Positive Living Magazine

N E W S A N D T R E AT M E N T I N F O R M AT I O N F R O M T H E P O S I T I V E L I V I N G S O C I E T Y O F B R I T I S H C O L U M B I A

ISSN 1712-8536

MAY • JUNE 2018 VOLUME 20 • NUMBER 3

Tooth or consequences Dental care for PLHIV

Know Your Qmunity

AccolAIDS

Single Tablet Formulas

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FIGHTING WORDS

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NUTRITION Gearing up to fight for a Sure fire tips on making a National Pharmacare plan star out of your salads that supports PLHIV

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COVER STORY

Don’t fear the dentist, there’s a new dental clinic for Poz people

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LET’S GET CLINICAL

New studies probe health outcomes for co-infected people

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A SPACE FOR EVERYBODY

Embracing pan, bi, and non-monosexual people

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

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ViVA WOMEN

On the importance of research to women’s health

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 positivelivingbc.org

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ACCOLAIDS 2018 And the winners are ...

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A SIMPLE PLAN FOR STFS GIVING WELL

Are single tablet formulas Rowan Brown rallies the troops right for you?

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VOLUNTEER PROFILE

Volunteering at Positive Living BC

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LAST BLAST Photos from AccolAIDS 2018

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 | 3 | MAY •• JUNE 2018

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 5800 HIV+ members.

POSITIVE LIVING EDITORIAL BOARD Joel Nim Cho Leung, co-chair, Neil Self, co-chair, Ross Harvey, Elgin Lim, Tom McAulay, 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 Puja Ahluwalia, Ken Coolen, Jason Hjalmarson, Tom McAulay, Jason Motz, Val Nicholson, Ellie Schmidt, Neil Self, Yaz Shariff, Sean Sinden, Heather Wong-Mitchell 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 | 1101 Seymour St. Vancouver BC V6B 0R1

 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

© 2018 Positive Living

from the chair I’m

filled with pride lately when I see how Positive Living BC programming is busier, more vibrant, and robust than it has been for a long time. Take that funding cuts!

Those readers who access programs and services onsite at 1101 Seymour Street know what I’m talking about. The Members Lounge is hopping these days with freshly designed, feel-good activities for members. Bingo, Book Club, Movie Day and a reinvigorated Average Joes are just a few of the new means by which we’re helping people living with HIV (PLHIV) build healthy social connections with their peers… and add a little bit of cheer to their daily grind. Please visit positivelivingbc.org and join our social media channels to keep upto-date on our growing calendar of events. And then visit us for all the fun and games we have in store for you.

Of course, our members outside the Lower Mainland don’t always have such easy access to Society programs and services. That’s why the Planning Committee for Positive Gathering 2018 made every effort to offer opportunities for guests to really get to know their peers and the community-based HIV services in their regions of the province. We have yet to find a new funder for

P5SITIVE LIVING | 4 | MAY •• JUNE 2018

NEIL SELF

Positive Gathering, but knowing how valuable this program is to you all, we aren’t giving up. We’ll keep you posted.

It is in no small part that much of the success of Positive Living BC over the last twenty years was due to strong leadership from various boards and our long-time Executive Director, Ross Harvey. Ross will be retiring at the end of August this year and boy will we miss him!

Ross’s strong and steady leadership, jovial and personable attitude, quick wit and impressive vocabulary have been staples at Positive Living BC since before my time here. It will be a strange sight indeed to attend a Positive Living BC AGM without Ross in attendance. I would encourage all members to take the time to personally thank Ross for his exemplary service to Positive Living BC and the HIV community in general. Please consider attending our AGM in August to wish him all the best!

On a personal note, I would like to publicly thank Ross for helping develop my personal leadership—he has been a source of knowledge, wisdom, and support for all of us board members over the years, and I am not sure I would be half the leader I am today without his mentorship. 5

Social determinants of health in Ontario

pPeople living with HIV in Ontario

have access to good health care and medications, yet they are still dying younger and at substantially higher rates than the rest of the population.

The findings, published in the journal AIDS and Behaviour, suggest that the overall well-being of these people is being negatively impacted by the social determinants of health—non-medical or non-genetic factors such as income, job status, education and housing.

Led by Dr. Sean Rourke, researchers followed 602 people with HIV recruited from community-based agencies for five years. PLHIV conducted peer-to-peer interviews with other HIV-positive people and then verified who was still alive at one, three, and five years, using information, if necessary, obtained from relatives, partners, friends, obituaries and local AIDS memorial lists.

Of the 454 people whose mortality the researchers were able to confirm at the end of the study, 53 had died, the equivalent of 22.3 deaths per 100,000 people, substantially higher than the rate in the general population of 6.7 per 100,000 people. Seventy-three percent of those who died were under 50. People outside of the Greater Toronto Area (GTA) died at even higher rates, especially in northern Ontario: 59 percent outside vs.

42 percent inside the GTA. When the researchers divided the study participants by gay men, women, and heterosexual men, they found that

past incarcerations and homelessness were major factors among gay men who died, along with poor self-rated health.

Dr. Rourke noted that both homelessness and being incarcerated can have significant effects on a person’s health and may even contribute to the progression of HIV, especially right after being incarcerated.

For women and heterosexual men, Caucasian ethnicity, history of incarceration and describing themselves as being in poor or fair health predicted an increased risk of mortality.

Across Canada, an estimated 75,500 people in Canada were living with HIV in 2014, the most recent year for which statistic are available. Due to advances in antiretroviral therapy, the number of deaths due to HIV infection declined by half between 1997 and 2011, and five-year survival rates among those diagnosed with AIDS increased from 7 percent (19811986) to 65 percent (1997-2012).

“Despite these incredible advances in science, we now need to pay much more attention to address the social and structural drivers affecting PLHIV,” said Dr. Rourke.

“We need to address mental health and addiction issues, housing, social isolation and income supports, for example. We also need to make sure the health system is redesigned in ways to support access to co-coordinated patient-centred care and services for people living with a chronic disease so that they are not only living healthier, but conditions are in place so that they can thrive into older age.”

Source: www.stmichaelshospital.com P5SITIVE LIVING | 5 | MAY •• JUNE 2018

HIV in sub-Sahara Africa: testing and treatment start at home improves therapy

pLesotho, Africa is one of the worst hit

countries by the HIV/AIDS epidemic worldwide. A quarter of the adult population is HIV-positive. Many people however do not know their HIV status and, hence, are not undergoing treatment. In the remote mountainous regions of Lesotho, access to HIV testing and treatment is especially challenging. Bad roads and the need to walk for hours to access the nearest health centre prevent patients from beginning antiretroviral therapy (ART), or cause them to interrupt treatment prematurely.

A clinical study, designed by Niklaus Labhardt and his group at the Swiss Tropical and Public Health Institute (Swiss TPH) validated a new approach. Field teams from SolidarMed, a Swiss NGO, visited remote villages in Lesotho. Community health counsellors and trained-nurses approached every village household and offered a voluntary HIV test to the residents.

Those who tested positive received information about ART and were offered to commence therapy at home on the same day. This approach allowed patients to start therapy without having to attend a distant clinic.

“With this strategy, we reach people living in remote rural areas who would normally not get tested or start the lifesaving ART.,” said Labhardt. “With this simple strategy, we can offer patients faster and more successful therapy options.”

Compared to standard strategies, the number of treated patients increased

significantly. Three months after the initial HIV-test at home, 69 percent of patients were undergoing treatment—an increase of 26 percent over the standard approach (43 percent). Adherence to the therapy was also higher among patients. A year after starting therapy, HIV was no longer detectable in half of the patients, meaning that they will not develop AIDS or infect other people with HIV. In contrast, only one-third of those following the conventional treatment strategy had undetectable viruses after one year.

The study is one of the first clinical trials to test a strategy for reaching the 90-90-90 objectives of the WHO and the UN program, UNAIDS. The 90-90-90 targets postulate that by 2020, 90 percent of HIV-infected people should know their HIV status, at least 90 percent of those testing positive should receive ART and in 90 percent of those undergoing therapy, the virus is suppressed. ART has both a therapeutic and a preventive effect, as people undergoing ART cannot transmit HIV to their sexual partners.

Source: www.swisstph.ch

Manitoba HIV update

pThe annual number of newly diag-

nosed HIV infections has fluctuated in Manitoba over the last 11 years.

The number of HIV cases reported to Manitoba Health, Seniors and Active Living (MHSAL) in 2016 was 23 percent higher than the previous year and 47 percent higher compared to 2014. This reflects new cases for Manitoba and not necessarily new diagnoses. The crude

rate of 9.6 new HIV cases per 100,000 population in 2016 was the second highest rate in the 2006-2016 period; the highest rate occurred in 2010 with 9.8 new HIV cases per 100,000 population.

MHSAL will monitor the provincial HIV surveillance data to determine whether this increase continues.

The number of newly diagnosed HIV cases varied between the sexes and age groups. Males accounted for the majority of newly diagnosed HIV cases with a crude rate (12.9 cases per 100,000 population) approximately double that of females (6.2 cases per 100,000 population) in 2016. This trend held across most years during 2006-2016. In terms of age at HIV diagnosis in 2016, the largest age group category for males was the 40-49 years age group, while it was 30-39 years age group for females.

In 2016, 55 percent of all newly diagnosed HIV cases self-identified as Black or Indigenous (27.3 percent each), and 20 percent self-identified as Caucasian. There was a slight increase in the representation of both Black and Indigenous in 2016, and a slight decrease in representation of the Caucasian, Asian, and Latin American ethnicities over the previous year.

In 2016, endemic exposure remained the main primary exposure category identified in Manitoba, followed by heterosexual activity and MSM, and MSM who indicate the injection of drugs in decreasing order. Endemic exposure was the most self-reported risk category in females, P5SITIVE LIVING | 6 | MAY •• JUNE 2018

while MSM was the most self-reported risk exposure category in males. Heterosexual activity remained the second most self-reported risk category among both sexes. It is important to note that 29 percent of new HIV cases in 2016 had no identifiable risk as a primary risk exposure category and therefore should be interpreted with caution.

The data presented in this report highlight the need for further research.

Surveillance data provides a general overview of the situation over time but cannot provide insight into the causal factors. The incidence of HIV infections in Manitoba continues to be high particularly among MSM, people who identify and Indigenous or Black, males aged 40 or above, females between 30-49, and people from countries where HIV/AIDS is endemic.

More investigation is needed to better understand why these trends persist and more importantly how to change the trends in the future.

Source: Government of Manitoba, Manitoba Health, Seniors and Active Living, Public Health and Primary Care Division, Epidemiology and Surveillance. 5

By Neil Self

National Pharmacare – Our Next Battle

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fter some encouraging early results against the ongoing criminalization of HIV non-disclosure at the Federal level and some minor but significant gains in the anti-poverty and housing fronts on the Provincial level, the next big battle for PLHIV will be the campaign for a national Pharmacare program.

PLHIV are living longer which means they are aging with HIV. Combine the aging process with several known co-morbidities (cancer, cardio-vascular disease, depression) of HIV and you have a growing population with the potential for requiring more pharmaceutical interventions. This means that many people, mostly those on low incomes, are vulnerable to cost increases of medication. The Positive Action Standing Committee often gets requests to help members advocate for public coverage of a drug that is not on the BC Pharmacare formulary or is not covered by government health insurance.

Canada is the only developed country with a publiclyfunded healthcare system that does not also have a comprehensive public pharmaceutical program. It makes no sense that if you are admitted to a hospital in Canada, your drugs are provided for free, but the minute you leave the hospital, you are on your own. BC has a Catastrophic Drug coverage program where huge drug costs related to HIV and cancer are covered by the Province, but anything else is up to additional government or private insurance to cover. Many PLHIV in BC can pick up their free ARVs but are then required to pay for increasing medications to deal with any side effects, mental health challenges, or other chronic health conditions related to aging. Without a broad-based Pharmacare program, those costs will only increase.

The idea of a national Pharmacare program has been in the news a lot of late, with recent announcements in

the Provinces that amount to a partial Provincial program (Ontario’s announcement that drug coverage for people under 25 will be covered by the Province and BC’s recent reduction and eventual elimination of the Medical Services Plan regressive health tax) and the Federal Government’s creation of an advisory council to consider how to implement a national Pharmacare program. The idea is not new, but the urgency has grown and the economic argument has become more prominent. The Parliamentary Budget Officer estimates that a national Pharmacare program will save the health care system $4.2 billion dollars annually in Canada.

These are savings that cannot be ignored by governments of any political stripe.

You can help! Contact your representatives to let them know that it is time for the implementation of a national Pharmacare program. They can educate themselves and consider supporting organizations that are lobbying the government for a national program, such as Canadian Health Coalition, BC Health Coalition, Pharmacare 2020 and the Council of Canadians. Rumours abound that the Federal Liberal party is going to make a national Pharmacare program an election issue for the 2019 Federal election. If they are, we need to hold their feet to the fire and make sure whoever gets into power, carries through on the promise. 5

Neil Self is Chair of the Positive Action Committee and the Society’s Co-Chair.

P5SITIVE LIVING | 7 | MAY •• JUNE 2018

Volunteer with

Positive Living BC! Be part of something inspiring and join our enthusiastic volunteer team.

Your contribution will support people living with HIV. Our members are working towards a healthy future with HIV!

For more info contact us at 604.893.2298 marcs@positivelivingbc.org www.positivelivingbc.org

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How to make your salad sing

By Ellie Schmidt

ver noticed how many salad recipes are out there, or how many completely different salads seem to show up at potlucks, summer barbeques, or winter feasts? Are salads just a side dish? Ever wonder why you feel hungry an hour after eating a salad? What makes up a salad, anyway?

There are no rules when it comes to building a salad. Salads can consist of just about any kind of ready-to-eat food.

Salads can be eaten as an appetizer or as a side dish. They can even be sweet and enjoyed as a dessert—remember those ambrosia salads your grandmother used to make? Salads can be served at just about any point during a meal. But if they are so versatile, why not make the salad the main course?

A healthy meal consists of a variety of nutrients from all food groups. It is suggested that half your meal be made up of be vegetables, a quarter protein, and a quarter whole grains. This variety will help you maintain a healthy weight, will provide a good selection of nutrients needed by the body, and will satisfy hunger. Or you could create a salad as your entire meal.

Pull out a bowl and add two handfuls of mixed vegetables. Then add a handful of whole grains. Finish by adding a serving of protein the size of the palm of your hand. Toss with some dressing, and presto! This salad is a healthy, well-balanced, complete meal. It delivers macronutrients—protein, carbohydrates, and fat—in healthy proportions. It also provides a multitude of micronutrient vitamins and minerals, and fibre, something that few Canadians get enough of in their diet. Because this salad is made up of a range of whole, unprocessed foods, digestion and absorption will take longer which satisfies hunger and regulates blood sugars. This

P5SITIVE LIVING | 9 | MARCH •• APRIL 2018

is the kind of eating that reduces the risk of chronic diseases such as diabetes and heart disease. Enjoy a glass of water with this healthy meal.

Clean and prep as many vegetables as you like. Include some fruit for a sweet flavour boost.

Use any combination of the whole grains/carbs. When adding grains, make sure they have been cooked and cooled.

Choose one or more proteins or some dairy.

Toss the salad with some homemade dressing.

To save time, have some ingredients prepped and ready for salad making.

Cook a pot of brown rice or hard boil some eggs ahead of time and store them in the fridge. Prepare a batch of salad dressing so it’s ready for an assortment of salad meals. Keep a variety of canned fish and beans available in the cupboard.

Create a unique salad dressing. All salad dressings have basic oil to acid ratio: three parts oil (canola, olive, grape seed, peanut, etc.) and one part acid (balsamic vinegar, red wine vinegar, sherry vinegar, apple cider vinegar, or lemon juice). Add a few other key ingredients: a touch of sweet (honey, maple syrup, or brown sugar), touch of salt, or a dab of mustard.

Now let the imagination take over. Garlic, dry or fresh herbs (oregano, dill, parsley, mint, cilantro, etc.), shallots, and a touch of heat (dried chillies, ground pepper, hot sauce). If a creamy dressing is desired, add a spoonful of mayonnaise, sour cream or yogurt. 5

Ellie Schmidt is a dietitian working for Vancouver Coastal Health in the Downtown Eastside.

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Research for a better tomorrow

S

By Val Nicholson pring has arrived and with a renewal of the earth, we should be thinking of how to become more involved in our own health. Being an active research participant is one way to get involved.

Two studies which are focused exclusively on and for women are the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) and the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA). These studies are community-based and use the MIWA principle, that is the meaningful involvement of women living with HIV (WLHIV), and have peers both engaged and involved at every level.

An excerpt from the CHIWOS Study site explains that, “Research has demonstrated that women face not only biological susceptibility to HIV, but also amplified vulnerability due to social factors such as poverty, marginalization, violence, and gender inequity. WLHIV have unique care needs, but frequently face inattention to their specific social circumstances and health needs, particularly those of a sexual, reproductive, and mental health nature, and may experience diverse challenges in accessing care. While there is limited literature and research about how women use HIV/AIDS health and social services, these factors indicate that many women could benefit from women-specific services that would more fully address their unique needs in a supportive, inclusive, and accessible manner.”

SHAWNA’s end goal is “to document over time how various social, policy, and place-based factors shape WLHIV’s experiences navigating their HIV status; sexual and reproductive health rights and needs; and access and uptake of sexual health and HIV care and how do these

factors intersect to impact on WLHIV’s sexual and reproductive health and HIV outcomes.”

No doubt you have done surveys which at times take up hours to do. Some of you may think that we have been researched to the max. As women, our bodies are always going through change. Doctors don’t know for sure what the longterm effects of medications have on our bodies. Research could change this uncertainty; and our stories and voices are critical to make these changes.

There are several types of research from surveys, storytelling, sharing circles, photovoice, body mapping, and land-based research, which honours culture. Voices and stories are powerful tools, and if we yield them in the name of research, we can improve the quality of care WLHIV need.

There are several community-based research projects ongoing in Vancouver and across the nation; from sexuality, reproduction, housing, stigma, criminalization, dental, ageing and brain studies, there is no shortage of need for women to share their life experiences for the betterment of our collective health.

Viva will soon have a research tab on the Positive Living website that will list research projects that are looking for interested participants and peers to get involved in the research. We are also contacting research studies to post their findings, our data, so it can get back to you, the community. 5 Val Nicholson is a Peer Navigator at Positive Living Society of BC.

P5SITIVE LIVING | 11 | MAY •• JUNE 2018

Award Winners

The

By Ken Coolen AccolAIDS Awards honour the extraordinary achievements and dedication of those responding to the HIV/AIDS epidemic in BC, and the thousands of people living in BC who are affected. Congratulations to all nominees and winners of the 2018 AccolAIDS Awards Gala!

SOCIAL/POLITICAL/ COMMUNITY ACTION

This award is presented to a recipient who has undertaken an initiative that has resulted in a change of public policy or process to the benefit of individuals and/or communities affected by HIV/AIDS.

SCIENCE/RESEARCH/TECHNOLOGY This award recognizes achievements in the areas of research, technology, traditional or complementary treatments and/or the application of such advances in clinical practice that have improved the lives or circumstances of people living with HIV/AIDS.

KARI HACKETT has worked tirelessly throughout the past 25 years as a strong ally to the HIV community in BC. She is now the Executive Director of Positive Living Fraser Valley (PLFV). Kari has been a champion for her dedication and perseverance in the fight for HIV funding in the Fraser Health Region.

DR. MARK HULL leads ground-breaking clinical research at BC Centre for Excellence in HIV/AIDS (BC-CfE). Dr. Hull has been a champion of PrEP in BC. He has dedicated his work to improving the lives of people living with and at risk of HIV infection in BC through his clinical work, teaching, research and implementation efforts.

PHILANTHROPY

INNOVATIVE POLICY, PROGRAMS & SERVICES This award acknowledges HIV/AIDS-specific or related policy, programs, or services which demonstrate a unique, progressive, empowering and/or creative approach to individual or community health promotion and assisting PLHIV. From policy to service delivery, innovation in access to and levels of service, harm reduction approaches and/or quality of service or programs contribute to their overall success and reflect an understanding of the current and changing nature of the HIV epidemic.

Throughout DR. CAROL MURPHY’s career she has been known as a trailblazer and advocate for those living with HIV in Vancouver. She established Spectrum Health which has a reputation for excellence and is a major contributor to the local HIV treatment community. Dr Murphy’s groundbreaking work serves as an inspiration to primary care advocates throughout the province.

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This award recognizes a recipient who is motivated by a commitment to human welfare and contributes time, resources and/or financial support to advance a specific cause.

MAC COSMETICS has been a supporter and advocate for those living with HIV since the creation of the MAC AIDS Fund in 1994. MAC encourages their employees to work in the community, and they have donated countless hours of volunteer time, and raised money to support HIV/AIDS organizations in the lower mainland.

DEAN THULLNER has been giving back to the HIV/AIDS community ever since his own diagnosis. He unites the community creating and producing events such as Brilliant! and SHINE. Dean is also the creator and producer of the fundraiser RED 2016 & 2017 for Positive Living BC, an HIV/AIDS-service organization.

KEVIN BROWN POSITIVE HERO AWARD This award has been established in memory of one of Positive Living BC’s founding members and the first Chair of the Board of Directors. It is presented to an individual living with HIV/AIDS who is regarded with great admiration and respect for his/her contributions to the HIV/AIDS movement.

KIARA ASHTON volunteers with YouthCO, the Heart of Richmond AIDS Society, and the Camp Moomba Advisory Committee. She supports these organizations through raising awareness, educating peers, leading workshops, and challenging stigma in addition to being an active high school student.

YOUTH LEADER This award celebrates the participation and leadership of youth in furthering education, philanthropy, activism, service, and/or community development initiatives related to HIV/AIDS.

DR. DAVID TU is a family physician at the Vancouver Native Health Society medical clinic. He works with many PLHIV. He was the first physician lead for the STOP HIV/AIDS Program. He focuses now on innovating health systems to be more effective for Indigenous Peoples in the Downtown Eastside.

ACCOLAIDS PANEL’S MERIT AWARD This year, the AccolAIDS Advisory Panel bestows the Above and Beyond award, honouring those who have made a significant and long term commitment to the BC HIV/AIDS movement. They are noted for outstanding contributions, initiatives, and leadership and their enduring impact.

JOHN DUB has been committed to HIV advocacy for the past 25 years working with various community-based organizations in Vancouver. He has been a speaker, and focus of a film about HIV in Vancouver. John is an inspiration for all, for he empowers others living with HIV by sharing his personal journey.

ACCOLAIDS “PEOPLE’S CHOICE” COMMUNITY AWARD All nominees submitted by nomination deadline are posted on the AccolAIDS website, giving people everywhere the opportunity to vote for their hero online.

Ken Coolen is a member of Positive Living’s Fund Development team.

P5SITIVE LIVING | 13 | MAY •• JUNE 2018

Your Full Potential

The importance of self-care

In

By Puja Ahluwalia 2014, UNAIDS launched the ambitious 90-90-90 treatment targets; 90 percent of PLHIV will know their status and of those, 90 percent will receive sustained antiretroviral therapy and finally, 90 percent of people on treatment will have viral suppression. The more ambitious 9595-95 targets are to be achieved by 2030. I hope we meet these goals as set out by UNAIDS. At Realize, our concern is that this goal does not take into account quality of life, physical function, social participation, employment status, or other factors related to life beyond a person’s viral load. We want to work with the community to support PLHIV to ensure that they can realize their full potential.

In an article on understanding successful aging in the context of HIV, P. Solomon and her colleagues found that people aging with HIV felt that successful aging was possible if a person maintained social support, took responsibility, lived a healthy lifestyle, and engaged in meaningful activities. These themes included elements of empowerment and self-advocacy, both of which can be considered part of self-management. Thirty-five articles on self-management for PLHIV were looked at and it was determined that most focused on self-care, interpersonal skills, technical knowledge, cognitive skills, positive attitudes, planning for the future, and role management with overall goals of wellness, management of personal health, and health service utilization.

Self-management is growing in popularity among health care workers who specialize in chronic health conditions like HIV. The goal of self-management is to improve quality of life by encouraging people to manage their condition and have strategies to ensure optimal function. There are many programs and strategies that fall under the moniker of self-management, but the principles, are the same.

Physical activity is an aspect of self-management that can be considered a part of self-care, and management of personal health overall. PLHIV have reported that participation in physiotherapy or exercise impacts their emotional and psychological well-being.

Participation in a community-based exercise program found that PLHIV reported better relationships with family, partners, and friends. So, the research indicates that PLHIV notice benefits of participation in exercise and physiotherapy; but, it has been found that the majority do not participate in physical activity.

The reasons behind not participating can include cost, lack of public funding options, stigma, or not enough awareness of the benefits on the part of the individual. However, starting physical activity does not have to involve going to a gym; it can involve movement of any kind such as yoga, swimming, or gardening.

Physical activity can start with something as simple as getting off the bus one stop early and walking.

If we are moving towards the goals of ending transmission of HIV by 2030, we also need to focus on quality of life for those living and aging with HIV. This includes participation in physical activity. This one step can move us towards PLHIV truly realizing their full potential. 5

Puja Ahluawalia is a Physical Therapist and Project Coordinator at Realize.

P5SITIVE LIVING | 14 | MAY •• JUNE 2018

photo Kangsoon Park

Armed to the teeth New dental clinic to help PLHIV with their smiles

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By Yaz Shariff

here’s nothing like a visit to the dentist to fill you with fear. It’s the opinion of many immigrants like myself that Canadians view equality and social solidarity as fundamental principles of Canadian identity.

Most healthcare providers uphold these values, yet some fall short or even scorn patients at times, confirming the health care arena is not exempt from discrimination.

Canada is a world leader in oral care, but income and dental insurance are the two main determinants for access to dental care. Barriers to healthcare exist for a disproportionate number of PLHIV. Financial concerns, discrimination, or a lack of experienced healthcare providers willing to take on HIV-positive patients can all leave you wanting to brush off that dentist visit.

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continued next page

Stigma hindering access to dental treatment is more than a historical relationship, and outdated and misinformed policies linger today. All too often reports of discrimination circulate, borne out of historical fear at the height of the epidemic. Common accounts of patients refused treatment, dentists wearing double gloves, surgical procedures being refused and only offering treatment at the end of the clinic day are prevailing. Non-disclosure of a significant medical condition to a medical professional affects the provision of health services.

Disclosing in the healthcare arena is still a challenge for many accessing dental care in a population that would be of great benefit. PLHIV are more likely to be affected by certain dental challenges than the general population and disclosing to your dentist a full medical history is of particular importance when you have a HIV diagnosis. Many oral conditions are problematic for the general population and the tooth fairy does not discriminate based on serostatus, however, disproportionate concerns arise for the community that need tailored therapy and attention. 90 percent of HIV-positive patients will have at least one HIV-related oral manifestation. Between 30-80 percent who take ARVs will experience oral manifestations of the virus.

Dry mouth can be attributed to medications including ARVs, numerous other therapies and recreational drugs. This decrease in salivary flow causes tooth decay. Left untreated an infection of the soft tissue of the tooth can occur. Bacteria form thick yellowish fluid called puss and if this is unable to drain itself from the area it can lead to an often painful abscess. Medications used to treat other long term conditions can commonly affect saliva production contributing to dry mouth as people age with HIV.



Disclosing in the healthcare arena is still a challenge for many accessing dental care.

Periodontal disease is a severe inflammation of the gums that can lead to tooth loss. A precursor to periodontal disease consistently seen in PLHIV is linear gingival erythema, previously known as HIV-gingivitis. This can cause bad breath and typically manifests as bleeding gums. If not treated, periodontitis can develop. Necrotising Ulcerative Periodontitis (NUP) appears to be unique to those with compromised immune systems. Symptoms may go unnoticed until damage is extensive enough to cause tooth loss.

Oral manifestations of the HPV can be obstructive and distressing. HPV is the virus responsible for warts and certain variations of this virus can cause oral cancers. HPV is up to twice as more common in PLHIV. A regular visit to a dentist provides crucial screening and prevention of these cancers.



Oral conditions can be painful and cause trouble swallowing or chewing which can affect adherence to a HIV regimen.

Oral candidiasis (oral thrush) is caused by a fungal (Candida) infection. Candida is part of our natural flora and coexists with us without troubles for the most part. On occasions, Candida will have the opportunity to flourish (e.g. as CD4 counts decrease) and develop into an infection that usually appears on the tongue and roof of the mouth. Candidiasis is more likely to occur at CD4 counts below 150.

Canker sores may be slow to heal and more likely to develop in severity at reduced CD4 counts. Untreated, they are prone to secondary infections and cause difficulty eating comfortably.

These oral conditions can be painful and cause trouble swallowing or chewing which can affect adherence to an HIV regimen. It can also result in weight loss or malnutrition due to the difficulties eating and compromising nutritional intake may affect the absorption of some ARVs. The presence of oral disease can correlate with immune function and disease progression.

Dentists are the only healthcare professional trained in prevention, diagnosis, and treatment of dental disease and these often unrecognised reasons for treatment adherence illustrate the importance of disclosing one’s status.

While the mouth is not usually the body part people obsess over the most, opening wide is not only beneficial for oral health. Dentists see more than teeth and good oral health is integral to overall health and well-being.

Of particular interest for the community is cardiovascular disease, osteoporosis and certain cancers and a dental team can contribute to the prevention and diagnosis of these conditions. There’s also a social impact of a missing gnasher or a pungent oral odour can have. Disclosure is important for a thorough check of drug interactions, to provide tailored systematic screening strategies, appropriate choice of treat-

P5SITIVE LIVING | 16 | MAY •• JUNE 2018

ments, and reducing risks of secondary infections related to certain treatments.

Stigma has more than a negative effect on oral health and can undermine personal dignity, cause humiliation, or trigger negative feelings. Anticipation of stigma can also affect the subsequent access to other health services as well as tarnish the image of the dental profession. Inadequate oral health care can exacerbate other medical conditions, compromise adherence, and diminish a person’s quality of life.

Most oral-related health problems associated with HIV are treatable and the best way to prevent any of these issues is to visit a dentist regularly. As fulfilling a trip to the dentist can be, sharing HIV status is not easy to do. No legislation exists forcing individuals to disclose to any healthcare provider. UNAIDS defines HIV-related stigma and discrimination as a ‘process of devaluation’ of people either living with or associated with HIV. Canada’s human rights laws protect PLHIV from discrimination based on their serostatus. It is a violation of human rights and an infringement on one’s right to equality to impose extra precautions around your care or to be refused treatment in the eyes of the law. However, it is deemed appropriate for a healthcare expert to refer you onto another medical practitioner who specialises in HIV care and this would likely not be considered discriminatory. The law differs between provinces and is less clear if the patient is to undergo exposure-prone invasive procedures or if the healthcare provider experiences an accidental exposure requiring post-exposure prophylaxis (PEP).

Dentists follow a professional code of ethics that includes the protection of a patients’ confidential information. First and foremost is the emphasis on patient health and wellbeing followed by the provision of care with respect, dignity, and without discrimination. Refusing care on the grounds of HIV status is not only an offence in the eyes of the law but can be judged as professional misconduct.

Historically, dentists were often first to refer patients for HIV testing based on the oral manifestations of the virus. Some of the first signs of disease progression can be dental problems. In the era of HAART, the usual mouthy suspects of Kaposi sarcoma, thrush, herpes or hairy leukoplakia have all decreased. Paramount to mention is the overwhelming majority of dental interactions within the community are treated with professionalism and compassion. For every regrettable interaction there is a flood of unreported care and attention for PLHIV. Surveys have placed Canadian dentists as some of the most generous in the world contributing $125 million dollars of volunteer dental services in

2015 and a projected total of almost one million hours enabling 300,000 Canadians to access dental services.

However, there is still an underlying issue carried to this day associated with disclosure to a healthcare provider that should not exist. Worldwide it is standard practice to engage your patient in care, countless dollar resources are committed to making clinics less clinical and more accessible. A newly diagnosed person is still hearing tales to be weary of disclosing to a highly trained healthcare professional a medical condition this profession has had a critical role serving.



First and foremost is the emphasis on patient health and wellbeing 

Community-based research continues to investigate these barriers. Positive Living BC will help dental students and hygienists by offering a lived experience early on in the students’ career, sealing their understanding of the multiple barriers PLHIV experience and a neutral delivery of care.

Dental treatment is one of the least offered services Community Based Organisations offer to PLHIV. Thanks to a $420,000 contribution from the Ministry of Health we’re now able to offer restorative dentistry, minor oral surgery, oral medicine and oral support with timely oral hygiene in an understanding and compassionate environment for which Positive Living BC has a long and proud history of.

Our clinic is not-for-profit and will be self-sustaining. All patrons with no coverage receive 25 percent off for any treatments.

Positive Living members with no coverage receive free exam with X-rays and 25 percent off for any treatments. If you or someone you know living with or without HIV may benefit from professional quality dental care, please forward our message. Attending our dental clinic will support PLHIV. 5 Yaz Shariff is the Treatment Outreach Coordinator at Positive Living BC.

P5SITIVE LIVING | 17 | MAY •• JUNE 2018

A space for everybody

By Heather Wong-Mitchell

V

ancouver is a tough city to make friends in. Sure, we meet folks all the time but connecting with those who are interested in moving from casual acquaintances to real friendships is challenging.

That’s where QMUNITY comes in. We host a variety of social and support groups for those looking to connect and build community. These groups are peer-facilitated by those who identify within the specific community—like Zoey and Mil, who co-facilitate BiFocus, a group for people who identify as bi, pan, or non-monosexual.

What brought you to QMUNITY?

Zoey: When I first moved to Vancouver, I wanted to connect to my local queer community. As a non-monosexual, I’ve had difficulty in the past finding spaces where I felt fully accepted and seen for my whole self, both inside and outside of the queer community. But I was optimistic that I’d find something meaningful here.

Mil: As part of my process of coming to terms with my sexual identity, I came across Qmunity’s Bifocus group and it was great to find other people going through similar experiences.

Why is this group important to you, and to our wider communities?

Zoey: One experience that is unfortunately common, is struggling to find non-monosexual resources. With non-monosexuals showing increased rates of anxiety, depression, and suicidality— among other mental health concerns—it is critical that we build support and connection. For me, our group provides a non-judgmental space not only to share feelings, fears, knowledge, and questions about our lives and identities, but to foster our empowerment as individuals and as an all-too-often unseen community.

Mil: Just knowing that I’m not alone and that there are people from whom I can learn so much makes such a positive impact on my mental health that I think it’s important to share that. That’s why I wanted to get Bifocus back on track. Let’s complain together, celebrate together, be sad together, laugh together, and just be together.

Can you share one of your favourite memories from a group meeting?

Zoey: Often people in our group share how laborious it can be to continually have to explain, justify, and educate others about their identity. I cannot express the joy it brings me each time one of our group members breathes a sigh of relief, taking note that this group gives them a reprieve and lets them be themselves without explanation. Don’t get me wrong, we are a diverse group and there are all sorts of things we don’t know about each other.

However, seeing how often what we do share enables this sense of ease and belonging is one of the things that leaves me feeling rejuvenated and energized [after] a Bifocus meeting.

Mil: One day a male participant said how in college he had a girlfriend but was obsessive about his best friend only to realize that he had fallen in love with him. When I heard that I got a little teary-eyed because the same thing had happened to me, but only I couldn’t accept that I had fallen in love with my best friend because in my social environment that was not a possibility. It was just so beautiful to feel that connection—I think it’s a healing process that brings us together. 5 Heather Wong-Mitchell is Operations Coordinator at Qmunity.

P5SITIVE LIVING | 19 | MAY •• JUNE 2018

A simple plan for STFs

The

By Yaz Shariff

term “De-Simplification” is used to describe the change from single tablet formulations (STFs) to multi-tablet generic and patented components. Over the last 12 years, pharmaceutical companies have introduced several STFs to market, often successfully encompassing entire regimens into one pill. This did not come without significant cost to drug programs and individual consumers. However, as time has passed, patents have expired, releasing generic alternatives of active ingredients into the market.

A patent inherently exists to prevent competition in order for pharmaceutical companies to recoup the many millions of dollars in patented drug development costs and to fund further research and development. The current gradual and future introduction of generic alternatives has left health authorities in high income countries pondering the potential of sustainable cost savings to be had by switching patients to cheaper generic equivalents.

The challenges our health authorities face in keeping the cost of treatment sustainable is exacerbated by (largely) stagnant healthcare budgets and they are under increased pressure to

mitigate rising costs. Of the medical costs attributed to HIV infection, three quarters are due to the costs of antiretroviral therapy (ART).

Researchers at the Southern Alberta Clinic in Calgary have projected a potential saving of C$4.3 million by “de-simplifying” one treatment regimen—Triumeq. This annual saving highlights the potential reduction in the ART costs a single clinic in Calgary (the Southern Alberta Clinic) could make. This figure is based on 100 percent of the 607 patients taking Triumeq switching to de-simplified multi-tablet regimens built on newly available generic equivalents of previously patented drugs. In this instance, the once daily dose of Triumeq would be de-simplified to one abacavir/lamivudine tablet and one dolutegravir (Tivicay), both also to be taken once a day.

Within the study, 48 percent of patients were agreeable to switching to save costs and researchers recognize that de-simplification may not be acceptable for every patient. Concerns physicians noted focussed on reduced adherence, perceived patient preference, and increasing the pill burden on vulnerable patients. None of the physicians expressed concerns over diminished potency, therapeutic levels, or tolerability.

P5SITIVE LIVING | 20 | MAY •• JUNE 2018

It’s recognised that de-simplification is not for everyone and certain populations would not be best served by breaking up STF. This includes vulnerable populations living in unsafe environments for medication storage. People who travel may prefer the simplicity of STFs. For elderly populations with declining abilities, having to deal with more pills often in addition to other medications might cause confusion. However, STFs are usually bigger and the individual component medications would be easier to swallow. Populations who have difficulties with adherence will probably continue to benefit from STFs. STFs may also prevent preferential adherence to one component of a regimen than others seen in a minority of patients. For example, taking one tablet of the new de-simplified regimen more frequently than the other. This would not previously be an issue as STFs combine all medicines into one tablet.



De-simplification is not for everyone and certain populations would not be best served by breaking up STFs.

Researchers in the Netherlands have also been considering this issue. They have added concerns around disclosure of HIV status and the perceived difficulties of hiding multiple medication bottles; these concerns could also be a factor to consider when contemplating the exacerbations stigma has on accessing treatment. The Dutch researchers have recommended before implementing de-simplification on a large scale it would be useful to assess the effectiveness of generic vs. brand-name drugs, cost savings, and patient preferences.

This matter is of increasing significance and will continue to receive Positive Living BC’s close attention. The size of the effect that STFs used in HIV treatment have on adherence is yet to be determined. There is a definite need for more research to investigate the effect switching from a STF to a multi-tablet regimen has on the likelihood of adhering to a regimen and consequently on treatment failure or resistance. As long as provincial and federal funding restraints exist there will be scrutiny over healthcare budgets. If “de-simplification” becomes common practice in ART prescribing, greater clarity is needed in the reallocation of the funds thereby saved. If any savings attained are to be taken out of HIV care this also needs to be made explicit (and any such attempts will be vigorously opposed by Positive Living BC).

As the notion of Treatment as Prevention (TasP) becomes integral in strategies reducing transmission of HIV and ending

the HIV epidemic, the economic benefits of TasP are not visible in any budget line. A retrospective look at de-simplification in the Balearic Islands off the coast of Spain found lower pharmaceutical cost but higher overall healthcare cost in the first year following the change.



STFs may also prevent preferential adherence to one component of a regimen than others. 

With the impending release of more generic ARTs, this question becomes even more relevant. We are aware this is not without its concerns for our members so it is important that you be aware of the support available. There is no suggestion medication regimens will change or any de-simplification would be detrimental. Any change in regimen should be implemented on an individualised basis tailored to your care needs. If the situation arises where your prescribing physician suggests “de-simplifying” your treatment, you have the right to ask her or him to reconsider.

You have the right to make informed choices on the direction of your own healthcare.

Your doctor can advocate for you on the therapy that is most clinically appropriate for you and that is inclusive of the use of STFs. As an organisation invested to protect the interests of our members, we can also provide information and support. We encourage you to get in contact if you have been affected by any of the issues discussed. 5 Yaz Shariff is the Treatment Outreach Coordinator at Positive Living BC.

References Hosein, S. (13 Feb. 2018). Will de-simplification of HIV treatment become common in high-income countries? [online] Catie.ca.

Available at: http://www.catie.ca/en/catienews/2018-02-13/ will-simplification-hiv-treatment-become-common-high-income-countries [Accessed 15 Feb. 2018].

Bhiva.org. (2016). BHIVA - BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update). [online] Available at: http://www.bhiva.org/HIV1-treatment-guidelines.aspx [Accessed 15 Feb. 2018].

P5SITIVE LIVING | 21 | MAY •• JUNE 2018

Giving Well

Rowan Brown

Q: What sort of tasks do you do for the society?

A: I don’t consider myself a people person, in the sense of dealing directly with people or difficult situations “on the spot,” so I was looking to help out in other areas. I didn’t think I would feel comfortable at an information desk, since I was still learning about the society. I felt if I worked behind the scenes, I could get to know the people and the organization. Most of the work I have been doing is with The Red party, the AIDS WALK, AccolAIDS, and getting ready for the Red Ribbon Breakfast. I’m interested in getting involved with this magazine as a writer.

Q: How did you first hear about Positive Living BC? A: I heard about it from a friend who’s worked here for several years. I’d been doing other volunteer activities since I retired, was active in my Strata council, and decided that I wanted to do something that was more people oriented, with a charitable organization.

Q: Tell me about the training and support you received as a volunteer.

A: I did a one-day training program, led by Marc Seguin (Positive Living BC’s Volunteer Services Manager). It was very educational, to understand the organization, especially to understand the difference between Positive Living BC and other AIDS Service Organizations (ASOs). The idea of Positive Living being that we all need help in one way or another, we all need community.

The better I understood this, the more I could see how Positive Living was providing help, and community and direction to people who need it.

Q: What is your favourite thing about being a volunteer?

A: The main thing is the idea that I am helping people that need help in the form of a support network.

Q: Tell me about participating in the AIDS WALK over the years?

A: I can’t remember when I started, probably in the early 1990’s. I don’t feel comfortable collecting pledges—I give

For

this installment of ‘The Giving Well,’ Jason Hjalmarson, our Fund Development Director, sits down with Rowan Brown—a volunteer, donor, and long time participant in the AIDS WALK.

P5SITIVE LIVING | 22 | MAY •• JUNE 2018

A DONOR PROFILE

By Jason Hjalmarson

a donation and show my support by participating in the walk, and have fun doing so. There is a lot of competition for people’s support, since many other organizations are now doing walks to raise money. For many people, supporting the HIV/AIDS issue just isn’t as urgent as it used to be. HIV isn’t a death sentence anymore; it can be managed with medications. For some, this works very well, but for others it doesn’t. Many people think HIV has gone away, but rates of transmission have remained steady, with some places actually seeing an increase in how many people contract the disease. The federal government has committed funds to fight AIDS internationally, while groups like Positive Living, who do that work at home, get their funding cut. It’s great that we’re trying to help stop the spread of HIV internationally, but we shouldn’t forget about our friends and neighbours who are still living with the disease and continue to need a support network.5 Jason Hjalmarson is director of fund development at Positive Living BC.

By Tom McAulay

In

A CALL ON MEMBERS TO RE-ENGAGE! the April/May 1996 BCPWA Newsletter, I came across Radio Free PWA, a forum for members to comment freely on matters of concern. The striking change from then to today is the issue of membership engagement. Positive Living BC was created 32 years ago in a model that began with 100 percent membership engagement, until the membership grew into the hundreds. For the first decade, most members were fully or partially engaged in all aspects of our work.

Radio Free PWA came to be at our 10-year mark. So even then there were signs of membership disengagement that today, I dare to say, reaches epic proportions. A simplistic explanation for this would be to say that it’s just a numbers game—that the more members we have, the greater the number of those who are less engaged. While that may have been true in the past, today the situation is more complex.

There are two elements at play contributing to the lack of membership engagement we now see. First and foremost is the success of treatments. When everyone diagnosed with HIV was handed a so-called death sentence—I was told in 1986 that I had no more than two years to live—there was an urgency to get involved. We all had a stake, for ourselves as well as our friends, in our mission to empower PLHIV through mutual support and collective action.

Even through the second decade with the advent of successful combination therapies that dropped the death rate to near zero, the side effects and complications of the early treatment regimen still held us in the bondage of trying to manage our illness. Just

trying to live was a full-time job. Now, simplified treatment regimes allow PLHIV to live normal lives. We can keep jobs, even find new jobs, or stay in school; we don’t lose our homes, we don’t lose all our friends. Our disease can remain invisible if we so choose, and we are not dropping like flies. The urgency has shrunk from the entire HIV community to just ourselves.

Herein lies the second element at play, what I term as the stratification of our members into two categories: those who do not need the services and supports of community-based organizations, and those that do. The folks who need and use the services and programs at Positive Living BC are people with the most complex medical needs, the most chaotic lifestyles, the poorest, and the least able to manage their own lives.

The problem for Positive Living BC to deal with today is how we re-engage our membership when they don’t need or use our services and programs as they once did. How do we maintain our ethos of membership participation and direction when our pool of capable and/or willing volunteers has fallen?

One way to accommodate membership participation at the Board level would be to move Board meeting times to early evenings so members that are employed could participate, and we are willing to do so. We do need to come up with ways to address membership engagement in this new era of PLHIV not having the same stake in the success of, and dare I say, the continuance of a member driven organization such as Positive Living BC. I don’t have those answers yet, but this issue is high on my agenda. 5 Tom McAulay is a member of the History Alive Committee.

P5SITIVE LIVING | 24 | MAY •• JUNE 2018

The co-infections connections between HIV & HCV

Two

studies from the CTN, published in AIDS and Behaviour and AIDS Care, look at the occurrence and impact of depression in people co-infected with HIV and HCV. The publications are part of the Canadian Coinfection Cohort (CCC), which follows over 1,700 people with both HIV and HCV in Canada. The CCC has received support from the CTN since 2007 and is led by Dr. Marina Klein from McGill University.

Data from a federally funded food security substudy of the CCC, led by Dr. Joseph Cox, was used for these studies, in which the researchers enrolled a group of 725 CCC participants. At each of five study visits over two years, participants completed clinical testing as well as a number of questionnaires.

The studies shows that those co-infected not only experience more depression than HIV-positive people, but also that depression has a significant impact on their overall health. “Over half of participants reported depressive symptoms,” said Dr. Klein “This is significantly higher than in PLHIV alone [28 percent] or in the general population.”

Researchers also found that depression had negative impacts on study participants’ health. “What we found is that people with depressive symptoms were less likely to properly adhere to their antiretroviral therapy,” said Dr. Cox “They were also more likely to have a detectable viral load.”

Despite the association between depressive symptoms and viral load detectability, the researchers did not see a clear impact on CD4 count. This finding could be because people who present with depression during clinical visits may receive adherence support from health providers to help them regain viral control.

An interesting finding was that participants with depressive symptoms also had a lower monthly income and were more likely to experience food insecurity. In the food insecurity analysis, almost 60 percent of the 725 participants reported experiencing food insecurity and those that did were more likely to have depressive symptoms.

“The relationship that we saw was that the more severe the food insecurity, the greater the risk of depression,” added Dr. Klein.

By Sean Sinden

The notably higher rate of depression in people with both HIV and HCV compared to rates reported in studies in HIV alone suggests the need to study the social and physiological factors specific to co-infection as it relates to depression.5 Sean Sinden is the Communications & Knowledge Translation Officer for the CTN

Other Studies enrolling in BC CTNPT 014

Kaletra/Celsentri combination therapy for HIV in the setting of HCV BC sites: Vancouver Infectious Diseases Centre, Vancouver; Cool AID Community Clinic, Victoria

CTN 222

Canadian co-infection cohort BC site: St. Paul’s

CTN 262

Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) BC Coordinator: Rebecca Gormley, 604.558.6686 or rgormley@cfent.ubc.ca

CTN 281

EPIC 4 Study BC site: BC Women’s Hospital and Health Centre

CTN 283

The I-Score Study BC site: Vancouver ID clinic

CTN 292A

Development of a screening algorithm for predicting high-grade anal dysplasia in HIV+ MSM BC site: St. Paul’s

CTN 292B

Treatment of high-grade anal dysplasia in HIV+ MSM BC site: St. Paul’s

Visit the CIHR Canadian HIV Trials Network database at www.hivnet.ubc.ca for more info.

P5SITIVE LIVING | 25 | MAY •• JUNE 2018

In grateful recognition of the monthly donors supporting Positive Living BC For a full list of donors visit positivelivingbc.org

$5000+ LEGACY CIRCLE

CUPE BC Fraser Health Authority Peter Chung The Benevity Community Impact Fund

$1000 - $2499 CHAMPIONS

Blair Smith Bramwell Tovey Cheryl Basarab Don Evans Fraser Norrie Humberto Guillen Jackie Yiu Joseph Ford Karla Ahlquist Marthinus Wasserfall Oak Tree Clinic Paul Goyan Paul Gross Scott Elliott Silvia Guillemi Spectrum Medical Group Vancouver Foundation YouthCO HIV & Hep C Society

$500 - $999 LEADERS

Andrea Hull Ariane Alimenti Barry Wartnow Memorial Fund BC Centre for Excellence in HIV/AIDS Carol Murphy Christian M. Denarie Cliff Hall Conniet Lo Darrin D. Pope Dean Mirau Dena R. Ellery Emet G. Davis James Goodman Jeff Potts

Leslie Rae Linda Harth Malcolm Hedgcock Mark Gilbert Pierre Soucy Rebecca Johnston Robert Capar Ross Harvey Si Wai (Francis) Zih Stan Moore Valerie Nicholson

$150 - $499 HEROES

Adam Reibin Adrian Smith Barry DeVito Bonnie Pearson Brian Anderson Brian Descoteaux Carmine Digiovanni Colin Macdonald Colin McKenna Daniel Retzlaff Davie Village B.I.A. Dawn Prato Dennis Parkinson Edith Davidson Elizabeth Briemberg English Bay Swim Club Erik Carlson Glyn A. Townson Glynis Davisson Gregory Bondy Gretchen Dulmage James Ong Jane Talbot Jean Sebastian Hartell Joel N. Leung John Bishop Joss J. de Wet Karen (Karri) Moffatt Kate McMeiken Katherine M. Richmond Keith A. Stead Ken Coolen Larry Hendren

Lawrence Cryer Len Christiansen Lisa Bradbury Lorne Berkovitz Mark Mees Matthew Hinton Maxine Davis Mike McKimm Pam Johnson Patricia Conti Patricia Dyck Patricia E. Young Patrick Carr Penny Parry Ralph E. Trumpour Ralph Silvea Rob Spooner Ron J. Hogan Ronald G. Stipp Ross Thompson Rowan Brown Sandra Bruneau Sergio Pereira Stephanie Tofield Stephen French Susan C. Burgess Tiko Kerr Vince Connors Wayne Avery William Granger

$20 - $149 FRIENDS

Adrienne Wong Alberto Durazo Alex Puttonen Allan Hovan Allan MacIntosh Andrea Bird Andrea Reimer Andrew Todd Clarke Angela McGie Banz Clulow Bradley Little Brian A. Yuen Brian Warnke Catherine Dangerfield

P5SITIVE LIVING | 26 | MAY •• JUNE 2018

Catherine Jenkins Chris G. Clark Chris Kean Dale Blote Dillon McLellan Eagle Eye Entertainment Elle Diniz Florence Osubrouie Francis Durnford Gbolahan Olarewaju George Schwab Glida Morgan Grant Minish Greg McKibbin Hans-Krishna Von Hagen Heather Inglis Ireen Conroy James Connell Jamie Rokovetsky Jeff Anderson Jess Hodges John Murita John Yano Karen Scott Kim Lynette Abella Laura Kassama Lindsay Mearns Lisa Nevens Lisa Paley Lisa Raichle Mark Gomes Maryam Rajaee Matthew Ostrow Maxym Tkacz-Madison Michelle Aubie Mike Holmwood Miranda Leffler Neil Self Nicolas Demers Patience Magagula

To make a contribution to Positive Living BC, contact the director of development, Jason Hjalmarson.  jhjalmarson@positivelivingbc.org  604.893.2282

PROFILE OF A VOLUNTEER Tristan has been a wonderful, welcome addition to our stylist team. While haircuts are often not thought of as essential services, haircuts are a huge part of self-care, self-confidence, and avoiding stigma. With great affection, I see him as, Tristan - King of Transformation, or Tristan Scissorhands.

Richard Harrison, Engagenment Coordinator

*Tristan Pearson*

What is your volunteer history?

I’ve volunteered at soup kitchens, sung for different causes, and even started an event called Socks and Potatoes where I gather some friends in December and we wander Vancouver giving out clean socks and baked potatoes to those in need.

What is your favourite memory of your time here?

There has been a few times that I’ve had the honour of giving milestone haircuts: Fixing self-done-cuts-gone-wrong, first haircuts for new jobs, first gender confirming cuts. These cuts really stay with me.

How would you rate us?

10s across the board!

What do you see in the future for Positive Living BC? My hope is that there will be no need for organizations like Positive Living. Until then, Positive Living will continue to be a cornerstone in the positive community.

What is our strongest point?

The most valuable part of the association is the community it forms. The love and support found there can’t be contained within those four walls.

P5SITIVE LIVING | 27 | MAY •• JUNE 2018

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

1449 Powell St, Vancouver, BC V5L 1G8  604.682.6325  clients@alovingspoonful.org  lovingspoonful.org

cAIDS SOCIETY OF KAMLOOPS

(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

1101 Seymour St Vancouver, BC V6B 0R1  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 (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

bANKORS (WEST)

101 Baker Street Nelson, BC V1L 4H1

 250.505.5506 or 1.800.421.AIDS  information@ankors.bc.ca  ankors.bc.ca

bDR. PETER CENTRE

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

bLIVING POSITIVE

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

bPOSITIVE LIVING NORTH WEST

3862F Broadway Avenue Smithers, BC V0J 2N0  250.877.0042 or 1.866.877.0042  plnw.org P5SITIVE LIVING | 28 | MAY •• JUNE 2018

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

bREL8 OKANAGAN

P.O. Box 20224, Kelowna BC V1Y 9H2  250-575-4001  rel8.okanagan@gmail.com  www.rel8okanagan.com

bRED ROAD HIV/AIDS NETWORK

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 2018

JOIN A SOCIETY COMMITTEE!

EVERY 2ND WEDNESDAY | 2 pm | 2nd Floor Meeting 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”.

May 30

Reports to be presented >> Written Executive Director Report | Executive Committee | External Committee Reports | Events Attended

June 13

Reports to be presented >> Director of Fund Development | Executive Committee | Financial Statements - March | Events Attended

June 27

Reports to be presented >> Complete Board Skills Chart (2) | Standing Committees | Written Executive Director Report | Events Attended

July 11

Reports to be presented >> Complete Board Evaluation Chart (2) | Director of Programs & Services | Executive Committee | External Committee Reports | Events Attended

July 25

Reports to be presented >> Written Executive Director Report | Quarterly Department Reports - 4th Quarter/Year End | Events Attended

Board & Volunteer Development_ Marc Seguin  604.893.2298

 marcs@positivelivingbc.org

Education & Communications_ Adam Reibin  604.893.2209

 adamr@positivelivingbc.org

History Alive!_ Adam Reibin  604.893.2298

 adamr@positivelivingbc.org

Positive Action Committee_ Ross Harvey  604.893.2252

 rossh@positivelivingbc.org

Positive Living Magazine_Jason Motz  604.893.2206

 jasonm@positivelivingbc.org

ViVA (women living with HIV)_Charlene Anderson  604.893.2217

 charlenea@positivelivingbc.org

Positive Living BC is located at 1101 Seymour St, Vancouver, V6B 0R1.

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 | 29 | MAY •• JUNE 2018

Last Blast

Photography by Kangsoon Park & Kim Abella

P5SITIVE LIVING | 30 | MAY •• JUNE 2018

Str8 Guys Nite

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2018

A biennial awards gala honouring heroes in the BC HIV/AIDS movement

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