their lawyers, conducts research and analysis, advocates for prosecutorial guidelines limiting criminal prosecutions, develops resources (including documentary films), supports efforts to bring science to bear on the law, speaks out in the media, delivers workshops on HIV and the law, and supports community mobilization. The team has banded together with other advocates to establish the Canadian Coalition to Reform HIV Criminalization (the Coalition). Since the legal duty to disclose was established by the SCC and continues to be interpreted by judges, the Coalition has intervened in criminal cases where there was an opportunity for change. Beyond an interventionist role, the Team has engaged in advocacy at the provincial and federal level. In Canada’s constitutional federation, the criminal law is federally applicable throughout the country, but provincial governments are responsible for its administration and enforcement. The Team has united with other groups across the country to call on provincial Attorneys General to develop guidelines

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

for Crown prosecutors. (Guidelines cannot change the law, but they can affect how the law is applied: they can help the police and Crown prosecutors handle HIV-related criminal complaints in a fair and non-discriminatory manner, and can limit unjust criminalization by ensuring that decisions about when, whether and how to pursue cases are informed by current scientific evidence and by the social realities of living with HIV.)

By equating HIV non-disclosure with aggravated sexual assault, Canadian law harms PLHIV and survivors of sexual violence. Since 2010, the Ontario Working Group on Criminal Law and HIV Exposure (CLHE) has called on the Ontario Ministry of the Attorney General to develop sound prosecutorial guidelines, such as those recommended by the Working Group. But the Ministry has refused to engage in a meaningful consultation with the HIV community and other stakeholders, and the province has yet to develop useful guidelines. Similar efforts to develop prosecutorial guidelines are taking place in BC and Quebec. Positive Living BC board members met with the Deputy Attorney General Richard Fyfe in 2015 to push for the development of guidelines for Crown prosecutors in BC, and Positive Living BC continues to update his office with the latest in research and policy on this issue. Because there is no HIV-specific law in Canada, advocates cannot call for the repeal or “modernization” of HIV laws as they have done in the US. However, the federal government has the power to reform the law as it is interpreted by the SCC: Parliament can amend the Criminal Code to define criminal conduct and determine punishment, and the federal government can play an important role in shaping how federal criminal law is understood and applied by provincial Attorneys General and their Crown attorneys that prosecute criminal cases. Recently, following discussions with Positive Living BC, the Legal Network and others, the federal Minister of Health and the federal Minister of Justice recognized that HIV criminalization is problematic and needs addressing. The Coalition welcomed

the promising statement by the Justice Minister on World AIDS Day and is calling on the Minister of Justice to convene a meeting with relevant stakeholders — involving PLHIV, including those who have experienced HIV criminalization — to discuss measures to limit the expansive use of the criminal law. Given the changed political context, the Coalition, including Positive Living BC and the Legal Network, will convene a think tank in 2017 to explore options for federal law reform, including the question of whether legislative changes to the Criminal Code are an option, and to craft recommendations to the federal government. The federal government’s announcement has already had an impact at the provincial level, at least in Ontario where a roundtable with provincial ministers and CLHE convened on December 5, 2016. The Ontario Attorney General said the federal statement was encouraging, while the Minister Responsible for Women’s Issues said she was ready to work with the federal government on this issue. CLHE, including the Legal Network, will continue to push for measures to be taken at the provincial level such as sound prosecutorial guidelines to put an end to unjust prosecutions. In addition, Positive Living BC, the Legal Network and its partners will continue to engage with federal authorities and intervene in proceedings before Canadian courts where there is an opportunity to shape the law. As previously mentioned, that includes convening a think tank to formulate a strategy for the reform of HIV Criminalization in Canada, and if required, launch a nationwide campaign in support of that strategy. Finally, we will all continue to work with partners to mobilize widespread community opposition to unjust HIV criminalization and build a consensus in support of measures to limit misuse of the criminal law. For more on the history of criminalization and HIV non-disclosure, see Positive Living 16.5-16.6. 5 Cécile Kazatchkine (l) is a Senior Policy Analyst at HIV/AIDS Legal Network. Neil Self is co-Chair of Positive Living BC and a Member of Canadian Coalition to Reform HIV Criminalization.

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By Taylor Perry

ake Thomas is a long-time Positive Living member and former artistic director of Theatre Positive. He sat down with the History Alive team on April 18, 2016. The following are excerpts from that interview. On being diagnosed with HIV: My first encounter with AIDS was when I was living in Toronto. I guess this was 1986, and I went to my doctor and had blood work done, although he didn’t do the test for AIDS, but I had all the symptoms of PCP or some other AIDS syndromes. And he told me that if he did do the blood work he would have to report it to insurance agencies and to act just as if I had it. On the origins of Theatre Positive: In 1994, Jackie Haywood approached me about doing some theatre for PLHIV, so we formed Theatre Positive. It was designed to be by, for, and about people with AIDS. We blended the theatre community at large with [PWA] members, so you could not tell by looking who had and who didn’t have AIDS. It gave the amateurs some other strength on stage because they were working with professionals, which helped quite a bit. On Theatre Positive’s early shows: Our first performances were at the 1996 International AIDS Conference. There we did “Andre’s Mother” by Terrance McNally, a fabulous little play, [and] “Poster of the Cosmos” by Lanford Wilson, a fabulous little gem of a play. “Charlie” written locally by a fellow called Hoddie Allen, “Soul Brothers” which was written by Jackie Haywood, and I introduced something called “the line” which was basically like a chorus line—where people turned and did sound bites of what it was like to live with AIDS, or what it was like in their personal journey.

On connecting Theatre Positive with PWA members: From the beginning, we would have auditions. I called them auditions, [even though] anybody who was a member of the PWA could come in and we accepted almost everybody. I would give them this little sheet of paper, asking them various questions about their experiences with HIV, how they were living with it, what they thought their future would be like, what their hopes and dreams were. And from that I would pull the information that we needed to do the line. On HIV and theatre community: The AIDS epidemic hit the gay community very, very hard. We lost tons of theatre artists. When Rock Hudson came out and admitted he was dying of HIV/AIDS, that signaled to all of us, that this disease was here and now. And it is a big story and a very dramatic story. Hollywood to begin with, of course, didn’t really want to talk about it very much but eventually they did. Theatre was probably the first place that embraced the HIV/AIDS controversy. On the healing power of theatre: Theatre is amazing. It is a ritual that is enacted by people onstage and an audience, and you have to have both. And there is a script that is in the middle of that, that is either written by someone else or by the people onstage. But all three voices come together and do magical work. The audience goes away, hopefully, with a cathartic experience, from what they have heard and seen. For the actors, being involved with the audience is a cathartic experience. 5 Taylor Perry is a volunteer with Positive Living’s History Alive project.

P5SITIVE LIVING | 12 | MARCH •• APRIL 2017

All photos R. Paul Kerston

Gonzalo, peer navigator

On the frontlines in Buenos Aires

by R Paul Kerston

9:00 am in the Infectious Diseases Clinic, as patients wait to be seen and just ahead of arriving doctors, a man—wearing a white lab coat—walks through the front doors, navigates a full waiting room, and heads down a corridor, past closed doors. Entering one of the first rooms there, this man works in the clinic but he’s not medical staff: He’s a Peer Navigator working at Fernandez Hospital in the capital city of Buenos Aires.

Gonzalo is employed by Fundación Huésped (FH) a separate NGO providing medical care and social assistance. FH has been providing expertise in HIV to the Argentine community since 1989, working in both the human rights and health care areas. The hospital where Gonzalo works is about three kilometres north of the city’s centre and just about as far east from the hospital grounds. continued next page

P5SITIVE LIVING | 13 | MARCH •• APRIL 2017

Having no permanent office, Gonzalo uses various rooms and, with his own password, he enters electronic patient charts as easily as other clinic staff and, in fact, is called by doctors to help when they encounter trouble with the system. As needed, he often goes across the hall and enters from the back into the glassed-off reception area office, assisting front-office staff by helping direct and process patients and their paperwork, even using hospital stamps when required. At the hospital’s main laboratory, he also enters from the back and gets laboratory results printed for patients back at the clinic. The complex routines and staff of this capital city’s public hospital are familiar and he explains the routines to patients as needed. It’s frequently a crowded clinic, people come from all walks of life and they have multiple, often complex, needs. Further, this clinic isn’t exclusively for PLHIV. Still, Gonzalo’s years of experience within the system and his strong working relationships with personnel help him navigate an over-burdened and seemingly unworkable health system infrastructure. Among the many things Gonzalo does: He registers patients within the clinical record-keeping system, delivers positive HIV test results (trained volunteers provide the negative HIV test results), makes appointments for labs and doctor visits, and ensures that patients have their lab results before their doctor visits. He also (by own initiative – and with permission) obtains refills from the pharmacy for patients that live out of province and sends those medications to them every month by bus .



And though tango is the national dance, a two-step is required for prescriptions. 

Gonzalo’s job isn’t made easier by typical bureaucratese: the page outlining hospital appointment procedures takes almost five minutes to read through and fills an entire page. Online, it’s no less daunting. Fortunately, the Infectious Diseases Clinic operates autonomously, with a separate appointment system. Gonzalo can make those appointments himself, via e-mail requests or even by cell phone, avoiding the instructions for other hospital departments. Though patients can be prescribed up to six months of antiretroviral medications, the pharmacy only dispenses a month at-a-time. And though tango is the national dance, a two-step is required for prescriptions: Each month, patients must present prescriptions to the clinic reception staff where, among others, Gonzalo can stamp it to assure pharmacy personnel that the system has things logged correctly (despite pharmacy staff performing a similar logging procedure). Only after this paper-stamping can patients pick up their meds at the separate pharmacy.

All blood tests are performed within the Clinic, not in the hospital’s main lab. One makes an appointment for lab exams and on the appointed day, the lab order and appointment receipt must both be presented at a specific window in the main hospital’s lab area (and only between 7am and 8:30am in the mornings) for registration. Only then can one proceed to the clinic for the actual blood draw. The lineups for hospital lab procedures and appointments can fill much of the hospital’s main corridor length – a full block from side to side.

Gonzalo explains lab procedures and that viral loads are done only three times yearly, and how patients and staff keep track of that with a paper issued for that purpose. As the hospital transitioned from nurses and volunteers performing some of Gonzalo’s current duties, there was initial resistance to having ‘outside’ persons (such as Gonzalo) which was helped via training given in handling confidentially. Now, interaction between hospital staff and Gonzalo appears seamless. He is able to arrange sometimes difficult-to-obtain appointments in a number of hospital departments—often getting referrals sooner than would otherwise be possible. Despite this progress, though, other hospital departments have yet to implement a similar system. Gonzalo’s duties include collaboration in clinical trials being performed at FH—a distance away. Some patients need to pick up medication or have an appointment at the hospital, and instead of their going to do this, Gonzalo helps take care of that for them. Further, he is a member of the Foundation’s Community Advisory Board and serves on the Community Advisory Board (ICAB) with international representation at the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network, based in the United States. Additionally, he’s on the hospital’s ethics committee. Gonzalo pointed out that the stigma that often accompanies HIV-positive individuals is further perpetuated—despite the measure’s intent—by a code used for lab tests of HIV-positive persons in

P5SITIVE LIVING | 14 | MARCH •• APRIL 2017

this country: Anyone knowing the code’s use knows things which wouldn’t be so obvious simply by using the patient’s name for testing—making the situation stand out where it needn’t, and thus perpetuating potential discrimination and stigma. Gonzalo recognizes that PLHIV are not sick but have “a virus for life” and with proper care, can live nearly normal lifetimes, now. When Gonzalo speaks of the fulfilment he gets in his work, he becomes more animated. He clearly loves helping people. Staff at FH feel this makes Gonzalo quite special. People don’t always know or express their needs succinctly, particularly when facing stressful situations. Gonzalo often anticipates these things for them. And despite occasionally feeling exhausted, he lights up even as he describes beginning days at 8:00am and often finishing many hours later. Unfortunately, no established system exists to help him cope with job stress at present. Another Peer Navigator through FH is Nadir. Nadir does not work at Fernandez Hospital, but is connected with Muniz Hospital, another city-run facility. She does accompany clients and visit them at Fernandez Hospital, though, when needed. She is uniquely positioned to assist transgendered women who are more visible and in larger numbers in this region than in Vancouver and who are—as elsewhere—often marginalized, and thus frequently involved in sex for survival. They are at high risk for HIV infection. She assists with knowledge exchange, pre-test discussions, testing, treatment and housing concerns, among other issues throughout the cascade of care, and she is also on the FH Community Advisory Board. As with Gonzalo, Nadir bridges the world of patients and physicians, plus other health care providers, particularly for those with more complex needs. Active “from a very early age” as she grew to further understand the trans community, she has been involved for the past three years in human rights, working particularly in health promotion with La Asociación de Travestis, Transexuales y Transgéneros de Argentina (ATTTA – a national organization). She is also a member of the health secretariat of La Federación Argentina LGBT (Lesbians, Gays, Bisexuals and Trans) in addition to her work with a network of Latin American and Caribbean trans persons called REDLACTRANS. Nadir has worked through FH for the past year in helping to bridge an important gap with this population: Lack of appropriate health care. Stigma has caused these individuals to fear and to largely avoid the health care system – resulting in considerable self-treatment, often using privately-obtained hormonal treatments, outside the health system, as well as avoiding testing and treatment for sexually-transmitted infections, including HIV. Nadir reaches out to her community functioning as both a peer counsellor (offering information and support) as well as being a peer navigator (helping guide patients to knowledgeable providers, through an often complex system). In addition to

Nadir, peer navigator.

above-mentioned duties, she brings them to care facilities, follows up with positive test results, gives appointment reminders and accompanies patients to appointments. Living in the city’s core, she’s familiar with the living quarters which a number of trans persons utilize, often referred to as hotels, or pensiones. Living in these single-room-occupancy (SRO) type facilities is a necessarily cheap alternative for persons often finding themselves unemployable (in the traditional sense). Nadir is also involved at FH in clinical studies as a social co-investigator. To illustrate the need for Nadir’s work, Dr. Claudia Frola of FH provides a figure of 34-35 percent HIV prevalence as of about 10 years ago, compared with roughly 0.4 percent in the general Argentine population. At the Fernandez Hospital’s clinic, 170 trans persons are registered within the system, roughly 150 of whom are HIV-positive. This is out of a total of roughly 4,500 persons in the records system, there, altogether. Two people, chosen at random, who help others not for profit or personal glory, but because they see the void in the health care system, a crack that they can fill. There is no funding for such compassion. And sadly, no end to the need for people like Gonzalo and Nadir. 5 R. Paul Kerston was a staff member at Positive Living BC until his retirement in 2014. He now lives, rather blissfully, north of Buenos Aires.

P5SITIVE LIVING | 15 | MARCH •• APRIL 2017

Nurturing your native plants

By Lorenzo Cryer

ative plants come in all shapes and sizes, ranging from mosses, ferns, wildflowers, shrubs and trees. These plants form a close relationship with the environment and have co-evolved to create a complex network of relationships with animals, fungi, and microbes. My favourites to include in garden designs are Arbutus, Trilliums, Liliums Columbines, Dogwoods and Cedars. I love going for a walk in the bush, especially in late March-early April to see flowering natives in all their glory. Look down to see Columbines, Fawn lilies, Forget-me-nots, Sedums and Trilliums. At eye level, the Salmonberry adds a riot of colour and fragrance. Way up, Pine, Spruce, and Cedar trees send up candles of new growth. With some conifers, the new cones are a vivid and brilliant sight. Trilliums are a beautiful wildflower. They can be upright or nodding and are produced as a lone funnel-shaped flower, with three simple petals held above a whorl of three leaves. There are numerous species found in woodland habitats, flowering before the leaves appear. Trilliums are hearty and grow best in cool soil with plenty of water. Columbines are a true favourite. Here in the Pacific Northwest, Aquilegia Formosa is the parent of many popular garden cultivars. You can find it in most parks and wooded areas. These plants prefer a well-drained light soil, enriched with manure. Protect from strong winds. In colder climates, they are deciduous and should be cut to the ground in late winter. They self seed easily, and in some instances, vigorously. Pacific Dogwood is a slender tree. In cultivation, it is more compact and could be considered a tall shrub. The flowerheads are 4-5 inches across with pure white bracts, aging pinkish, and

the small cluster of flowers is a dull purple. Autumn foliage varies from yellow to red. This native can be short lived. The smallish Arbutus tree can be found in Mexico, the Mediterranean, and North America. The bark peels from the tree, revealing a mosaic of patterns and colour. The leaves feel leathery. Small clusters of pinkish/white bell-shaped flowers hang from the branches. Some of the flowers become globes of yellowish/red, fleshy hard fruit, which is edible but not tasty. These seedpods can take time to mature. Propagation is from seed, which is extracted from the flesh of the fruit it produces. This plant that hates to be moved, so plant where it can be left intact. The Raspberry is a deciduous, perennial shrub of the Northern Hemisphere. Smooth reddish brown stems can have few, or many, prickles and serrated leaves with a felt-like underside. The five small white five flowers appear on the side shoots of the previous years growth. The red berries are both succulent and aromatic. These plants are moderately to fully frost hardy and prefer moist fertile soil in a sunny position. The canes should be cut to ground after fruiting. Beware, when planted in the ground, they naturalize fast and can become a pest. All of these plants are available for purchase through your local garden centre and from independent growers. Please, do not take these plants from the wild. 5 Lorenzo Cryer owns and operates Dig Dug Done, a garden design consultancy in Vancouver.

P5SITIVE LIVING | 16 | MARCH â&#x20AC;˘â&#x20AC;˘ APRIL 2017

This building is rockin’: A new building update By Ross Harvey

here’s nothing quite like the thrill of moving into your new home. Suddenly the world seems full of new possibilities, exciting alternatives and places to put all kinds of stuff which just won’t fit in your old place. Or an excuse to jettison a bunch of clutter you didn’t really need any more. Positive Living BC and its members are going to be experiencing that happy circumstance very soon—at or around July 1st, to be precise. That’s when the Society will move into its new quarters at its old site, the southwest corner of Helmcken and Seymour Streets in Downtown Vancouver. And what a new site it will be! Along with long-time partner AIDS Vancouver, Positive Living BC will occupy space on the first, third, and fourth floors. That space will include rooms devoted to various elements of the Society’s programs and services, and offices for the Board, for employees, and for volunteers. Broadly speaking, the division will be: dental clinic on the first floor, operations/ administration, and communications offices on the third floor, and members’ programs/ services and supporting offices on the fourth floor. The space will include four purpose-built rooms for the Complementary Health Clinics including acupuncture, massage, naturopathy, reflexology, reiki, Thai yoga massage and therapeutic touch—all of which will come as welcome news to any member who availed themselves of these services in our current temporary space at 803 East Hastings. Although perhaps there was something to be said for the novelty factor of getting a massage inside a real bank vault. P5SITIVE LIVING | 18 | MARCH •• APRIL 2017

There will be a proper editing suite in which Communications can prepare image and sound material. There will be a large space for volunteer digital work stations. There will be a kitchen large and well-equipped enough to sustain a proper Community Kitchen program. There will be a two-chair Hair Salon. But the crowning glory will be the new Members’ Lounge. Situated along the entire east side of the fourth floor, overlooking Emery Barnes Park, the Lounge will feature its own fully functional kitchen, will benefit from lots of natural light, a revamped iCafe along its north wall, and beside an expanded Polli and Esther’s Closet. As well, there will be a separate, smaller Lounge intended for the exclusive use of our women members. Finally, there will be a brand new, state-of-the-industry two-chair dental clinic offering PLHIV basic dental hygiene, check-ups, and restorative dental work. As any member who

has availed themselves of our current dental program will tell you, it’s not exactly pleasant being attended to by a dental student hunched over you, light shining in your face, while you’re stretched out on a massage table. In the new dental clinic, all that will be a thing of the past, and the by-words will be comfort, sanitation, and professionalism. Overall, Positive Living BC will enjoy 9,250 square feet in the new building; the total available space on the first four floors is 21,270 square feet. Once we’re all moved in, there will be a housewarming party. Keep your eyes peeled for the announcement. 5 Ross Harvey is the Executive Director of Positive Living BC.

HEALING RETREATS FOR HIV+ PEOPLE

to apply download application at positivelivingbc.org/healingretreats P5SITIVE LIVING | 19 | MARCH •• APRIL 2017

By Tom McAulay

PAST LIVES AND MODERN TIMES

y name is Tom McAulay and I have a vision that has turned into this column. A short history of myself (I hope) will elucidate why my personal perspective and insights may resonate with other readers. I am a 58-year-old gay white male who tested positive when I was 27. I have borne witness to the history of the HIV/AIDS movement: I recall hearing of a “gay cancer” in a gay bar in 1979. My other significant credential for writing this column is my past history with the Positive Living BC. From 1995 through 2001, I was chair and then vice-chair on the board of directors, representing the Society locally, nationally, and internationally. Then, I burnt out. For 15 years, I was lost and living life only in the moment. I was taking up space just waiting around until I died. I was not in a depressed state of hopelessness with nothing to live for—I was blissful, albeit it more often than not higher than a kite, waiting for the inevitable. About five years ago, I figured out two important things. One, I was not dead yet and was not going to die in the near future. This was quite the revelation considering I was given two years to live at diagnosis. And two, the realization that my diagnosis stole my belief in the future. When you don’t believe in your own future, you stop making plans. When you have no plans, you set no goals. When you have no goals, you have no idea which direction you should move. Coming back to volunteer at Positive Living BC in August 2015 is the direct result of believing in my future again. More specifically it is the final phase of my rehabilitation back into a life full of dreams and desires from the meaninglessness of drug use and nothing to live for. This has given me a unique perspective on what is going on in our community today and how it compares to our past collective history. And this is exactly what I hope this column will now do.

I will be gleaning through all the past issues of this magazine in all its iterations from the earliest newsletters to BCPWA News to the current magazine looking for pertinent and interesting stories and articles that I see as relevant today. I expect to find a variety of tidbits and tomes so sometimes I may weave a tale and sew tidbits together while other times an entire article might be reprinted with little input from me at all. The stories will reveal themselves as my searches continue. To conclude this inaugural column, a short quote from cover of the Vancouver PWA Coalition Newsletter Issue 5, February 1987:

Hmm. Here we are in 2017 once again fighting to save the Federal funding that has supported and made the HIV community-based movement possible. 5 Tom McAulay is a member of the History Alive Committee.

P5SITIVE LIVING | 20 | MARCH •• APRIL 2017

A life in treatment outreach By Alan Wood

evin’s breathing was laboured that night in 1989 at St. Paul’s as he fought a losing battle with pneumocystis pneumonia. Would he make it through my shift? I wondered. Three years earlier, Kevin Brown led a group of PLHIV in founding the Vancouver Persons with AIDS Coalition. So many friends succumbed to this hideous disease. Seemingly unstoppable; a cure hopelessly out of reach; experimental treatments dubious at best—the disease was a death sentence. A newbie out of nursing school, I made HIV/AIDS my key focus. Enrolled since 1982 in a double blind prospective cohort study of gay men living with, or at risk of contracting HIV, neither my GP nor I knew my status. Common thinking then was pragmatic in downplaying the need to know; there was no proven treatment and the risks of knowing were significant. The truth was uncovered in 1987 when, prior to a minor procedure, an HIV test was required. Not only was I positive, the cohort study tracked my seroconversion back to a ‘fun’ trip to New York in 1984. Soon after this discovery, I became a PLBC member. Dr. Julio Montaner, in the most compassionate way possible, said, “There is still reason for optimism; you have at least a good couple of years left.” This was in 1992. I didn’t feel optimistic. Thirty years post-diagnosis, I’m still here, and undetectable for over a decade. Many peers also diagnosed in the 1980s are still here too. So, had we proved Julio wrong? Or was it through working with enough of us that he proved himself wrong? In the late-80s, Julio’s appeal to me was unforgettable. “Without you and other PLHIV,” he said, “we can do nothing; no drug trials or treatments and no hope for a vaccine or ultimately, a cure. No matter the direction you choose, there are risks that can’t be controlled, but the answers we need reside exclusively within PLHIV.”

In 1997, I helped prepare for the opening of the new Dr. Peter Centre (DPC). This was my first job with an organization fully dedicated to providing health services to PLHIV. But the face of HIV/ AIDS was changing. The burden of the epidemic had shifted, so we followed it, focusing greater attention on the needs of marginalized, vulnerable PLHIV in the Downtown Eastside. Most DPC participants are also PLBC members and a strong collaborative partnership between the two agencies has long been established. After seven years at DPC, I joined VCH to assist in opening the InSite supervised injection site. A few years later, I returned to UBC to complete a Masters degree. During my graduate work, I was privileged to conduct and publish HIV-related research in affiliation with the BC Centre for Excellence in HIV/AIDS, and to become a part-time faculty member. In 2008, I began working with the Ministries of Health in BC and in Nunavut. Recently returning to BC, the opportunity to join PLBC was serendipitous, like a homecoming. I appreciate the warm welcome I’ve received. As Treatment Outreach Coordinator, I will apply my experience, skills, and talents to facilitate improvements in the lives of PLHIV, especially related to improved health care and treatment experiences. 5 Alan Wood is a Treatment Outreach Coordinator at Positive Living.

P5SITIVE LIVING | 22 | MARCH •• APRIL 2017

CTN 299: Preventing BMD loss in aging women

By Sean Sinden

ith the recent commemoration of International Woman’s Day, this is a fitting time for the initiation of one of CTN’s newest studies, which will focus on preventing or improving the negative effects of ARV on the bone health of aging women living with HIV. Osteoporosis, a skeletal disease that is relatively common in aging women, results in a decrease in bone mineral density (BMD) and an increase in bone fragility and fracture risk. Osteoporosis is more common and more severe, increasing with age, in PLHIV compared to people without HIV. HIV may increase BMD loss through its effect on the immune system and inflammation and as a result of ARV. TDF/FTC (tenofovir and emtricitabine) is a commonly used component of ARV regimens despite the greater loss of BMD seen as a result of TDF. The mechanism behind the increase in BMD loss with ARV that includes TDF is unclear but large cohort studies have shown an increase in fracture risk with this drug, especially with increasing age. Tenofovir alafenamide (TAF) is the prodrug form of TDF, meaning that it changes into its active form only after being metabolized in the body, thus the levels in the blood are lower. TAF causes significantly less BMD loss than TDF but has the same positive HIV effects (viral suppression rates, CD4 increases, resistance rates etc.). CTN 299, an investigator-initiated study supported by a grant from Gilead Sciences, will study whether switching from TDF to TAF can help reverse or prevent BMD loss in aging women. Women age 45-55 living with HIV on a cART regimen containing TDF/FTC and a suppressed viral load will be included in this study. The trial duration is two years per participant and the study looks to enroll 128 people. This study will use two study groups: one group of women will switch to TAF/FTC immediately and the other will remain on their current regimen and switch after 48 weeks. Researchers will compare the changes in bone structure and fracture risk as well as the safety and tolerability of the two treatments at 48 weeks and at the end of the study (96 weeks). In British Columbia, this study will be recruiting at Vancouver’s Infectious Diseases Centre. Other study sites include multiple

clinics in Ontario and Quebec and two in Italy. For more information about this study, please visit www.hivnet.ubc.ca or contact info@hivnet.ubc.ca.5 Sean Sinden is the Communications and Knowledge Translation Officer for the CTN.

Studies enrolling in BC , a partial list CTNPT 003

Bone and renal outcomes in tenofovir exposed BC site: BC Women’s Oak Tree Clinic

CTNPT 011

Monitoring penicillin levels for syphilis BC sites: St. Paul’s | Oak Tree Clinic

CTNPT 014

Kaletra/Celsentri combination therapy for HIV in the setting of HCV BC sites: Vancouver Infectious Diseases Centre (VIDC), Vancouver | Cool Aid Community Clinic, Victoria

CTN 222

Canadian co-infection cohort

BC site: St. Paul’s

CTN 248

Incentives Stop AIDS and HIV in drug users BC sites: VIDUS/ACCESS Project, Vancouver | Cool Aid Community Clinic, Victoria, and more

CTN 273

Brain Health Now!

BC site: St. Paul’s, Vancouver

CTN 286

TriiAdd Study BC sites: Cool AID Community Clinic, Victoria | Oak Tree Clinic; Vancouver IDC

CTN 292A

Development of a screening algorithm for predicting high-grade anal dysplasia in HIV+ MSM BC sites: TBD. Visit the CIHR Canadian HIV Trials Network database at www.hivnet.ubc.ca for more info.

P5SITIVE LIVING | 23 | MARCH •• APRIL 2017

In grateful recognition of the generosity of Positive Living BC supporters Gifts received November – December 2016

$5000+ LEGACY CIRCLE Peter Chung Theatre Cares

$2,500-$4,999 VISIONARIES Wildlife Thrift Store

$1000 - $2499 CHAMPIONS

Gina Best J. Bhandary Don Evans Paul Goyan Paul Harrigan Dean Nelson Fraser Norrie Fountainhead Pub Alin Senecal-Harkin Harvey Strydhorst Bramwell Tovey Metropolitan Pharmacy

$500 - $999 LEADERS

Cheryl Basarab Deborah Bourque Melody Burton Emet G. Davis Christian M. Denarie Scott Elliott James Goodman Silvia Guillemi Cliff Hall Ross Harvey Mike Holmwood Rebecca Johnston Katharine McEachern Dean Mirau Leslie Rae Blair Smith Dean Thullner

David C. Veljacic Mahmoud Virani

$150 - $499 HEROES

Wayne Avery Lorne Berkovitz John Bishop Elizabeth Briemberg Harold Brown Susan Burgess Robert Capar Erik Carlson Patrick Carr Aimee Cho Len Christiansen Vince Connors Ken Coolen Maxine Davis Edith Davidson Glynis Davisson Carmine Digiovanni Gretchen Dulmage Wilson Durward Patricia Dyck Dena R. Ellery Don Evans Stephen French Judith Garay Ricardo Hamdan Jean Sebastian Hartell Ron J. Hogan Pam Johnson Tiko Kerr Pierre Langevin William Langlois Colin Macdonald Tony Marchigiano Kenton R. McBurney Mike McKimm Kate McMeiken Mark Mees Walter Meyer Zu Epren Stanley Moore Laura H. Morris James Ong Dennis Parkinson

Penny Parry Bonnie Pearson Sergio Pereira Darrin D. Pope Allan Quinn Katherine M. Richmond Robert Selley Johanna Simmons Keith A. Stead Tim Stevenson Ronald G. Stipp Tom Szeto Jane Talbot Triphonia Teta Ross Thompson Stephanie Tofield Glyn A. Townson Ralph E. Trumpour Craig Wilson Brian A. Yuen

$20 - $149 FRIENDS

Susan Ackland Ariane Alimenti Bernard Anderson Jeff Anderson Michelle Aubie Lorena Baran Gisele Baxter E. Paul Beagan Brent Bondarenko Lisa Bradbury Steve Bridger Rowan Brown Sandra Bruneau Mary Burpee Stephen Caldwell Ann Caulfield Julie Cerra Chris Clark Doug Clavelle David Conlin Judith Cotter Alexander Daughtry Douglas Davison Barry DeVito

Ronald Dixon Jamie Dolinko Tobias Donaldson John Dub Karl Eberle Kathleen Gammer Jennifer Getsinger Peter Godfrey Sidney Gold Jay Goldman Vern Guimond Margaret Harriman Tracey Hearst Tuula Helin Patricia Hepplewhite Steve Herringer John & Gail Hetherington Barbara Horsman Wayne Hughes Grant Hurrle Heather Inglis Faranak Jamali Richard Kadulski Chris Kean Meredith and Roy Keery Mark Kennedy D. Richard King Wilma Kingston Nancie Knight Daryl Kochan Janice Lam Brian Lambert Myrna Latham Elena Lau Miranda Leffler Frank Levin Linda Lind Tom Little Sharon Lou-Hing Marilyn Ludwig Sylvia Makaroff Tomas Martin Salvatore Martorana Patricia McClain Owen McCooey Angela McGie Lindsay Mearns Carol Molley

P5SITIVE LIVING | 24 | MARCH •• APRIL 2017

Peggy Morrison Robert Mulvin Yvan Nadeau Margot Nutter Mark O’Neill Corey Ouellet Dariusz Pac Leona Peter Bonnie Poole Eleanor Power Lisa Raichle Dextor Ray Blair Redlin Andrea Reimer Patricia Reynolds Tessa Richardson Stewart Robson Ann Sessford Richard Shaw Adrian Smith Jessica Somers Frank Stephan David Sternthal Zoran Stjepanovic Grace Tan Margaret Warbrick Floyd C Wartnow Shirley Welsh Kenneth Whitehead Adrienne Wong Margaret Wyness John Yano Sheldon Zipursky

To make a contribution to Positive Living BC, contact the director of development, Zoran Stjepanovic.  zorans@positivelivingbc.org  604.893.2282

PROFILE OF A VOLUNTEER As a key frontline volunteer, Stephen brings his big and beautiful personality to all his interactions! The reception team could not do without him. He’s a member of the family and is always willing to help where and when he can. Alex Regier, director of operations & administration

*Stephen Reuvers*

What volunteer jobs have you done with Positive Living BC? I have done pastry pick-up, lounge, Polli’s Closet, and reception. When did you start with Positive Living BC? I have been with the organization for three years. Why did you pick Positive Living BC? Mary Petty at St. Paul’s suggested it. How would you rate Positive Living BC? Terrific! I have developed friendships and a feeling of brotherhood. It’s given me a sense of purpose and of helping. It’s been supportive for my recovery from drugs.

What is Positive Living BC ‘s strongest point? A sense of community. What is your favourite memory of your time as a volunteer at Positive Living BC? Seeing members “float,” all smiles and happy after receiving some body treatment. What do you see in the future at and /or for Positive Living BC? Unfortunately with cutbacks we have lost some staff but with the new building change means growth and continued support for the organization. I shall remain as your bubbly, effervescent receptionist.

P5SITIVE LIVING | 25 | MARCH •• APRIL 2017

Where to find

HELP

If you’re looking for help of information on HIV/AIDS, the following list is a starting point. For more comprehensive listings of HIV/AIDS organizations and services, please visit www.positivelivingbc.org/links

bA LOVING SPOONFUL

bANKORS (WEST)

cAIDS SOCIETY OF KAMLOOPS

bDR. PETER CENTRE

Suite 100 – 1300 Richards St, Vancouver, BC V6B 3G6  604.682.6325  clients@alovingspoonful.org  lovingspoonful.org (ASK WELLNESS CENTRE) 433 Tranquille Road Kamloops, BC V2B 3G9  250.376.7585 or 1.800.661.7541  info@askwellness.ca  askwellness.ca

bAIDS VANCOUVER

803 East Hastings Vancouver, BC V6A 1RB  604.893.2201  contact@aidsvancouver.org  aidsvancouver.org

bAIDS VANCOUVER ISLAND (Victoria)

713 Johnson Street, 3rd Floor Victoria, BC V8W 1M8  250.384.2366 or 1.800.665.2437  info@avi.org  avi.org

bAIDS VANCOUVER ISLAND (Campbell River)  250.830.0787 or 1.877.650.8787  info@avi.org  avi.org/campbellriver

bAIDS VANCOUVER ISLAND (Courtenay)  250.338.7400 or 1.877.311.7400  info@avi.org  avi.org/courtenay

bAIDS VANCOUVER ISLAND (Nanaimo)  250.753.2437 or 1.888.530.2437  info@avi.org  avi.org/nanaimo

bAIDS VANCOUVER ISLAND (Port Hardy)  250.902.2238  info@avi.org  avi.org/porthardy

bANKORS (EAST)

46 - 17th Avenue South Cranbrook, BC V1C 5A8  250.426.3383 or 1.800.421.AIDS  gary@ankors.bc.ca  ankors.bc.ca

101 Baker Street Nelson, BC V1L 4H1  250.505.5506 or 1.800.421.AIDS  information@ankors.bc.ca  ankors.bc.ca

bPOSITIVE LIVING NORTH WEST

3862F Broadway Avenue Smithers, BC V0J 2N0  250.877.0042 or 1.866.877.0042  plnw.org

bPURPOSE SOCIETY FOR YOUTH

1110 Comox Street Vancouver, BC V6E 1K5  604.608.1874  info@drpetercentre.ca  drpetercentre.ca

& FAMILIES 40 Begbie Street New Westminster, BC V3M 3L9  604.526.2522  info@purposesociety.org  purposesociety.org

bLIVING POSITIVE

bRED ROAD HIV/AIDS NETWORK

RESOURCE CENTRE OKANAGAN 168 Asher Road Kelowna, BC V1X 3H6  778.753.5830 or 1.800.616.2437  info@lprc.ca  livingpositive.ca

bMCLAREN HOUSING

200-649 Helmcken Street Vancouver, BC V6B 5R1  604.669.4090  info@mclarenhousing.com  mclarenhousing.com

bOKANAGAN ABORIGINAL AIDS SOCIETY 200-3717 Old Okanagan Way Westbank, BC V4T 2H9  778.754.5595  info@oaas.ca  oaas.ca

bPOSITIVE LIVING

FRASER VALLEY SOCIETY Unit 1 – 2712 Clearbrook Road Abbotsford, BC V2T 2Z1  604.854.1101  info@plfv.org  plfv.org

bPOSITIVE LIVING NORTH

#1 - 1563 Second Avenue Prince George, BC V2L 3B8  250.562.1172 or 1.888.438.2437  positivelivingnorth.org

P5SITIVE LIVING | 26 | MARCH •• APRIL 2017

61-1959 Marine Drive North Vancouver, BC V7P 3G1  778.340.3388  info@red-road.org  red-road.org

bVANCOUVER NATIVE HEALTH SOCIETY 449 East Hastings Street Vancouver, BC V6A 1P5  604.254.9949  vnhs@shawbiz.ca  vnhs.net

bVANCOUVER ISLAND PERSONS

LIVING WITH HIV/AIDS SOCIETY 1139 Yates Street Victoria, BC V8V 3N2  250.382.7927 or 1.877.382.7927  support@vpwas.com  vpwas.com

bWINGS HOUSING SOCIETY 12–1041 Comox Street Vancouver, BC V6E 1K1  604.899.5405  wingshousing@shaw.ca  wingshousing.org

bYOUTHCO

205–568 Seymour Street Vancouver, BC V6B 3J5  604.688 1441 or 1.855.968.8426  info@youthco.org  youthco.org

POSITIVE LIVING BC SOCIETY BUSINESS UPCOMING BOARD MEETINGS

JOIN A SOCIETY COMMITTEE!

WEDNESDAYS 3 pm | BOARD ROOM

If you are a member of the Positive Living Society of BC, you can join a committee and help make important decisions for the Society and its programs and services. To become a voting member on a committee, you will need attend three consecutive committee meetings. Here is a list of some committees. For more committees visit positivelivingbc.org, and click on “Get Involved” and “Volunteer”.

April 12, 2017

April 26, 2017

Reports to be presented >> Standing Committees | Director of Operations & Administration | External Committee Reports | Events Attended

May 10, 2017

Reports to be presented >> Written Executive Director Report | Executive Committee | Financial Statements - March | Events Attended | Reminder to attend Volunteer Recognition Event

Board & Volunteer Development_ Marc Seguin  marcs@positivelivingbc.org  604.893.2298 Education & Communications_ Adam Reibin  adamr@positivelivingbc.org  604.893.2209 History Alive!_ Adam Reibin  adamr@positivelivingbc.org  604.893.2298 Positive Action Committee_ Ross Harvey  rossh@positivelivingbc.org  604.893.2252 Positive Living Magazine_Jason Motz  jasonm@positivelivingbc.org  604.893.2206

May 24, 2017

Reports to be presented >> Executive Committee | Events Attended

ViVA (women living with HIV)_Charlene Anderson  charlenea@positivelivingbc.org  604.893.2217

Positive Living BC is located at 803 East Hastings, Vancouver, V6A 1R8. For more information, contact: Alexandra Regier, director of operations  604.893.2292 |  alexr@positivelivingbc.org

Name________________________________________ Address __________________ City_____________________ Prov/State _____ Postal/Zip Code________ Country______________ Phone ________________ E-mail_______________________ I have enclosed my cheque of $______ for Positive Living m $25 in Canada m $50 (CND $) International Please send ______ subscription(s)

m BC ASOs & Healthcare providers by donation: Minimum $6 per annual subscription. Please send ____ subscription(s) m Please send Positive Living BC Membership form (membership includes free subscription) m Enclosed is my donation of $______ for Positive Living * Annual subscription includes 6 issues. Cheque payable to Positive Living BC.

P5SITIVE LIVING | 27 | MARCH •• APRIL 2017

Last Blast This pussy bites back By Hope Springs

ince my advice column got bought up by Women’s Motor Trend Magazine, I have been spending time on personal growth and inner peace tucked away in a dank cabin well past it’s best-before date on a Gulf Island stocked with quinoa hemp salad fixins, faded board games (think mouldy hourglass sand and sticky dice), a selection of books everyone says I must read and Mexican beer, while I can still afford it. All settled in for a frosty, faux spring. Then what-the-flaps happens, our “liberty and justice for all” neighbouring country goes sideways in the weirdest and most evil fashion by electing a bobbled-headed circus performer as their leader. Adios, road trips south for cheap Spanks and staggering rounds of duty-free cheese. He won the women’s vote? Bowls me over to see the females cavorting around the outer circle swooning (probably swooning because their pussy guard is chaffing). Women who support this hair-do-from-Satan court jester range from mean, bleached Barbie’s to truck-driving, exhaust-dragging beer-hat-wearing good ol’ gals. Both sets are deplorable. I can’t fathom four years of watching this fool with his square backside and hideous ties swagger to any podium available followed by The Chinless Ones or Blonde Elvira, all with their fingers in so many pies and vaults it would be considered criminal if it happened to anyone else. And right behind him, his Number Two. I have been bunged up with a number two before and that is what this guy is like, let me tell you. While Number One is a rich, narcissistic playboy in demise wearing the Emperor’s New Clothes, Number Two is a hate-filled, slithering snake waiting in the shadows to take it all down.

The artists, who are saving my sanity, surfaced like the moody, talented heroes they are, making history with hilarious, thought-provoking graphics revealing this farce for the dark, scary shit that it is. The press is pressing on. Fact-checkers have been sent into face-planting exhaustion trying to keep a watch in the ‘now you see it, now you don’t’ information pit of truths, lies, and life on Mars that is coming out of Washington, DC. Soon the walnut shells will be lined up next to the blue cards on the television anchor’s desk. I am so happy to be a Canadian gal that I could jut wrap myself up in my Canadian Tire red n’ white flag and take my beaver-tail, lobster-roll-chomping heart to an Alberta oil field and dance. We need to stay alert, encourage our politicians to stand firm on our values, sign petitions, show up, gather, march, drink, rage and rag for the destruction and the downfall of that squinting orange creep and his bag men. Ask your US friends to call or write their Congress and to keep up the pressure. We’re going to see a lot of passionate people coming our way. They won’t be burning draft cards. Yet. You will find me hoarding extra batteries and clean water, with maple leaf flapping on the clothesline, lazy dog in the yard, and a hell cat in the kitchen. “You don’t need a weatherman to know which way the wind blows” – Bob Dylan. Even he has better hair than Cheeto the Tweeter. Yours, with her fist in the air. 5

Hope Springs is a pen name to protect what’s left of the author’s sanity.

P5SITIVE LIVING | 28 | NOV •• DEC 2016

JOIN US FOR AN EVENING OF CABARET, FUN, FASHION AND FLAIR SATURDAY | MAY 13

SHOW 9 PM

750 PaciďŹ c Blvd

Tickets & Info > redvancouver.ca

Harbour Events Centre

Doors open at 7 PM

A Positive Day in Vegas Hosted by Conni Smudge Auctioneer David C. Jones

Show produced by Dean Thullner & Volume Studios

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