Positive Living Magazine

NEWS A ND T RE A TM E NT I N F O RM A T I O N FRO M TH E PO S ITIV E LIV IN G SO CIE T Y O F B R ITISH CO LUM BI A

ISSN 1712-8536

MARCH • APRIL 2019 VOLUME 21 • NUMBER 2

Terminal Dignity

Reaching the end of your life

John Yano

Stigma Study

Couples & HIV tests

I N S I D E

Follow us at:  pozlivingbc  positivelivingbc

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FIGHTING WORDS

Celebrating the Federal Government’s unjust prosecution announcement

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COVER STORY

The first in a series about getting your affairs in order before you die

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LET’S GET CLINICAL

Stigma could affect the brain of PLHIV

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NUTRITION

The key to your weight loss goal? Being SMART

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BETWEEN THE TEETH

Get to know the tools for healthier teeth

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ALZHEIMER RESEARCH GIVING WELL HIV drug as a treatment option

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

How political activism spurs on one of our dedicated donors

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VOLUNTEER PROFILE Volunteering at Positive Living BC

 positivelivingbc.org

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CERVICAL PRE-CANCER TESTING Lower treatment success for for HIV-Women

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BACK TALK

Finding relevancy in yesterday’s news

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LAST BLAST

How prepared are you for an earthquake

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 2019

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 6,000 HIV+ members.

POSITIVE LIVING EDITORIAL BOARD Tom McAulay, co-chair, Joel Nim Cho Leung, co-chair; Glen Bradford, Jason Motz, Adam Reibin MANAGING EDITOR Jason Motz

DESIGN / PRODUCTION Britt Permien FACTCHECKING KT Moon COPYEDITING Maylon Gardner, Heather G. Ross PROOFING Ashra Kolhatkar CONTRIBUTING WRITERS Hesham Ali, Laura Bailey, Glen Bradford, Stephen Garrett, Moyette Gibbons, Liz Highleyman, Jason Hjalmarson, Tom McAulay, Roger Peabody, Mollie Rappe, Wendy Rondeau, Sean Sinden, Alena Spears PHOTOGRAPHY Britt Permien DIRECTOR OF COMMUNICATIONS AND EDUCATION Adam Reibin DIRECTOR OF PROGRAMS AND SERVICES Glen Bradford TREATMENT OUTREACH COORDINATOR Wayne Campbell SUBSCRIPTIONS / DISTRIBUTION John Kozachenko, Matthew Matthew Funding for Positive Living magazine is provided by the BC Gaming Policy & Enforcement Branch & by subscription & 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

© 2019 Positive Living

from the chair

It

seems my last Message from the Chair has stirred the pot for some of our members. And this is a good thing. However, I wish to apologize to anyone I offended or given people cause for concern. It was never my intention to do so. I realize my words and style of writing can come across as blunt and abrasive. And that I must own.

On the other hand, I’ve also been praised and told how great it is that I’m willing to speak my mind and say it as I see it. People have said to me, it’s great to see some activism or “spunk” speaking up for the voices of positive people. In a way, my style is resulting in exactly what I wanted out of my approach to writing these messages which is to hear back from our membership. It might be noted that this is the first time in five years that readers have commented directly about the Message from the Chair.

So why am I doing this? Well, it is my goal to express the issues that I think are pertinent to our organization moving forward. Everything that I have said so far, and things that I plan on saying in the immediate future, are all based on conversations I have had with a variety of people over the last three years in my current tenure as a Board member. Therefore, I am bringing forth issues and questions that are coming from membership.

Some of the issues that I bring forward may well prove to be extremely unpopular. How will I know this if I never

P5SITIVE LIVING | 2 | MARCH •• APRIL 2019

TOM MCAULAY

hear back from people? I must accept that part of my role as leader of this organization is to put my head on the proverbial chopping block if that’s what it takes to elucidate the difficult issues.

But I am doing this because I don’t want to make any decisions in a vacuum that affect the members.

Our governance structure hasn’t changed in 30 years whereas everything about HIV/AIDS has. Thirty years ago when the organization was run mostly by member volunteers there was plenty of opportunity for conversations and discussions to occur where membership could express their opinions and ideas. Today, there are a lot fewer members congregating and having similar conversations in our facility. So how do we get a conversation going? Well, by stirring the pot.

It is my hope that by doing this, more members will be inspired to engage with the Society to participate in the conversation that we must start if we are to envision our future growth and sustainability as a meaningful voice of our membership and positive people in general. Now is the time to start talking because change will take years. And in a couple of years, it may be too late to start a dialogue on our future. The future is now.

Of course, anyone can email me at any time at tomm@positivelivingbc.org. 5

SFU researchers find new clues to controlling HIV

pSFU professor Mark Brockman and

co-authors from the University of KwaZulu-Natal in South Africa have identified a connection between infection control and how well antiviral T-cells respond to diverse HIV sequences.

Brockman explains that HIV adapts to the human immune system by altering its sequence to evade helpful antiviral T-cells.

“To develop an effective HIV vaccine, we need to generate host immune responses that the virus cannot easily evade,” he says.

Brockman’s team has developed new laboratory-based methods for identifying antiviral T-cells and assessing their ability to recognize diverse HIV sequences.

“T-cells are white blood cells that can recognize foreign particles called peptide antigens,” says Brockman. “There are two major types of T-cells—those that ‘help’ other cells of the immune system, and those that kill infected cells and tumours.”

Identifying the T-cells that attack HIV antigens sounds simple, but Brockman says three biological factors are critical to a T-cell-mediated immune response. And in HIV infection, all three are genetically diverse.

For a T-cell to recognize a peptide antigen, the antigen must first be presented on the cell surface by human leukocyte antigen proteins (HLA), which are inherited.

And since thousands of possible HLA variants exist in the human population, every person responds differently to infection.

In addition, since HIV is highly diverse and evolves constantly during untreated infection, the peptide antigen sequence also changes.

Matching T-cells against the HLA variants and HIV peptide antigens expressed in an individual is a critical step in the routine research process. But, says Brockman, “our understanding of T-cell responses will be incomplete until we know more about the antiviral activity of individual T-cells that contribute to this response.”

It is estimated that a person’s T-cell “repertoire” is made up of a possible 20-100 million unique lineages of cells that can be distinguished by their T-cell receptors (TCR), of which only a few will be important in responding to a specific antigen.

To reduce the study’s complexity, the team examined two related HLA variants (B81 and B42) that recognize the same HIV peptide antigen (TL9) but are associated with different clinical outcomes following infection. By looking at how well individual T-cells recognized TL9 and diverse TL9 sequence variants that occur in circulating HIV strains, the researchers found that T-cells from people who expressed HLA B81 recognized more TL9 variants compared to T-cells from people who expressed HLA B42.

Notably, a group of T-cells in some B42 expressing individuals displayed a greater ability to recognize TL9 sequence variants.

The presence of these T-cells was associated with better control of HIV infection.

This study demonstrates that individual T-cells differ widely in their ability to recognize peptide variants and suggests that these differences may be clinically significant in the context of a diverse or rapidly evolving pathogen such as HIV. “Comprehensive methods to assess the ability of T-cells to recognize diverse P5SITIVE LIVING | 3 | MARCH •• APRIL 2019

HIV sequences, such as those reported in this study, provide critical information to help design and test new vaccine strategies,” says Brockman.

Source: The full study can be read in Nature Communications.

Being HIV-positive and staying on antiretroviral therapy in Africa

pA team of researchers has carried out

a review of the evidence examining what influences people who are HIV-positive to go to health services and then stay on ARVs in Africa.

In a paper published in the Journal PLOS One the team, led by Liverpool School of Tropical Medicine Professor Paul Garner, used advanced methods of thematic synthesis to examine over 59 studies carried out in Africa, extracting key messages from the qualitative research. Professor Garner said: “We wanted to bring together the mass of research exploring what influences people taking and continuing to take antiretroviral drugs. Much has been achieved by governments, donors, NGOs and the World Health Organization in ensuring that people have access to these life-saving treatments, but our review offers—for the first time—a more comprehensive understanding of the influences to treatment seeking and adherence to help health workers design approaches to keep people on their meds.”

Looking at the evidence the team identified nine themes impacting on adherence and treatment seeking which they grouped under three main headings. The first of these was the acknowledgement that people who are HIV-positive often must navigate the chal-

lenges presented by external issues such as poverty, unpredictable life events, and stigma which can influence initiating and maintaining ARV therapy. Second, the health system is often seen as punishing and uninviting, which can drive people out of care. Third, long-term engagement requires adaptation and incorporation of ARV into daily life, which is a process facilitated by factors including inherent self-efficacy, social responsibilities, previous HIV-related illness and emotional, practical, or financial support.

Dr. Ingrid Eshun-Wilson, lead author on the paper said: “The mix of all these factors happen over time, so there appears to be a tipping point when patients choose to either engage or disengage from care, with HIV-positive patients potentially cycling in and out of these care states in response to fluctuations in influences over time.”

“Our review goes beyond presenting barriers and facilitators such as cost and distance from care, which are well known,” said Dr. Eshun-Wilson. “We describe broadly how external influences and personal motivation interact and drive ART adherence and engagement decisions and

presents a model for understanding why people do what they do.”

Source: www.istmed.ac.uk

An approach for targeting HIV reservoirs

pCurrent HIV treatments need to be taken

for life by those infected as ARV is unable to eliminate viral reservoirs lurking in immune cells. Institut Pasteur scientists have identified the characteristics of CD4 T lymphocytes that are preferentially infected by the virus—it is their metabolic (or energy-producing) activity that enables the virus to multiply.

Thanks to metabolic activity inhibitors, the researchers have managed to destroy these infected cells, or “reservoirs”, ex vivo. Their findings were published in the journal Cell Metabolism last December.

The ARVs used today are designed to block HIV infection but cannot eliminate the virus from the body. The virus remains in reservoirs—the CD4 T lymphocyte immune cells, the main targets of HIV. However, the virus does not infect all types of CD4 cell and until now the reason for this was not well known. In this study, re-

searchers have identified the characteristics of the different CD4 subpopulations, which are associated with HIV infection.

The more the CD4 cells are differentiated, or experienced, the more they need to produce energy to perform their function. Experiments have shown that it is the metabolic activity of the cell, and in particular its glucose consumption, that plays a key role in susceptibility to HIV infection. The virus primarily targets cells with high metabolic activity. To multiply, it hijacks the energy and products provided by the cell.

This requirement constitutes a weakness for the virus and could be exploited to tackle infected cells. Scientists succeeded in blocking the infection ex vivo thanks to metabolic activity inhibitors that have already been investigated in cancer research.

“We have observed ex vivo that, thanks to certain metabolic inhibitors, the virus is no longer able to infect cells and amplification is halted in reservoirs of patients receiving antiretroviral treatment.”

Source: www.pastuer.fr/en 5 Many heartfelt thanks to the members of the Vancouver Men’s Chorus who have donated $1,011 to Positive Living’s sock & underwear fund. In terms of numbers, that’s $239 in underwear, $317 in socks and $455 in monetary donations. That works out to 60 pairs of underwear and 197 pairs of socks. As a result, we can now increase our monthly sock and underwear allotment to members to two pairs a month. Special thanks to our own Wendy Stevens and George of the VMC for getting the ball rolling.

P5SITIVE LIVING | 4 | MARCH •• APRIL 2019

Combination therapy more effective in treating patients with leishmaniasis and HIV

By Moyette Gibbons

The

results of clinical trials conducted in Ethiopia by the Drugs for Neglected Diseases initiative (DNDi), in partnership with Médecins Sans Frontières (MSF), the University of Gondar, and Addis Ababa University, open the way for more effective and safer treatments for people with both HIV and visceral leishmaniasis (VL), a group of patients who have historically suffered from poor treatment options.

Visceral leishmaniasis (also known as kala-azar), with up to 90,000 cases estimated in Asia, Africa, and South America, is the second largest parasitic killer after malaria, with 20,000-30,000 deaths every year. HIV affects visceral leishmaniasis by altering its severity, worsening treatment outcomes and relapse rates, and increasing the risk of death. Co-infection remains prevalent in several parts of the world, notably in North-West Ethiopia, where 20 to 40 percent of visceral leishmaniasis cases occur in PLHIV. “The region has the highest global burden of visceral leishmaniasis in PLHIV. Young workers in Ethiopia, who have migrated to the lowlands for seasonal work and are at risk of contracting HIV, are also exposed to sandfly bites that cause visceral leishmaniasis as they sleep in improvised shelters,” said Dr. Jorge Alvar, Senior Advisor on Leishmaniasis at DNDi. “There is an urgent need for better treatment and outcomes for this seriously ill and neglected population.”

Current World Health Organization (WHO) guidelines recommend the treatment of HIV/VL co-infection with liposomal amphotericin B (often better known as AmBisome, the brand name of the drug produced by Gilead), but the recommendations lack proper evaluation in most endemic areas.

Between 2011 and 2014, MSF began using a compassionate use regimen, combining AmBisome with the oral drug miltefosine in North-West Ethiopia.

“The medical imperative was to reduce the alarmingly high treatment failure rates, so we tried something new,” said Dr. Koert Ritmeijer, Neglected Tropical Diseases Advisor at MSF. “Based on our experience treating more than 150 patients in routine care at Abdurafi Center, the results were very encouraging, but needed confirming in controlled clinical studies.”

To provide the needed scientific evidence, DNDi ran a Phase III study, starting in 2014, testing both AmBisome monotherapy (40 mg/kg) as per current WHO and international recommendations, and a combination of AmBisome infusion (30 mg/kg) and miltefosine orally for 28 days (100 mg/day) in 58 HIV/VL patients in two sites in Ethiopia.

Results demonstrated the high efficacy of the combination therapy, with 67 percent cure rate when treatment lasted 28 days, and increased to 88 percent cure rate when patients who were not cured received a second round of treatment to clear Leishmania parasite, with a full treatment lasting 58 days.

“Considering the individual and public health benefits, there is a strong case for the prompt adoption of this treatment in international and national guidelines,” said Dr. Alvar. “The results also suggest a new case management strategy is needed, whereby using one or two rounds of treatment depends on whether negative parasitology has been achieved.” 5 The results were published in January on PLOS Neglected Tropical Diseases.

P5SITIVE LIVING | 5 | MARCH •• APRIL 2019

Get smart about nutrition goals

D

id you make a New Year’s resolution this year? How’s it going?

If you’re succeeding, you’re one of the few. According to the Statistics Brain Research Institute, only 8 percent of resolutions succeed, and 80 percent are stopped by February. If you’re within the other 92 percent, don’t worry: This is not a failure, but a learning opportunity.

Resolutions fail because the goal may not have been concrete. You may feel overwhelmed by your own expectations. You may want to make changes, but if life is coming at you from multiple directions, maybe now is not a good time. Resolutions can be changed to make them more manageable in times of stress.

As you work through your goals, try not to get discouraged at the speed of progress. Long-term changes take time. Do what’s best for you and your body.

So how can we make successful resolutions?

For starters, make sure your goals are SMART: Specific, Measurable, Attainable, Realistic and Time-Oriented.

Specific: Your goal should be able to answer the questions how, what, when and where.

Measurable: Your goal should be able to answer how much or how many.

Attainable: Your goal should be achievable.

Try not to make goals too big.

Realistic: Your goals need to be practical.

Only you know what you can and can’t realistically accomplish, and this may change depending on your lifestyle and social circumstances.

Time-Oriented: Your goals should include a time frame. It’s a good idea to set both short-term (weeks) and long-term goals (months or years) for yourself.

As a dietitian, most resolutions that I hear about revolve around weight loss. Instead of making goals directly about weight loss, you may

By Alena Spears

find goals of changing certain dietary patterns or activity more realistic. Here’s an example of what a SMART nutritional goal looks like: Goal: You want to eat more fruits and vegetables.

Specific: I will eat 1 piece of fruit at breakfast and 1 piece of fruit for my afternoon snack. I will eat 1 cup of vegetables at lunch and dinner daily. Six servings per day total.

Measurable: Write down fruit and vegetables I eat in a food journal. Use a measuring cup to measure vegetables.

Attainable: I will buy enough fruit and vegetables on my Sunday grocery shop and do a quick shop on Thursday if I run out. I will go to the market for cheaper produce.

Realistic: To start, I will eat at least 1 serving of fruit or vegetable at every meal. I will add another serving at lunch and dinner and another fruit at snack.

Time Oriented: Starting Monday, I will eat 3 servings per day. By week 4, I will reach my goal of 6 servings per day.

Every New Years, I see a lot of detox diets and end goals for weight loss. Often, these resolutions are too extreme, with a lot of big changes made abruptly. The motivation is high at the beginning, but as aspects of the goal prove too difficult to maintain, the motivation dips. The individual gets discouraged and, soon, the resolution is abandoned. But this does not need to be your reality. Why wait until 2020? Make a SMART goal for yourself now and begin to feel more motivated, happier, and healthier. 5 Alena Spears is a Registered Dietician at St. Paul’s Hospital.

P5SITIVE LIVING | 7 | MARCH •• APRIL 2019

Tools for a happier smile

By Wendy Rondeau

In

the last issue of Positive Living magazine, UBC dental hygiene students provided a thoughtful article on the importance of good oral hygiene and how it impacts the tissues in and around the mouth of PLHIV. (See ‘Oral Report: common dental concerns for PLHIV’, January 2019, issue number 21.1, page 11).

The purpose of this article is to provide the reader with a better understanding of why good oral hygiene is so important for everyone and present options to help achieve this goal.

The dental community has made great leaps in the last 50 years in helping their patients retain their teeth. The cause of the most common dental diseases (cavities and gum and bone disease) are generally due to bacteria. The mouth is a warm, moist environment that helps those bacteria thrive. Removing what causes the disease helps reduce the disease process.

Research shows that poor oral health can increase a person’s risk of Cardiovascular Disease (stroke or heart attack), as well as diabetes. There is also recent limited research that suggests that the inflammatory process of oral disease may possibly increase the risk of Alzheimer’s Disease.

Unfortunately, after their removal, the bacteria will start to reform within two hours. The good news is it takes 24 hours for the bacteria to organize enough to continue the destructive process.

Making an effort to spend the time everyday to clean all the surfaces of your teeth (above and below your gums) will notably reduce disease.

Considering using ‘tools’ that help improve your ability to remove bacteria. This includes electric toothbrushes with either ultrasonic or rotary brushes as both are effective. Some people

are irritated by the noise of the ultrasonic. Finding the brush that you’re most comfortable with is essential. Remember to angle the bristles to access the area below the gums. Never push hard enough to slow the speed of the brush head.

Spending ten minutes once a day will make a difference. If you sit in front of the TV or computer each day, using the electric brush without toothpaste will alleviate the boredom of standing in front of the bathroom sink. Follow up with fluoride toothpaste to reduce cavities.

Flossing to remove bacteria from between your teeth is critical because toothbrushes are not able to access those surfaces. If you’re not a ‘fan’ of flossing, there are alternatives available. Floss handles are easier to use but are, generally, not as efficient as the ‘wrapping and buffing’ technique of flossing.

Water flossers (WaterPik) are becoming more popular. Some people find that becoming proficient takes practice but worth that time, in the end.

Stimudents are triangular shaped toothpicks that can be used almost anywhere. ProxyBrushes are like mini brushes that help clean under bridge work or around braces. If you have any question, ask the members of your dental team.

Keep in mind, if you take care of your teeth, they will take care of you. 5 Dr. Wendy Rondeau is a member of the Community Dental Clinic Advisory Group.

P5SITIVE LIVING | 9 | MARCH •• APRIL 2019

RETREATS

August 23, 24, 25 & 26, 2019

loon lake retreat loon lake retreat HEALING RETREATS FOR HIV PEOPLE +

Interviews Start May 13, 2019 General inquiries to retreats @ positivelivingbc.org or 604.893.2200 to apply download application at positivelivingbc.org/healingretreats

Relationship counselling encourages couples HIV testing

By Laura Bailey

I

t’s long been known that couples’ HIV testing and counselling is an effective way to mutually disclose HIV status and link to health care—unfortunately, couples don’t use it even though it’s widely available.

Lynae Darbes, associate professor in the School of Nursing at the University of Michigan, wanted to change that, so she and her team developed an intervention designed to improve the likelihood that couples will decide to engage in HIV testing together.

The intervention, called Uthando Lwethu (“our love” in Zulu) took place in a rural area of South Africa in a province with the highest prevalence of HIV in the country. Of the 334 couples enrolled in their study, 42 percent of the experimental group chose to participate in couples HIV testing, compared to 12 percent of couples in the control group.

The idea was that providing relationship skills to couples would improve their communication and their relationship in general, and this would in turn improve their ability to talk about sex and HIV, as well as HIV testing.

The idea came about from Darbes’ earlier work, in which she asked couples why they didn’t do HIV testing together.

“Many people talked about the importance of communication, but didn’t know how to talk about HIV,” she said. “It

seemed like if we taught them more effective communication, they could discuss HIV and testing, and then they might be able to actually do it.

What people haven’t acknowledged is that we haven’t factored in relationship dynamics as much as we should with HIV couples testing. HIV is a complicated conversation to have.”

All couples received a group counselling session together, then were randomly placed into the experimental or control groups. The experimental group received an additional couplesbased group session, in single-gender groups, followed by four single-couple counseling sessions. Topics included communication skills, intimate partner violence, and HIV prevention. The control group only received the first group counselling, but after the study they were offered a condensed version of the couples counselling sessions.

In order to make testing and counselling easily available in the rural area, where health services are often hundreds of miles away, researchers took a mobile testing van to the study participants instead of asking them to travel. Since the area lacks health professionals and therapists, the study team trained laypeople to advise the couples.

In addition to a higher couples’ HIV-testing rate, the experimental group also chose to test much sooner than couples in the control group. At baseline, nearly 40 percent of the participants (both men and women) had never been tested for HIV, which surprised Darbes, considering the high rate of HIV in the area. As well, most couples had not disclosed prior test results to partners.

“I think that general relationship conversations can cascade out into other health outcomes, and you can talk about issues and behaviours more easily if you improve your overall communication,” Darbes said.

The next step is to apply for a grant to investigate ways to feasibly implement the counselling in a real-life community setting. 5 Source: www.umich.edu

P5SITIVE LIVING | 11 | MARCH •• APRIL 2019

HIV-positive women have lower treatment success for cervical pre-cancer

W

By Liz Highleyman

omen living with HIV (WLHIV) are more likely than HIV-negative women to have residual or recurring abnormal cells after treatment for pre-cancerous cervical lesions, according to research published in Clinical Infectious Diseases.

This systematic review and meta-analysis found that treatment for cervical intraepithelial neoplasia (CIN), or abnormal cells that could progress to cancer, was almost three times more likely to be unsuccessful in HIV-positive women.

However, the study was unable to classify women according to CD4 cell count, so it does not shed much light on outcomes among women on antiretroviral therapy with well-preserved immune function.

Several types of human papillomavirus (HPV) can cause cervical, anal, oral and other cancers.

Cervical cancer is a major cause of cancer-related death for women worldwide, but it usually is not fatal in industrialised countries thanks to regular HPV screening and Pap tests.

Studies have shown that WLHIV are more likely than HIV-negative women to have persistent HPV infection and to develop CIN and invasive cervical cancer. Those with lower CD4 counts, indicating greater immune suppression, are at higher risk.

Searching MEDLINE, HIV conference abstracts, and other sources in any language from January 1980 to May 2018, researchers identified 40 eligible studies in which HIV-positive women with confirmed cervical abnormalities were followed for at least six months post-treatment. Four were clinical trials, 16 were observational cohort studies, and 20 were retrospective studies.

A meta-analysis of the data found that the pooled prevalence of treatment failure among HIV-positive women– defined as the continued presence of residual grade 2 or higher CIN, or recurrence of high-grade CIN after treatment–was 21.4%. Half of the women had residual or recurrent cervical abnormalities of any grade.

There was no difference in the likelihood of treatment failure using cryotherapy versus LEEP. Failure was more likely in women with positive margins, meaning some precancerous cells were found at the edges of the surgically removed tissue, compared to those with negative margins.

Of note, the treatment failure rate was higher in high-income compared with low-income countries.

In the ten studies that included both HIV-positive and HIV-negative women, the WLHIV had more than a twofold higher risk of treatment failure with grade 2 or higher CIN (23.4% versus 9.5%, respectively; odds ratio 2.7). Further, HIV-positive women had a fivefold higher likelihood of having post-treatment cervical abnormalities of any grade.

“This meta-analysis provides evidence that, even after cervical screening and treatment, WLHIV remain at high risk of CIN2+/HSIL cervical lesions,” the researchers wrote in their discussion. “In the context of increasing effort to scale up cervical cancer screening in limited-resource settings, these findings highlight the importance of reflecting upon the appropriate post-treatment follow-up of this population.” 5 A longer version of this article originally appeared on Aidsmap and is reprinted here in modified form.

P5SITIVE LIVING | 12 | MARCH •• APRIL 2019

Am I ready to go?

Preparing for end of life: Part 1

For

by Stephen Garrett with contributions by Glen Bradford

many adults living in the 1980s and 1990s, an AIDS diagnosis had a 10-year prognosis; fear of AIDS tore apart families and friends and many had to get ready for the end of their lives alone. Now that treatment for HIV is so advanced, those who have access to ARVs should expect to live, fall in love, grow old and die just like anyone else. Having a long life includes planning for the end of

our lives. This is the first in a series of articles addressing end of life planning.

I remember, when I was much younger, getting set for a family getaway. Mom would always start asking the question, “Are you all ready to go?” weeks before we left. She wanted to make sure we packed the things we needed to make the summer adventures fun, exciting, and chaos free. It was a tall order for a family of seven plus a dog all squeezed into a Ford Country Squire. continued next page

P5SITIVE LIVING | 13 | MARCH •• APRIL 2019

Now that I am inching closer to the end of my life, Mom’s question has new relevance to me. I have asked myself over the past years, am I ready to go? For the end of my life to be graceful, dignified, and chaos free, I need to get my affairs in order.

What to do? I found someone who was an estate planner.

We got together and planned and worked on documents that now reside in the planner’s office files and in our own Ready to Go Binder that lives in our home office. Here are the documents we put together.

Last Will and Testament

A will or testament is a legal document by which a person, the testator, expresses their wishes for distribution of their property once they die. The will names one or more persons, the executor(s), to manage the estate until its final distribution.

Making a will is an important part of planning for your relationship partner or family’s future. If you own property and die without a will, your property will be divided according to BC law, and the costs to administer your estate will increase. You’ll also be giving up the right to appoint the guardian of your choice for any children in your care. If you do not own property, you may not have to have a will, but you will need to have other legal documents discussed below. You can learn more about wills online with an easy Google search.



I have asked myself over the past years, am I ready to go?

Power of Attorney

A power of attorney or letter of attorney is a written authorization to represent or act on another’s behalf in private affairs, business, or legal matters.

Representation Agreement

A representation agreement is the key legal document in British Columbia for personal planning/advance care planning. A representation agreement is the only way to authorize someone—called your representative—to assist you or to act on your behalf for health care and personal care matters. The person you designate as your power of

attorney and your health care representative can be the same or different people.

Advance Care Directives

An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions your representative should take for your health if you are no longer able to make decisions because of illness or incapacity.

For those people who do not require a will, designating a person to be both your power of attorney and a representative for your health care choices, all laid out in your advance care directive, can be a less overwhelming approach. Just make sure it is all legally documented with an attorney or notary public. To find a lawyer, call Lawyer Referral at 604.687.3221 or 1.800.663.1919. To locate a notary public near you, contact the Society of Notaries Public of BC at 604.681.4516 or 1.800.663.0343. You can get help with all the above at both AIDS Vancouver’s legal clinic or with their case managers or with Positive Living BC’s legal clinic. Contact either agency to find out when the next clinic is running.

Memorial Society Funeral Arrangement Form

A funeral arrangement form contains all the important details regarding the disposition of your body. It clearly describes the services you want to purchase from the funeral provider, services that will meet the needs of your loved ones, not necessarily the services the funeral home wishes to sell to you. Cremation costs can be anywhere from $850$2,500 or more, so shop around. People in common-law relationships will have to legally prove they were in a common-law relationship with you in order to dispense with your body the way you wish. Prearranging this with the funeral home is a big help to your partner.

Celebration of Life Plan

A celebration of life plan is not burdened by social expectations—it can be pretty much anything you want it to be—it’s important to realize that the event you’re planning should meet the emotional needs of the guests. So, think about exactly who will be there, and what they’re likely to want or need. Then, bring in your unique lifestyle and personality characteristics; add live music or refreshments, and you’ve got the beginnings of a remarkable celebration

P5SITIVE LIVING | 14 | MARCH •• APRIL 2019

of life. There are many other memorial service ideas that can help you decide. Take time to think about how you want to be remembered.

For CPP to pay the death benefit, the deceased must have made contributions to the CPP. See sidebar for more details.

Life Insurance Policy Recap

People to Call List

If you have a life insurance package, it is important you identify in your kit where it is held so your representatives can activate it.

Medical Assistance in Dying—BC Ministry of Health Form

In the past, medically assisted deaths were not legal. In 2017 this changed and now a planned death is legal under very specific conditions. Still, how this is activated is not the same everywhere. Our next article will be on palliative care, hospice care, and medically assisted deaths.



If you have a life insurance package, it is important you identify in your kit where it is held so your representatives can activate it. 

It can be difficult for one person to take on the burden of telling everyone, over and over, that you have died. If the designate doesn’t know everyone or have everyone’s contact information, someone can be left out. It is helpful to create a phone tree of people who can contact people so the burden of telling this information is not on one person.

You may not have to create all the documents mentioned in this article. Whatever you put together, make sure someone knows where to find it. Look for the next article in this series to answer more questions you may have about end of life preparations. 5 Stephen Garrett (l) is the founder of We Can Die Better magazine and owner of Just Alive Consulting.

Glen Bradford (r) is Director of Programs and Services at Positive Living Society.

Canada Pension Plan Death Benefit

The Canada Pension Plan (CPP) death benefit is a onetime, lump-sum payment to the estate on behalf of a deceased CPP contributor. As of January 1, 2019, the amount of the death benefit for all eligible contributors is a flat rate of $2,500.

If an estate exists, the executor named in the will, or the administrator named by the court, applies for the death benefit. Application for the benefit should be made within 60 days of the date of death. The completed application form is required along with certified proof of executorship and a certified copy or original version of the death certificate.

If no estate exists or if the executor has not applied for the death benefit, payment may be made to other persons who apply for the benefit in the following order of priority: the person or institution that has paid for or that is responsible for paying for the funeral expenses of the deceased; the surviving spouse or common-law partner of the deceased; or the next-of-kin of the deceased.

RELATED LINKS For more information about power of attorney, visit http://ww.nidus.ca/?page_id=218 For a lawyer referral visit https://www.clicklaw.bc.ca/helpmap/service/1044 or www.notaries.bc.ca To download an application for a Canada Pension Plan Death Benefit document visit https://catalogue.servicecanada.gc.ca/apps/EForms/ pdf/en/ISP-1200.pdf For more about CPP death benefits visit https://www.canada.ca/en/services/benefits/ publicpensions/cpp/cpp-death-benefit.html

P5SITIVE LIVING | 15 | MARCH •• APRIL 2019

HEALTH CLINICS Good for your body, Good for your soul!

To BOOK your appointment email clinic@positivelivingbc.org or call 604.893.2203

Health & Wellness services are FREE for Members of Positive Living BC

ACUPUNCTURE

MASSAGE THERAPY

NATUROPATHIC MEDICINE

REFLEXOLOGY

REIKI

THAI YOGA MASSAGE

THERAPEUTIC TOUCH

A

HIV drug could treat Alzheimer’s

By Mollie Rappe

new study has found that an HIV drug reduces agerelated inflammation and other signs of aging in mice.

“This holds promise for treating age-associated disorders including Alzheimer’s,” said John Sedivy, Professor of Medical Science and Biology at Brown University.

The drug, lamivudine, halts retrotransposon activity in old cells. Retrotransposons—DNA sequences able to replicate and move to other places—make up a substantial fraction of the human genome. Retrotransposons are related to ancient retroviruses that, if left unchecked, can produce DNA copies of themselves that can insert in other parts of a cell’s genome. Cells have evolved ways to keep these “jumping genes” under wraps, but as the cells age, the retrotransposons can escape this control.

The research shows that a vital class of retrotransposons, called L1, escaped from cellular control and began to replicate in both senescent human cells—old cells that no longer divide—and old mice. Retrotransposon replication is detected by an antiviral immune response, called the interferon response, and triggers inflammation in neighbouring cells.

These retrotransposons are present in every type of tissue, which makes them a compelling suspect for a unified component of cellular aging. Knowing that, the team uncovered the interferon response, the potential mechanism through which these jumping genes may cause cellular inflammation without necessarily causing damage to the genome.

“This interferon response was a complete game changer,” Sedivy said.

The interferon-stimulating copies of L1 DNA need a specific protein called reverse transcriptase. HIV and other retroviruses also need reverse transcriptase proteins to replicate. AZT, the first drug developed to treat HIV/AIDS, halts HIV reverse transcriptase. Current multi-drug cocktails used to treat or prevent HIV/AIDS still contain specific reverse transcriptase inhibitors. Sedivy and his colleagues thought that this class of drugs may keep the viral-like L1 retrotransposon from replicating and thereby prevent the inflammatory immune response.

The team tested six different HIV reverse transcriptase inhibitors to see if they could block L1 activity and the interferon response. Lamivudine stood out because of its activity and low side effects.

“When we started giving (lamivudine) to mice, we noticed they had these amazing anti-inflammatory effects,” Sedivy said. “Our explanation is that although L1s are activated relatively late in senescence, the interferon response reinforces the SASP response and is responsible for age-associated inflammation.”

Treating 26-month-old mice with lamivudine for as little as two weeks reduced evidence of both the interferon response and inflammation. Treating 20-month-old mice with lamivudine for six months also reduced signs of fat and muscle loss as well as kidney scarring.

“If we treat with lamivudine, we make a tangible dent in the interferon response and inflammation,” Sedivy said. “But it doesn’t quite go back down to normal. We can fix part of the problem, but we don’t actually understand the whole aging problem yet. The L1 reverse transcripts are at least an important part of this mess.” 5 Source: www.news.brown.edu

P5SITIVE LIVING | 17 | MARCH •• APRIL 2019

Giving Well PL: So that would mean you’ve been involved with us for about 15 years. That’s pretty impressive John, thank you. How else have you contributed?

CM: After attending a Healing Retreat at Loon Lake a few years ago, I was asked to officially join the Positive Action Committee (PAC).

PL:Tell me more about the mandate and work of the PAC; what sort of stuff goes on at the meetings?

F

or this edition of the Giving Well, our Development Director spoke to a longtime community activist, donor and supporter of Positive Living BC, John Yano.

PL: How did you first get involved in the Society?

CM: I first got involved in the early 2000s, maybe 2004. I was brought in by Victor Elkins, who was an active member of the Hospital Employees Union (HEU) at the time. He asked me to help decorate for AccolAIDS Awards gala. This was one of the early AccolAIDS Gala’s, I think it was the third one, certainly well before it grew into what it is today.

CM: Well, PAC, as far as I am aware, is intended to help advance the political goals of HIV-positive people in BC. It’s essentially Positive Living’s political action committee.

There are various issues that PLHIV deal with regularly that can be helped by government action, whether that be providing funding to programs that service the needs of our members and other PLHIV, or other policy decisions that impact PLHIV. It sometimes takes some lobbying or strategizing to get the government action we need.

PL:Tell me more about yourself personally. What do you do for work or hobbies or in your spare time?

CM: My major involvement seems to be in political activism. I am involved with the NDP both federally and provincially, and I have been active with the Coalition of Progressive Electors (COPE), the Vancouver civic political party, for a long time. In the last civic election I ran as an independent candidate for Mayor on a platform of making Vancouver affordable, sustainable, accessible and safe.

P5SITIVE LIVING | 19 | MARCH •• APRIL 2019

A DONOR PROFILE

By Jason Hjalmarson

My activism stems from my involvement with the HEU. I became politically activated by (former Premier) Gordon Campbell’s decision to rip up contracts that had been collectively bargained. I lived in Campbell’s home riding at the time and felt I could make a difference because of this. One of the first things I did politically was to start volunteering for the provincial NDP and that slowly just grew over time. I was a member of the HEU as a cook working in St. Vincent’s Hospital at the time. My position was being contracted out and I felt I had to do as much as I could to stop that from happening to other people, so I got into politics.

PL:Why is giving back important to you?

CM: As a gay man, and also, not having children, I believe my community involvement and activism is about leaving a legacy for myself. I want to contribute to helping to make the world a better place, even if it’s just in some small way. That still counts.

PL: Well, we are really grateful that you’ve chosen to support Positive Living BC! Thanks for all you do for us John! 5

Jason Hjalmarson is Director of Fund Development at Positive Living BC.

By Tom McAulay

A

headline from December 1993 reads: ‘A Cry for Mercy: Is AIDS the disease which makes the case for euthanasia?’ Russel Ogden tackled the thorny issue of doctor-assisted suicide for the newsletter that predates this magazine. At a time when Sue Rodriguez and Dr. Jack Kevorkian were household names, those of us in the HIV community were ahead of the game, as it were. Faced with unendurable pain, many of our loved ones looked for quicker, painless relief. How many questioned the morality of their decision? How many more wished for progressive legal help? And how many still said, ‘to hell with that: this is my damn life’? In reviewing this article, I can rejoice at how far we’ve come medically to make euthanasia less of an issue for us. It is a tribute to our predecessors for whom it was too late.

The epidemic raises serious moral and ethical questions with respect to euthanasia and assisted suicide.

In 1991, the B.C. Royal Commission on Health Care and Costs made four recommendations with respect to dying with dignity. These included Criminal Code amendments which would allow terminally ill patients the right to request, and receive, fatal doses of pain medication, and decriminalizing the offense of assisting suicide.

To date, the recommendations have not been adopted.

Perhaps one reason for the caution in adopting the recommendations, is the lack of research data to support euthanasia and assisted suicide … For AIDS patients, it is not a matter of choosing between life and death, but choosing between dying now or dying later. Many AIDS patients do not have the option of committing suicide because they are bed ridden, and unassisted suicide often depends on crude, violent or unreliable methods.

Physician-assisted suicide is one of those choices, and it is occurring with an unknown frequency. AIDS patients often seek assistance from compassionate doctors who risk their careers, and legal prosecution, by facilitating their deaths. Persons with AIDS sometimes request medications from several physicians in an effort to accumulate enough pills to successfully commit suicide. To avoid legal liability, physicians who grant a patient’s request for lethal medications may prescribe sedatives or narcotics with specific, carefully worded instructions about lethal dosage, and the dangers of combining the medication with alcohol.

Two studies [review] physician involvement in euthanasia and assisted suicide. The Remelink Commission … estimated that in the Netherlands, between 10-20% of all deaths among terminal AIDS patients involve euthanasia or assisted suicide.

The Commission also found “that 1.8% of all deaths in the Netherlands are the result of euthanasia with some form of doctor involvement.”

In the second study, Slome investigated attitudes among San Francisco physicians toward physician-assisted suicide of AIDS patients. Of the total sample of 69 physician members of the San Francisco County Community Consortium, 23% were “likely to grant a patient’s initial request for assistance in committing suicide.” A belief in humane medical ethics was the strongest predictor of the physicians decision to assist a suicide.

Tom McAulay is co-chair of the Positive Living Society of BC.

P5SITIVE LIVING | 21 | MARCH •• APRIL 2019

Stigma in HIV makes its mark

By Sean Sinden

S

tigma related to HIV remains a stark reality for many Canadians. Now, a study in JAIDS suggests HIV stigma may also have negative physical implications. This finding comes from Brain Health Now, an ongoing CIHR Canadian HIV Trials Network (CTN 273) study that focuses on understanding the biological, psychological, and social factors that affect brain health in PLHIV. Cognitive impairment is common in PLHIV, reported in between 30 and 50 percent of people in research cohorts. The causes of cognitive impairment are not known but, to date, most research has focused on biological mechanisms, such as the effect of HIV-related inflammation on the blood vessels. However, there are likely psychosocial contributors, including the physical and social environments of those who live with HIV. Stigma, broadly understood as negative attitudes and behaviours towards a person based on characteristics of that person, has been shown to negatively affect mental health in PLHIV. Recent research has shown that more than half of PLHIV report experiencing stigma, that it acts as a barrier to participation in society, and, generally, that it can impact quality of life.

However, less is known about the impact of stigma on cognition and mental functioning.

CTN 273 is a long-term cohort of over 850 PLHIV in Vancouver, Montreal, Calgary and Hamilton; the new publication included 512 people from the main cohort. Participants completed a battery of tests, including assessments of cognitive ability and mental health and a quality of life questionnaire.

The researchers found that stigma had a direct effect on cognitive performance and anxiety, including negative effects on daily engagement in meaningful activities. However, the relationship between stigma and social engagement is unclear: do people who feel stigmatized avoid social activities or do they feel stigmatized because they are excluded from these activities?

The ways that stigma affects cognitive performance may be through direct effects on the brain and blood vessels, as recurring negative social experiences and isolation have been shown to cause these physical changes in other studies. Stigma can also

negatively affect self-care, including adherence to antiretroviral therapy, which can damage the brain. This was not the case in this cohort as over 90 percent of people had undetectable viral loads throughout the study, but it is yet another reason that stigma in the HIV community cannot be ignored.

CTN 273 is led by Drs. Marie-Josée Brouillette and Lesley Fellows, both at McGill University in Montreal. 5 Sean Sinden is the communications and knowledge translation officer for the CTN.

Other Studies enrolling in BC CTN 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 283

The I-Score Study BC site: Vancouver ID clinic

CTN 292A

Development of a screening algorithm for predicting highgrade 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 | 23 | MARCH •• APRIL 2019

For a full list of donors visit positivelivingbc.org

$5000+

$150 - $499

LEGACY CIRCLE Peter Chung

HEROES Katherine M. Richmond Brian A. Yuen Len Christiansen James Ong Bonnie Pearson Brian Anderson Darrin D. Pope Dena R. Ellery Glynis Davisson Gretchen Dulmage Jamie Rokovetsky Jean Sebastian Hartell John Bishop Keith A. Stead Ken Coolen Lawrence Cryer Lorne Berkovitz Mark Mees Maxine Davis Mike McKimm Pam Johnson Patrick Carr Ralph E. Trumpour Ralph Silvea Ronald G. Stipp Ross Thompson Sergio Pereira

$1000 - $2499 CHAMPIONS Paul Goyan Fraser Norrie Joss J. de Wet Malcolm Hedgcock Paul Gross Blair Smith Don Evans

$500 - $999 LEADERS Cheryl Basarab Christian M. Denarie Cliff Hall Dean Mirau Emet G. Davis James Goodman Mike Holmwood Pierre Soucy Rebecca Johnston Robert Capar Scott Elliott Stan Moore Brian Lambert

Vince Connors William Granger Elizabeth Briemberg Barry DeVito George Schwab Jane Talbot Patricia Dyck Penny Parry Ron J. Hogan Ross Harvey Susan C. Burgess Tom Mcaulay Wayne Avery Gbolahan Olarewaju Stephanie Tofield Glyn A. Townson Stephen French Dennis Parkinson Edith Davidson Jeff Anderson Larry Hendren Patricia E. Young Rob Spooner Carmine Digiovanni

$20 - $149 FRIENDS Andrea Reimer Angela McGie

P5SITIVE LIVING | 24 | MARCH •• APRIL 2019

Catherine Jenkins Hans-Krishna Von Hagen Jackie Yiu Joel N. Leung John Yano Lisa Bradbury Sharon E. Lou-Hing Tracey L. Hearst Jason Hjalmarson Zoran Stjepanovic Adrian Smith Christine Leclerc Adrienne Wong Chris G. Clark Chris Kean Heather Inglis Lindsay Mearns Lisa Raichle Miranda Leffler Tobias Donaldson

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 “Jon has been a great addition to the CHF Team. Because of Jon’s dedication, we are able to provide CHF reimbursements to Members who use this program the most. He really cares about the Members who come to him to help with CHF questions.”

Brandon Laviolette, Treatment, Health and Wellness Coordinator.

*Jon Cain*

What is your volunteer history in general?

What volunteer jobs have you done with Positive Living BC?

I’ve always volunteered as a way of giving back to the community. I’ve done disaster relief with the American Red Cross, food bank coordinator, tax preparer, taught public speaking—the list goes on. I’ve volunteered with the Canada Revenue Agency’s Canadian Volunteer Income Tax Program since about 2000. The program sends out lists of agencies needing tax preparers and that’s how I found out about Positive Living.

Why did you pick Positive Living BC?

I’ve wanted to volunteer in an organization that had a lot of volunteer roles so that after tax season I’d be able to continue volunteering in other roles (some organizations just want you for the tax season).

How would you rate Positive Living BC?

Positive Living is one of the BEST places I’ve ever volunteered with. Everyone is so supportive, friendly, and willing to lend a hand. I feel very fortunate to volunteer with such an amazing organization.

P5SITIVE LIVING | 25 | MARCH •• APRIL 2019

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 | 26 | MARCH •• APRIL 2019

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 2019

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”.

March 20, 2019 Reports to be presented >> Executive Committee Update | Written Executive Director Report | Director of Program and Services | Events Attended April 3, 2019

Reports to be presented >> Executive Committee Update | Director of Operations & Administration | Events Attended

April 17, 2019

Reports to be presented >> Executive Committee Update | Written Executive Director Report | Director of Human Resources | PHSA Quarterly Reports | Membership Statistics | Volunteer Appreciation Event Attendance | Events Attended

May 1, 2019

Reports to be presented >> Standing Committees | Events Attended

May 15, 2019

Reports to be presented >> Written Executive Director Report | Events Attended Positive Living BC is located at 1101 Seymour St, Vancouver, V6B 0R1.

For more information, contact: Mike Hedges, director of operations  604.893.2268 |  mikeh@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)

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_ Adam Reibin  604.893.2252

 adamr@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

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 2019

Last Blast

Are you ready for the big one?

By Hesham Ali

The

last megathrust earthquake, defined to be of magnitude 8 or higher, hit our region approximately 319 years ago. Most scientists agree a similar event is likely in our lifetime. Regardless, we live in a seismically active area, and each year we experience hundreds of small magnitude 3-4 earthquakes. So, are you ready for when the big one hits? How about a magnitude 6-7 event? These are still substantial and can cause widespread damage and disruption.

As people living with HIV, we have an added concern in such situations—access to ARV medications in a timely manner. As you are all aware, our medications are dispensed from a central location at St. Paul’s hospital. So, what do you do if you run out or find yourself unable to make it downtown to refill a prescription? Even if your prescriptions were sent by courier, there’s bound to be some disruption in deliveries. While we hope normal services will be restored in a timely manner, we can’t assume this will be the case.

So, the smart option, as they teach in Scouts, is to always be prepared. This requires that you set aside a month’s supply of medications that you use on a regular basis, like your ARVs, but also others for chronic conditions you may have such as diabetes or a heart condition.

To that end, you may build up your own emergency supply over time. Go a week or ten days early to your scheduled refill date and build up a reserve that way. Talk with your health care providers and tell them why you’re doing this. Most of them will agree to assist you.

Keep your emergency supply separate. If you don’t already have an emergency kit, now is a great time to start one. You can buy a readymade kit from most general retailers. Or, if you want a more affordable and more personalized option, you can make up your own. Visit Prepared BC https://www2.gov.bc.ca/gov/content/safety/ emergency-preparedness-response-recovery/preparedbc for ideas and options. Keep your medications current by checking the expiry date and replacing them as you replace bottles of water and other essentials in your kit.

In the extreme event that you run out of medications and you don’t have access to emergency or new supply, just stop taking them. I know this may sound counter to all medical advice we have been given. However, this is the safest option. Don’t try to ration the medications you have left by taking them one day and skipping the next, or by cutting the pills in half to make them last longer. The right course of action is to continue taking your medications as prescribed and when you are out, just stop. Once services are restored and supplies are available, you can restart your regular regiment.

So, to summarize, the big one could hit at any time and we need to be prepared. While we hope our infrastructures won’t be severely damaged and that essential services would be restored quickly. It’s always best to be prepared. Scout’s honor! 5 Hesham Ali is a Peer Navigator at the Positive Living Society of BC.

P5SITIVE LIVING | 28 | MARCH •• APRIL 2019

POSITIVELIVINGBC.ORG

u FUN u SOCIALIZE u NETWORK u VOLUNTEER

YOUR TIME u GIVE BACK WITH YOUR SKILLS AND EXPERIENCE u SUPPORTING THE COMMUNITY FOR OVER 30 YEARS u JOIN OUR OVER 200+ VOLUNTEER TEAM u YOUR TIME SUPPORTS PEOPLE LIVING WITH HIV u WESTERN CANADA’S LARGEST HIV ORGANIZATION

FOR MORE INFO > 604.893.2298 marcs@positivelivingbc.org