Positive Living Magazine by 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

MAY • JUNE 2019 VOLUME 21 • NUMBER 3

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g n ible i v ss o ind from h ns 19 R

The London Patient

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What guides your food?

Indigenous health matters

POSITIVE LIVING BC VOLUNTEERS ARE WINNERS GAMES

FOOD & DRINK

CASINO

PRIZES AWARDS

2019

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I N S I D E

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MONEY MATTERS

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NUTRITION

Set yourself up for a richer A look at the big retirement with these changes to the Canadian financial tips Food Guide

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COVER STORY

The future of HIV/AIDS care was on display in Seattle at CROI 2019

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LET’S GET CLINICAL

Improving our understanding of preterm health and HIV

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PREPARING FOR END OF LIFE: PART 2 What you need to know about hospice care

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

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A NOTE FROM PAN

Crown Counsel’s Policy Manual disappoints prosecutorial activists

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GIVING WELL

Blair Smith on why he’s been donating every month for 30 years

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VOLUNTEER PROFILE Volunteering at Positive Living BC

 positivelivingbc.org

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TESTING, TESTING

Novel ways of making HIV and HCV testing more accessible

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BACK TALK

The cure of the ‘London Patient’ is a rarity. Health scams? Not so much.

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LAST BLAST

Understanding the role colonialism plays in Indigenous health

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 | MAY •• JUNE 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, Wayne Campbell, Victor Elkins, Jason Motz, Adam Reibin MANAGING EDITOR Jason Motz

DESIGN / PRODUCTION Britt Permien FACTCHECKING Jason Motz COPYEDITING Maylon Gardner, Heather G. Ross PROOFING Ashra Kolhatkar CONTRIBUTING WRITERS Glen Bradford, Sadeem Fayed, Stephen Garrett, Bill Granger, Jason Hjalmarson, Amanada Giacomazzo, Jennifer (Evin) Jones, R. Paul Kerston, Alexandra King, Tom McAulay, Pamela Narayan, Sean Sinden 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

from the chair

I explained in my last ‘Message from the Chair,’ I am “raising issues that I think are pertinent to our organization moving forward.” As such it gives me great pleasure at this point to welcome into the leadership role of Executive Director at Positive Living BC, Mr. Victor Elkins. Victor has been a longtime supporter of Positive Living BC, mostly in fundraising efforts. His most recent job was as the President of the Hospital Employees Union. Prior to that, he spent decades in the healthcare field. He brings with him wisdom and expertise from all his healthcare experience. His passion and care for the individual human being cannot be surpassed. We are fortunate indeed to have a person of this calibre and quality at the helm of our organization as we move into the future. As Executive Director, Victor will not only be responsible for our daily operations, but he will also work closely with the Board of Directors in setting both the short- and long-term strategic direction for the Society. He brings a fresh approach to the table as someone who, until now, was outside of the organization. One of the things that we found impressive in Victor’s interview was his empathy for the voice of people living with HIV while thinking outside the box in planning for the future. This is why I said in my last column that this is the perfect time for you to speak up and let us know which direction you want us to go in.

P5SITIVE LIVING | 2 | MAY •• JUNE 2019

TOM MCAULAY

Look for ways to participate coming down the pipe throughout the year. This will include a membership survey, a series of town hall meetings, and of course the Annual General Meeting, all of which ensures that you will have your voices heard. To quote Victor from his interview: “As need for services increase and funding decreases Positive Living BC needs to be creative—rethink, restructure, revisit the mandate, mission, and general goals of the Society. The organization must get ahead of the struggle to exist and continue to provide the high-quality services and programs that are currently offered today. Flexible or adaptable contingency plans for five, ten, or more years out need to be developed. Members’ needs will change in the years to come; funding will be hard to achieve at times but not impossible. It’s about survival yes, and everyone is in the same boat. The only difference is we will have to row faster. And we will.” I, for one, am excited about the opportunity we have in planning our future. And I hope you all will welcome Victor into our fold. As always, you can reach me at tomm@positivelivingbc.org. I do enjoy hearing from my peers in person. So keep talking to me! 5

The London Patient: another case of HIV remission reported

pA second person has experienced

sustained remission from HIV-1 after ceasing treatment, reports a paper led by researchers at University College London and Imperial College London. The case report, published in Nature and carried out with partners at the University of Cambridge and the University of Oxford, comes ten years after the first such case, known as the Berlin Patient. Both patients were treated with stem cell transplants from donors carrying a genetic mutation that prevents expression of HIV receptor CCR5. The subject of the new study has been in remission for 18 months after his antiretroviral therapy (ARV) was discontinued. The authors say it is too early to say with certainty that he has been cured and will continue to monitor his condition. “At the moment the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives, posing a particular challenge in developing countries,” said the study’s lead author, University of Cambridge Professor Ravindra Gupta. “Finding a way to eliminate the virus entirely is an urgent global priority but is particularly difficult because the virus integrates into the white blood cells of its host.” The report describes an anonymous male patient in the UK who was diagnosed with HIV in 2003 and began ARV in 2012. Also in 2012, he was diagnosed with advanced Hodgkin’s lymphoma. In addition to chemotherapy, he underwent a bone marrow transplant from a donor with two copies of the CCR5 Δ32 allele in 2016.

The transplant was quite uncomplicated, but with some side effects including mild graft-versus-host disease, a complication of transplants where the donor’s immune cells attack the recipient’s immune cells. The patient remained on ARVs for 16 months after the transplant, at which point the clinical team and the patient decided to interrupt ARV therapy to test if the patient was truly in HIV-1 remission. Tests confirmed that the patient’s viral load remained undetectable, and he has been in remission for 18 months since ceasing ARV therapy (35 months post-transplant). The patient’s immune cells remain unable to express the CCR5 receptor. He is only the second person documented to be in sustained remission without ARVs. The first, the Berlin Patient, also received a stem cell transplant from a donor with two CCR5 Δ32 alleles, but to treat leukemia. Notable differences were that the Berlin Patient was given two transplants, and underwent total body irradiation, while the UK patient received just one transplant and less intensive chemotherapy. “By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people,” said Professor Gupta. The researchers caution that the approach is not appropriate as a standard HIV treatment due to the toxicity of chemotherapy, but it offers hope for new treatment strategies that might eliminate HIV altogether. Source: http://dx.doi.org/10.1038/ s41586-019-1027-4 P5SITIVE LIVING | 3 | MAY •• JUNE 2019

Seasonal and geographic trends in syphilis

pMuch of the public health impact of

syphilis revolves around its impact on fetuses and neonates, newborns less than a month old, through the mother-to-child transmission (MTCT) of the disease. Researchers reporting in PLOS Neglected Tropical Diseases have now analyzed temporal and demographic patterns in gestational syphilis (GS) and MTCT of syphilis. In Brazil, rates of GS and MTCT of syphilis have been on the rise, with 37,436 pregnant women and 20,474 newborns affected in 2016. Researchers from the Universidade do Oeste Paulista in Brazil used the National System of Aggravations and Notifications to calculate the incidence of GS and MTCT of syphilis from 2007 to 2013 in the Pontal do Paranapanema region of Brazil. They used the data to construct maps of the region—which includes 32 cities—showing how incidence rates vary between regions and over time. Rates of MTCT for syphilis ranged from 0.37 to 2.30 per 1,000 live births between 2007 and 2013. The researchers found that there was no annual endemic period for syphilis, but that the month most susceptible to an endemic event of both GS and MTCT was February. In 2011, they there was an especially marked increase in GS cases, followed by an increase in MTCT the following year, suggesting that treatment of GS was not effective. In many cities, however, the number of MTCT cases was larger than the number of reported GS cases, suggesting a failure in the notification system. “Our study provided a new methodology to understand the syphilis dynamics as a

potential tool to improve the success of future measures to control and possibly eliminate MTCT of syphilis,” the researchers say. Source: www.plos.org

TB rates in Latin America

pAmong PLHIV in Latin America, those

diagnosed with tuberculosis (TB) at an initial clinic visit were about twice as likely to die within ten years as people not initially diagnosed with TB, according to findings from a large observational study. This increased risk persisted despite the availability of TB treatment and mirrored patterns seen previously in HIV-negative populations, according to research supported by the National Institute of Allergy and Infectious Diseases (NIAID). People with HIV are at greater risk of TB disease than HIV-negative people due to HIV-related immune system damage as well as geographical and behavioural risk factors shared by both diseases. In 2017, the World Health Organization estimates there were 920,000 new TB cases among PLHIV globally, and approximately 300,000 PLHIV died from TB. Due to this large burden of HIV and TB co-infection, NIAID supports research to improve TB prevention, diagnosis, and treatment in the context of HIV infection. “Tuberculosis remains the leading cause of death for people with HIV globally,” said NIAID Director Anthony Fauci. “This new analysis shows how devastating TB can be for people with HIV and underscores the need to do more to prevent and treat this co-infection.” Investigators analyzed the clinical records of 15,999 PLHIV who received care

in CCASAnet clinics in Brazil, Chile, Haiti, Honduras, Mexico and Peru. Each participant remained in care for at least nine months after their first clinic visit; they had not received antiretroviral drugs to treat HIV infection before arriving at the clinic. Researchers found that 1,051 individuals—nearly seven percent—were diagnosed with TB during their first visit and were prescribed anti-TB and HIV medications. After five years of observation, approximately ten percent of patients with TB had died, compared with fewer than six percent of those without TB at their initial visit. This pattern continued: after ten years of observation, more than 19 percent of the group initially diagnosed with TB had died, compared with 10.5 percent of the group without an initial TB diagnosis. “In recent years, the research community has observed that tuberculosis—even when treated and cured—is associated with an increase in an HIV-negative person’s long-term risk of mortality,” said Serena P. Koenig, of Harvard Medical School and a lead study investigator. “Now we know this is also true for PLHIV, but many questions remain as to why that is and how to lower that risk.” Source: http://www.niaid.nih.gov/

Higher mortality rates for US veterans with HIV and depression

pA US study of depressive disorders, HIV status, and mortality suggests depressive symptoms are moderately associated with death among veterans with HIV. With data from the Veteran’s Aging Cohort Study, researchers from Boston P5SITIVE LIVING | 4 | MAY •• JUNE 2019

University School of Medicine (BUSM) compared the risk of death among US veterans who were depressed to those who were not depressed. They compared the association between depression and death among those with HIV to those without HIV. Depression was measured in two ways: clinical diagnostic codes and a questionnaire. Among those with HIV, the study found a 23 percent increased mortality risk linked with elevated depressive symptoms ascertained by the questionnaire but no significantly increased mortality risk when depression was determined by the codes. For HIV-negative people, there was a six percent increased mortality risk associated with depressive disorders measured by the codes but no significant increased mortality risk for elevated depressive symptoms assessed by the questionnaire. Depression is the highest reported mental health condition in PLHIV in the US, with a prevalence ranging from 20 to 40 percent. “Our findings reinforce the need to assess and treat depressive symptoms and major depressive disorder in patients with and without HIV infection to potentially reduce mortality risk,” said study author, Kaku So-Armah, assistant professor of medicine at BUSM. Source: HIV Medicine 5

Financial Literacy for your retirement years

By Bill Granger

hatever your age, a financially sound retirement requires planning and action now. The financial implications of aging include paying for housing, meals, transportation, travel and recreation to fully enjoy your older years. A variety of savings and retirement pension instruments are available to people living with disabilities and on fixed incomes. The disability tax credit (DTC), registered disability savings plan (RDSPs), tax-free savings accounts (TFSAs), and registered retirement savings plans (RRSPs) each provide ways to achieve the value of saving money each month, compounded over a number of years before retirement. Living longer makes planning and saving ahead worthwhile. And having some savings accumulating earnings tax-free for your retirement will only make those years better for you! As you near age 65, you need to know how and when to apply for the Canada Pension Plan (CPP) , old age security, and potential guaranteed income supplement you are entitled to. Whether you are receiving CPP disability, provincial disability assistance, or contributed to the CPP during your working years, you must file applications six months before you turn 65 for continuing benefits. Your existing programs will end at age 65. CPP is payable to anyone who was resident in Canada and paid in through workplace or self-employed deductions. To receive full CPP benefits at age 65 you must have lived in Canada and paid in for 40 years or more. The average CPP is $664.41 per month because most people havenâ&#x20AC;&#x2122;t worked and contributed for the 40-year period. The maximum is $1,154.58 per month and includes any CPP Survivor Benefits you may receive following the death of your spouse. Information and application forms are available from Service Canada. Old Age Security (OAS) is a universal benefit available to everyone. Single people will receive $601.45 per month after their

65th birthday. If your income from pensions or all other sources exceeds $77,580 per year then the OAS is clawed back. Guaranteed Income Supplement is federal government supplement for low-income (a total annual income of less than $18,240 for an individual or $24,096 for married or common-law couples) seniors after age 65; single people receive $898.32 per month, each half of a married or common-law couple $540.77 per month. Happily, after age 65 your part-time income falls under an earnings exemption. It can exceed the current limits of $5,500 for CPP Disability and $12,000 for BC Disability Welfare without you having to declare it, other than for income tax. As well, a GST credit is paid to low income individuals quarterly and continues after age 65. An energy rebate is also refunded to those below the low-income threshold following submission of your BC income tax each year. Low income persons can claim annual GST and energy rebates on their income tax returns. More information and all application forms for everything discussed in this article are available from Service Canada. Please remember, these are 2019 numbers. Happy retirement years! 5 This article is based on a presentation given at the 2017 Positive Gathering. It has been edited for this magazine.

P5SITIVE LIVING | 5 | MAY â&#x20AC;˘â&#x20AC;˘ JUNE 2019

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Inside Canada’s new Food Guide

By Pamela Narayan ealthy eating is more than just what we eat. Our ability to make healthier choices is influenced by our environment, in terms of where, when, why, and how we eat. Earlier this year, as part of Canada’s Healthy Eating Strategy, the federal government launched a new version of Canada’s Food Guide (CFG) that embraces this theme. A lot has changed since the last edition was published in 2007. For starters, CFG is now available exclusively online (food-guide.canada.ca). The new CFG illustrates a colourful plate filled with a variety of food separated into three categories: 1/2 your plate made up of vegetables and fruit; 1/4 of protein; and 1/4 of grains. Overall, the new plate model provides a simpler approach to eating. The updated guide uses science-based recommendations to encourage Canadians to make healthy choices. Four food groups have become three, as dairy is no longer a food group on its own; fruit juice no longer counts as a fruit/vegetable serving; water is the recommended drink of choice; and plant-based protein such as beans, lentils, nuts, and seeds is encouraged. Not only is eating more plant-based proteins beneficial for your health, it is also more environmentally sustainable. Tips on how to add these recommendations are also given. For example, to incorporate more plantbased proteins into your diet, try planning meatless meals: beans in a burrito, lentils in a soup or casserole. The new guide is also a proponent of creating a positive food environment. Canadians are encouraged to be mindful about their eating habits and reconnect to the eating experience. Tips on how to actualize this include takeing the time to chew and enjoy your food, while noticing the sensations of hunger and fullness. The process of mindfulness includes using your senses to pay attention to the aromas, textures, and flavours of the food being eaten. To be fully present also means limiting distractions such as television and cellphones, especially since the tendency to eat more than you need is high when distracted.

Furthermore, cooking more often and involving others in planning, preparing, and eating meals adds to the enjoyment. This way, you are aware of what is going into your food while also being able to control the amount of salt, sugar, and saturated fat — all of which should be limited. The CFG is intended to simplify the research and provide evidenced-based nutrition information to help us make better food choices to reduce the risk for disease. It can be challenging to know what is right for you when conflicting nutrition information and “diet culture” is everywhere. CFG is a guide and a great place to start but talking with a registered dietitian can help provide more individualized advice. Eat well, live well. 5

Pamela Narayan is a registered dietitian with the Specialty Clinics at the Jim Pattison Outpatient and Surgery Centre in Surrey.

P5SITIVE LIVING | 7 | MAY •• JUNE 2019

PAN responds to new prosecutorial guidelines By Jennifer (Evin) Jones

ver the past few months, Pacific AIDS Network (PAN) and other allied organizations including the Canadian HIV/AIDS Legal Network (CHLN) have been in contact with BC Attorney General David Eby’s office regarding collective concerns about the ongoing broad and unjust use of the criminal law in relation to HIV non-disclosure, exposure, and transmission. We have called on the AG to ensure that BC’s prosecutorial guidelines are evidence-based, including the evidence of U=U, which has been formally endorsed by Canada; as well as the latest international expert consensus statement on the science of HIV in the context of criminal law. In January, we were told that Mr. Eby had asked for a new briefing from BC Prosecution Services, on the federal prosecutorial guidelines (announced by the Federal Minister of Justice on December 1st 2018). We were also told that it was the AG’s wish to receive this briefing, by BC Prosecution Service, before engaging PAN and any of our members in a consultation process (we did have a meeting set with Mr. Eby on December 10th, but this was postponed by the AG in light of the new federal directives that were published on December 8th). Earlier this month, we were advised by the AG’s office that the BC Prosecution Services had decided to issue a revised policy as part of its Crown Counsel Policy Manual (ostensibly in light of the federal prosecutorial guidelines). The revised “Sex 2” policy was published on April 16th. We are still in the process of analyzing the new policy, but on first reading, one of the biggest disappointments is that it fails to state clearly that there will be no prosecution against people who use condoms. Rather, it states that a public interest factor

that may weigh against prosecution is if a person living with HIV correctly used a condom during a single act of vaginal or anal sex and HIV was not transmitted. There are some positive declarations in the new guidelines–for example, that there will be no prosecution for suppressed viral load (i.e. under 200 copies/ml) for at least four months; it also states that there will be no prosecution for just oral sex but with the caveat, ‘if no other risk factors present’. These changes are progress. Though some significant ground has been gained, these new prosecutorial guidelines fall well short of the key recommendations made by the CHLN in its January 2019 submission to the BC Attorney General. This also feels like an opportunity lost, where once again prosecutorial guidelines are being adopted without adequate consultation with legal and scientific experts and community leaders, including PLHIV. In terms of next steps, those will be considered in consultation with the PAN board of directors, members, and other organizations working on this issue. But for now, I would like to acknowledge the CHLN and the members of the national Canadian Coalition to Reform HIV Criminalization for their ongoing leadership on this–and we will continue to seek ways to work together on this issue in future days. This article was published online on April 16th, 2019. It has been formatted for publication in this magazine. 5 Jennifer (Evin) Jones, is the Executive Director of Pacific AIDS Network.

P5SITIVE LIVING | 9 | MAY •• JUNE 2019

Bring testing to the people

By Amanda Giacomazzo

anada has signed on to global targets to eliminate HIV and hepatitis C (HCV) as public health threats by 2030. While ambitious, these targets are now a realistic possibility thanks to the effectiveness of modern medicine. HIV treatment can suppress the virus so successfully that HIV-positive Canadians who start treatment early can have life expectancies like their HIV-negative peers. This also prevents the transmission of HIV to their sexual partners. And most Canadians treated for HCV are now cured within weeks. But before people can benefit from effective treatments, they must first be diagnosed. Unfortunately, an estimated 14 percent of HIV-positive Canadians are unaware of their status, and an estimated 44 percent of Canadians living with chronic HCV infection don’t know they have it. Research tells us that most transmissions originate from people who are undiagnosed. We can’t expect to find those undiagnosed without changing our approaches to testing. Rather than waiting for individuals to present themselves at a testing clinic, novel approaches bring the offer of testing where people are—in communities, in non-clinical settings, even in homes. Testing is important as it is not only the gateway to care and treatment for those who test positive, but also a gateway to prevention for those who test negative. The following innovative approaches to HIV and HCV testing have shown promise to increase the proportion of people who know their status by overcoming individual, provider, or institutional level barriers to testing. Point-of-care (POC) testing allows a person to receive the result of an HIV or HCV test immediately at the location where the test is performed and can be used in an array of settings. If the test is reactive, then a second blood sample is taken and sent to the laboratory for confirmatory testing. Embedding POC testing into existing programs can be used to reach specific populations that may not access testing otherwise, while ensuring testing is done in a manner that is culturally safe and relevant. A POC testing program in Saskatchewan is bringing HIV testing to the community pharmacy setting and providing an opportunity for people to be tested for HIV when they visit the pharmacy for methadone, diabetes medication, or birth control. A research study implemented POC HIV testing in community-based pharmacies in Alberta and Newfoundland. The goal was to reach

those at risk of HIV and those who had never been tested. Future uses of the research could include expanding testing to HCV and other sexually transmitted and blood-borne infections (STBBIs). A collaboration between the Ontario provincial government, Halton Region Health Department, and two Ontario prisons (Maplehurst and Vanier) brought HIV, syphilis, and gonorrhea POC testing to those prisons. This project aimed to increase access to HIV testing through anonymous testing services provided by a local public health unit. The program was shown to be acceptable to prison healthcare providers, as well as to inmates. In Winnipeg, paramedics offer POC testing to clients in a homeless shelter in partnership with the Manitoba HIV Program. Pop-up clinics bring HIV and HCV testing directly to where clients are, for example, drop-in centres and soup kitchens. Models that involve employing peers as testers in Vancouver utilize street fairs, community centres, and single-room occupancy hotels as spaces for HIV POC testing. In this community-driven model, testing is also helping to alleviate stigma and provide educational opportunities within the community. Rapid point-of-care testing in dental clinics has been used to screen patients for HIV while they are receiving routine dental checkups in Vancouver. Dentists and clinic staff screen patients and then connect those that test positive to an outreach team responsible for improving engagement and linkage to HIV care. Similar approaches have been used for HCV testing in Italy. Standard testing for bloodborne infections like HIV and HCV involves taking a blood sample through venipuncture and sending it to a laboratory for analysis. If the test is reactive or positive, then a confirmatory test is performed. For HCV, this may involve an additional blood draw before the confirmatory test is performed. There are efforts to expand the range of healthcare providers that can perform standard testing, including expansion to peer-based and other lay provider testing, as well as efforts to simplify the testing process for both HIV and HCV. Combining HIV, HCV, and other STBBI testing approaches with harm reduction programming can also help to reach people where they are. Introducing STBBI testing to a program that distributes harm reduction supplies can provide a lower barrier approach to bring testing to people who are accessing supplies and can allow testing to target specific populations.

P5SITIVE LIVING | 10 | MAY •• JUNE 2019

The Public Health Agency of Canada (PHAC) and some provincial governments, including British Columbia and Saskatchewan, have released guidelines recommending that the offer of an HIV test be made part of periodic routine medical care. The routine offer of testing in primary care settings aims to remove barriers by normalizing HIV testing for everyone. In Vancouver, training and support for family physicians have been provided to ensure that providers have the skills and knowledge to routinely offer HIV testing to their primary care patients. The routine offer of testing in hospital settings can allow for all people admitted to medical, surgical and emergency units to have the option of being tested for HIV. Routine hospital testing has been integrated into hospitals in Vancouver through a phased approach. The initiative has made between three and eight positive diagnoses for every 1,000 tests performed, making it highly cost-effective. Home-based HIV testing is a discreet and convenient way to test for HIV that has the potential to reach individuals who need to be tested and may not otherwise seek a test. HIV self-testing allows for someone to test privately in their home or in a community or healthcare setting where private space is provided. HIV self-testing kits have been approved for use in many countries around the world (including the US, UK, and France) and was endorsed by the World Health Organization in 2017. It is currently under review by Health Canada.

Online testing, such as GetCheckedOnline, provides a new way of bringing testing to the people, as it provides online and confidential access to STBBI test requisitions and results. Clients download a lab requisition form and have the option of ordering a self-collection kit online. The kit is taken to a nearby laboratory, and clients receive their result online or via the telephone. Dried blood spot (DBS) testing involves applying drops of blood from a finger prick to a card that is mailed to a public health laboratory for screening and confirmatory testing of HIV and HCV. Currently, this collection technique is in limited use in Canada for diagnosis. DBS can improve testing access in remote communities, as the samples are very stable and more easily transported. Non-medical staff can also collect samples. This approach is being explored through research projects in Manitoba, British Columbia, and Ontario. 5

Amanda Giacomazzo is a knowledge specialist on treatment and prevention programming at CATIE.

P5SITIVE LIVING | 11 | MAY â&#x20AC;˘â&#x20AC;˘ JUNE 2019

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P5SITIVE LIVING | 12 | MAY •• JUNE 2019

By R Paul Kerston

hile considerable media attention has focused on a second HIV cure reported at the March Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, many other topics were also featured at this important annual scientific meeting. This new ‘London Patient’ cure –currently 18-plus months HIV-negative–was similar to that of Timothy Brown (the ‘Berlin Patient’) over a decade ago. The cure was accomplished through use of a stem cell transplant from a donor without the key CCR5 delta-32 co-receptor that lets HIV attach to the immune system, though there were differences from the Brown case.

The stem cell methodology is costly and likely to be used only to treat other serious diseases: Hodgkin’s disease, in this instance; and leukemia, previously. Importantly, it offers hope toward finding a cure, though this particular approach isn’t practical for the well over 30 million individuals, worldwide, living with HIV. There is currently a third patient (the ‘Dusseldorf Patient’) who has been off antiretrovirals since last November following a stem cell procedure; however, not all such procedures have proven effective. This news is still a great stride forward as reproducibility amounts to a proof of concept.

P5SITIVE LIVING | 13 | MAY •• JUNE 2019

continued next page

This article looks at some of the other notable examples of research presented at this year’s conference. Broadly-neutralizing antibodies (bNAbs): Antibodies form naturally in the human body to fight disease following exposure. This happens in childhood diseases such as chicken pox, which occur only once. HIV tests detect HIV antibodies. Certain bNAbs are naturally-forming antibodies which can block some HIV strains from entering immune system cells. They are also thought to help destroy HIV-infected cells. These antibodies form in only around 20-25 percent of HIV-positive persons, but they can be cloned. Research on bNAbs may lead to a therapeutic vaccine, which is where an existing disease is fought through introduction of medicine that assists the body to clear it–a form of cure but one where the body’s own defenses are assisted by medicine. Importantly, they may help reduce the viral reservoir, a key factor in viral rebound upon antiretroviral discontinuance. Researchers have been working in this area for decades, especially since the turn of this century. More and better information comes to light every year, particularly through ongoing trials in Europe, Africa, and the Americas, notably the HIV Prevention and HIV Vaccine Trials Networks, or HPTN and HVTN.



More and better information comes to light every year through ongoing trials in Europe, Africa, and the Americas.

Just a note regarding how conferences like CROI are set up: there are usually about four different broad areas (or ‘tracks’) which are then subdivided for fitting oral presentations and poster presentations into for the ease of attendees’ selections during the event. Often, one is called ‘Basic Science’ and another is ‘Clinical Science’ (along with epidemiology and social science, usually). The difference between ‘Basic’ and ‘Clinical’ is that the latter is primarily for and attended by physicians, nurses, and other clinicians because it deals with the science behind diagnoses and treatments (via clinical studies); whereas, the former is geared toward chemists, biologists, and biochemists and breaks things down to a molecular or ‘basic’ level. CROI had many basic science offerings on this subject this year. This is a promising area to watch, particularly next year when trial results are expected.

Pre-exposure prophylaxes (PrEP): There are continued developments regarding PrEP (prevention for HIV-negative persons) which is of particular interest in sero-discordant relationships, where one partner is HIV-positive. This includes current Phase III testing of long-acting cabotegravir, an integrase inhibitor that blocks the integration of the virus with immune system cells. Long-acting cabotegravir is being tested via injections at intervals of weeks, compared with the current approved pill (Truvada) taken daily. This trial, HPTN 083, aims to enroll 4,500 persons and follow participants for up to fourand-a-half years worldwide. This alternative is promising for those less inclined toward daily pill-based prevention. Used as part of combination treatment, cabotegravir is also in Phase III trials. Further, both the long-acting, injectable cabotegravir formulation plus a bNAb are being tested in yet another early phase switch trial (for treatment-experienced participants) as a combination therapy. Long-acting (injectable) treatments: This year at CROI, 48-week Phase III treatment (FLAIR + ATLAS) switch trial results were presented for long-acting, injectable cabotegravir in combination with injections of rilpivirine, an approved, newergeneration non-nucleoside reverse transcriptase inhibitor (NNRTI) not unlike efavirenz but with a longer half-life and reduced side effects. In total, there were over 1,100 participants in these two studies. FLAIR showed comparable results with dolutegravir plus abacavir and 3TC (93.6 percent efficacy in the injectable group vs 93.3 percent). ATLAS, in Argentina, was a comparison with long-term successful treatment, having a 92.5 percent success rate in the injectable arm. All of this is worth noting as clearly, long-acting agents for both treatment and prevention may hold a new future for individuals who find those options more attractive. Those so inclined might soon have the opportunity for injections dosed at intervals of weeks instead of pills taken every day. Surveys indicate that there is interest in this. Weight gain with integrase strand inhibitors: There is ongoing investigation into weight increases seen with the use of integrase inhibitor medications (approved for over a decade) such as dolutegravir (part of combination therapies) as well as raltegravir, elvitegravir, and bictegravir (this last is not currently available in British Columbia). Such weight gain can lead to a potential for blood sugar (diabetic) issues, in addition to other possible complications. Women and persons over age 60 appear to be more at risk for this weight increase, among other factors. The amount of increase averages about 12-13 pounds. CROI added to prior presentations

P5SITIVE LIVING | 14 | MAY •• JUNE 2019

in showing various data studying a total of 24,000 patients. One European study (NEAT-022) involved switching from a boosted protease inhibitor to dolutegravir and this study, particularly, appears to show a causal relationship, especially for virally suppressed persons switching from boosted darunavir.



Long-acting agents for treatment and prevention may hold a future for individuals who find those options more attractive.

Dual therapy: Finally, dual therapies continue to be studied with good results. Since the onset of successful triple-medication therapies in the mid-1990s, this was an abandoned approach, but with newer, safer regimens in even greater classes of medication than before, this has now become a reality. Dolutegravir with rilpivirine is the only dual therapy currently approved by Health Canada, under the brand name Juluca (ViiV) as a single pill taken once daily. As of this writing, it is not yet available in British Columbia but may be available by purchase. Ask your physician. Currently, dolutegravir is being studied together with 3TC, one of the oldest and most common HIV medications. Fortyeight-week data on Phase III Gemini 1 and 2 trials is very promising: Non-inferiority was demonstrated for dolutegravir plus 3TC compared with dolutegravir added to tenofovir and emtricitabine (FTC). Added together, this conference in Seattle showed that research continues for a variety of approaches that are gradually offering greater and greater hope for all. The tenth IAS Conference on HIV Science, from 21-24 July (in Mexico City) is the next big HIV meeting. Stay tuned for further developments on all these and other topics. 5

R Paul Kerston continues to puzzle out an existence in Buenos Aires but stays in touch.

P5SITIVE LIVING | 15 | MAY •• JUNE 2019

Home, hospital, or hospice? Preparing for end of life: Part 2 by Glen Bradford with contributions by Stephen Garrett

the beginning of the AIDS epidemic, palliative care and hospice care were not always good experiences for many PLHIV. Some health care providers and institutions stepped up to help in exemplary ways, most did not. But now, the overall end of life approach to what that experience is like for people living with both HIV and a potentially terminal illness is changing. Palliative care is for people living with a terminal illness with six months or less to live if the disease follows its typical progress. The person can still try treatment in the hopes of a cure for as long as possible while still getting relief from the symptoms and stress of a serious illness. The goal is to offer hope and improve quality of life for both the dying person and their loved ones. At some point, when the patient’s illness does not respond well to medical attempts to slow the disease’s progression or if a dying person chooses not to undergo certain treatments, then hospice care is begun. Hospice care provides the same comprehensive comfort care as palliative care but without the curative measures. In this situation the word “hospice” is used as an approach to care,

it is not tied to a specific place. Hospice care can be provided in any setting—home, nursing home, assisted living facility, or regular inpatient hospital ward and is for people of any age. Everyone has the right to palliative and hospice care, but not everyone has access to these types of care due to geography or availability within a hospital. That is why hospice care can be offered in hospitals, physical hospice settings, or in the home. Each has its advantages and disadvantages. If the loved one is medically able to be at home, palliative or hospice care at home is an option for people who want to end their life surrounded by the comforts of their home and not the clinical setting of a hospital. This requires the hospital to plan for the loved one to be transferred home in a medical transfer vehicle with easy access into the home for the transport team. The transfer beds are large. Narrow hallways with sharp turns can make it difficult for them to get a person into their home. Once inside, they will need to be in a room big enough to handle either their own bed or a medical bed, with room to get around as they will need help getting in and out of bed.

P5SITIVE LIVING | 16 | MAY •• JUNE 2019

Home care nurses can make regular visits to the home for medical support if the type of medical support is not too complicated. Home support workers are available but limited, so friends will need to help with shopping and food preparation, laundry, bathing. etc. Most folks underestimate the work involved for hospice in the home. Often, patients or their partner/friends overstate their involvement not realizing the actual time commitment the task involves. This will result in home support workers’ time being minimal, and an unrealistic burden being placed on loved ones. Often a spouse or partner will try to tackle this workload themselves because the ill person doesn’t want many people in their home. However, for it to work, high quality home care takes a team willing to work together and someone to coordinate it all. Spouses can be good care givers or coordinators if they already have those skills. Not everyone does, however, and a dying partner will not make those skills magically appear. The spouse may be grieving or may be in denial of the seriousness of the situation as a coping mechanism. The ill person may want to coordinate their own care, but this is not realistic. An ill person may not have the patience required to deal with setbacks. If someone cancels a shift, who do they call? Who will look for a replacement? (With advance notice, AIDS Vancouver can help with creating a care team plan.) As you can see, hospice care at home is complicated. It may be easier to stay in a palliative ward or a hospice facility in the community. The experience of being in palliative care in a hospital is not the same as being a regular inpatient in a hospital. The ward is quiet. The ratio of nurses to patients is much higher. Rooms are single or double occupancy, with single room occupancy for patients who have more complicated health needs or patients who are nearing the end of life. Tasteful spaces are set aside for visitors to gather their emotions or connect with one another outside of the ill person’s room. Sometimes they connect with strangers going through the same thing on the ward. Personalizing the room for someone is encouraged. But what if palliative, hospice, or home care is not an option? Many people spend the end of their life in a regular hospital ward. However, bringing an air of human dignity into the end of life stage for those in this situation is not too difficult. A short visit with the nursing staff can make a big difference. It is okay to make some requests. One can say, “This room is where (our loved one) is going to die and we would love it to be as homelike, comfortable, peaceful, and sacred as possible. Can you help us create a great ending like this?” Some suggestions would be to ask for hazard waste signage to come down, remove unnecessary medical equipment from the room, and put a sign on the door that says, ‘Please knock before entering.’ You will find that the staff will be happy to accommodate these requests.

Our next article in this series will be on choosing or being a participant in a health care provider assisted death. 5 Glen Bradford is Director of Programs and Services at Positive Living Society. Stephen Garrett is the founder of We Can Die Better magazine and owner of Just Alive Consulting.

HOSTING A FINAL GOODBYE GATHERING 9 When someone has a large network of family and friends, they may all want to come for a visit to say goodbye. This is a challenge for anyone. Instead, if your loved one is up for it, consider having a social event in the group room at palliative care. Here are some general tips to help plan things out. 9 Work with the dying person to make a list of invitees and stick to that list. 9 Provide snacks and drinks as people will need to eat their feelings. Keep it simple, it’s not a party. 9 Arrange for everyone to all arrive at once. Keep the invite private. Keep each visit short for everyone, especially for the patient. Use Facebook’s private event invite feature to gather people and set the parameters. 9 Once everyone has gathered, bring your loved one into the space in a smart looking wheelchair. Dignity is precious. Place them in a spot against the wall so they can see everyone. Arrange chairs on each side of the person so visitors do not tower over them. 9 People will take turns to say a few words before giving way for the next person. 9 Give those who have avoided talking a discrete five-minute warning before wrapping things up. When the loved one is done, wheel them out. Forty-five minutes should be the maximum for the event. 9 It can be tempting for the organizer to over control everything. Take a breath, step back, and let things flow organically. Don’t crowd the chair with your presence but keep an eye open in case you are needed. If it appears to be too much for the patient, turn it into a group goodbye and wrap it up fast. 9 Let those who need some time afterwards to stay, do so. Some may need to gather themselves. Be prepared to offer space and time for the guests.

P5SITIVE LIVING | 17 | MAY •• JUNE 2019

Giving Well gay bar were a mayor visited to campaign (Mike Harcourt). It held drag events, had the best strippers, but also sponsored baseball teams, the Gay Men’s Chorus would perform to raise funds, and we held one of the first large AIDS fundraising events there. The bar was big on community engagement; in many ways, it was a lot like a community centre. PL: Why is giving back important to you? BS: I was taught as a child to get involved and give back and so it’s something I didn’t realize that not everybody does. To my mom it was important that we gave back. She got me involved in different organizations and doing paper or bottle drives or fundraising for schools.

his month, a good chat with Positive Living BC’s longest running monthly donor, Blair Smith.

Positive Living: Tell me what’s important for people to know about you? Blair Smith: I’m a realtor. I get a lot of joy and satisfaction from my work, and it pays the bills. I had a partner for 26 years who passed away from HIV. He was active in the community, though in different organizations than I was. When I moved to Vancouver in 1982, I started working at a bar called “Buddies.” which was like Cheers for queers. It was the kind of place that built community. Buddy’s was the first

PL: Our Finance Director informed me that you’ve been a monthly donor since 1989, which makes you the longest running monthly donor we have. That’s incredible! What prompted you to start donating in 1989? BS: It would have started around the time that my partner was diagnosed. His diagnosis was a secret for quite a while. He was still working and giving monthly makes it easier for people to contribute. In those days my monthly donation wouldn’t have been a lot, but there were a lot of other events we supported as well, like the AIDS WALK or other fundraising events.

P5SITIVE LIVING | 19 | MAY •• JUNE 2019

A DONOR PROFILE

By Jason Hjalmarson

PL: You knew our founder, Kevin Brown, personally. What was he like? How did you meet him and get to know him? BS: Kevin Brown was on a bowling team with my partner. Kevin sewed and made the bowling team’s shirts. I still have one. Kevin and others felt that AIDS Vancouver couldn’t advocate because they secured government funding. Kevin believed that a member driven organization was needed to advocate for the needs of PLHIV/AIDS. So, he started one. Kevin was industrious. If he couldn’t do something himself, he would find somebody who could. He put a positive face on things, which I think was why he was able to bring so many people along with him. PL: Why is it still important to you today to continue supporting Positive Living BC? BS: Not everyone has the means to donate every month, but lots of folks can donate their time volunteering. Volunteering is a chance to give back, to learn skills, and to develop self worth. In the beginning this was important for PWA, people with HIV/ AIDS, who were always being told they were worthless, and they were going to die, could achieve big things by working together. It created a real bond between people, of love and community. 5 Jason Hjalmarson is Director of Fund Development at Positive Living BC.

By Tom McAulay

the aftermath of the news about the “London Patient” being cured of HIV recently, I took a look at back issues of our newsletter and in the first newsletter that I looked at I found this article right away and was reminded of some of the crazy “cures” and remedies that were being touted in the early days of scientific development of HIV knowledge and antiretroviral therapies. Below is a reprint of the article “LifeChoice Canada and ‘Factor R’ “ from issue 75 of the BCPWA Newsletter February 1994. “The Community AIDS Treatment Information Exchange (was asked) to prepare a statement about this product (Factor R). The text of this statement follows: Dishonesty, fraud, and profit gouging are no strangers to the field of AIDS research and treatment. Many questionable businesses try to exploit the fears of people with cancer and/or HIV/AIDS. For these conditions which do not have a cure and for which existing treatments are at best toxic, these offers of ‘alternative treatments/serums/elixirs’ at outrageous prices are inexcusable. These expensive treatments do not work and may even cause harm. Remember the stories about oral alpha-interferon for AIDS several years ago? Or the news on Laetrile for cancer in the 1970’s? Unfortunately, Laetrile never cured cancer. Clinical trials in Canada and Germany found that oral alpha-interferon did not provide any benefit to people living with HIV/AIDS. There is no evidence that Factor R has improved the quality of life or health of people with HIV/AIDS. The sales literature for Factor R claims that the medical community has ignored Factor R. In this they are correct, because there is no acceptable documentary evidence that Factor R can improve the health of people living with HIV/AIDS.

The company marketing Factor R claims that their product works by stimulating the immune system to produce antibodies. Unfortunately, they have not kept abreast of HIV/AIDS research. It seems clear that stimulating the immune system to produce antibodies does not help people living with HIV/AIDS and may even speed up the decline of their immune systems. Finally, take a look at the slick Factor R brochures. There is an application form inside that looks just like an application for a credit card or loan, so you can see what people behind Factor R really want.” Some final thoughts on the “London Patient.” Positive Living BC welcomes the news of a second case of long-term remission of HIV in a patient following a bone marrow transplant from a donor with an HIV-resistant genetic mutation. While the patient must still be monitored to ensure that HIV does not rebound, this case will help guide research towards an HIV cure. This case is promising news for HIV cure researchers. Still, it is important to note that bone marrow transplants are medically complex and carry risks. Although this is not a feasible strategy for curing HIV on a mass scale, the findings may guide researchers working on gene and antibody therapies for HIV. We want to thank all the research and efforts done in the fight against HIV from past to present to future. 5

Tom McAulay is Chair of Positive Living BC.

P5SITIVE LIVING | 21 | MAY •• JUNE 2019

Understanding the Importance of the Placenta in HIV, ART & Pre-Term Birth By Sean Sinden

long-term study looks to expand our knowledge of the effect of HIV and antiretroviral therapy (ART) on the placenta and the factors that can help predict the risk of pregnancy complications in women living with HIV (WLHIV). Preterm birth (PTB) is a common yet serious mother-child concern and can have lasting effects on childhood development. Even among those who adhere to their medication to control the virus, WLHIV have a higher rate of PTB than those without HIV. Multiple studies estimate that the risk of PTB in WLHIV is 1.5 to 3 times higher than HIV-negative women. The reasons behind the increased risk of PTB are not understood, but may be due to the combined effect of HIV and ART. Research, some from a prior CTN study, suggests that ART may have negative effects on the health of the placenta by changing how placenta cells function, leading to pregnancy complications. Researchers believe that ART may cause a change in the structure and function of the DNA in the mitochondria, a specific part of the cell, in the placenta. To investigate the link between placental health, HIV, and ART, a CTN-supported cohort study—taking place over the next five years—is inviting pregnant women with and without HIV in Vancouver, Montreal, and Toronto to participate. Once participants have provided their informed consent, blood samples, and vaginal and mouth swabs will be collected during clinic visits throughout the pregnancy. Study samples will also be collected when women are admitted for delivery, whether at term or preterm. After birth, placental and umbilical tissue samples will be collected, and final study samples will be gathered six weeks after delivery. Placental specimens will be compared to those of HIV-negative women from a past cohort. Once the samples are collected, the study team will study the relationships between mitochondrial DNA mutations, hormonal levels, inflammatory markers, ART regimen, and other factors and their ultimate impact on pregnancy outcomes and PTB. The study is led by Dr. Hélène Côté, Associate Professor at the University of British Columbia and member of the Women’s Health Research Institute, and Dr. Isabelle Boucoiran, Clinical Assistant

Professor at Sainte-Justine Hospital in Montréal. More information about the study is available on the CTN website at www.hivnet.ubc. ca/clinical-trials/ctn-291-2. If you wish to participate, please contact Evelyn Maan, Research Manager, at 604.767.5044. 5 Sean Sinden is the communications and knowledge translation officer for the CTN.

Other Studies enrolling in BC CTN 222

Canadian Co-infection Cohort

CTN 283

The I-Score Study

BC site: St. Paul’s Hospital BC site: Vancouver ID clinic

CTN 288

LHIVE Healthy — Online

CTN 291-2

Preterm Birth in HIV+ Pregnancies BC site: Oak Tree Clinic

CTN 292A

Screening for 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

CTN 293

REPRIEVE Trial

BC site: Vancouver ID clinic

CTN 299

Bone health in HIV+ aging women BC site: Vancouver ID clinic

CTN 300

ENGAGE study

BC site: BC-CfE

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

P5SITIVE LIVING | 23 | MAY •• JUNE 2019

For a full list of donors visit positivelivingbc.org

Elizabeth Briemberg

Andrea Reimer

Katherine Richmond

Jane Talbot

John Yano

Len Christiansen

Penny Parry

Lorne Berkovitz

Patricia Dyck

Lawrence Cryer

Wayne Avery

Gbolahan Olarwaju

Barry DeVito

Jamie Rokovetsky

Stephen French

Mark Mees

Edith Davidson

Glynis Davisson

Dennis Parkinson

Patrick Carr

Jeff Anderson

Vince Connors

Carmine Digiovanni

$5000+

$150 - $499

LEGACY CIRCLE

HEROES

Peter Chung

$1000 - $2499 CHAMPIONS Paul Goyan

Fraser Norrie Paul Gross

Malcolm Hedgcock Joss De Wet Blair Smith Don Evans

$500 - $999 LEADERS Michael Holmwood Robert Capar Pierre Soucy Dean Mirau

Stanley Moore Cliff Hall

Emet Davis

Cheryl Basarab

Rebecca Johnston Christian Denarie Scott Elliott

James Goodman Elgin Lim

Brian Lambert

Ross Harvey

Brian Yuen

George Schwab

James Ong

Ron Hogan

John Bishop

Tom McAulay

Jean Sebastian Hartell

Susan Burgess

Ralph Trumpour

Stephanie Tofield

Ross Thompson

Glyn Townson

Mike McKimm

Larry Hendren

Sergio Pereira

Rob Spooner

Ralph Silvea

Patricia E. Young

William B Granger Maxine Davis

Gretchen Dulmage Pam Johnson Dena Ellery

Bonnie Pearson Keith Stead

Ronald Stipp Ken Coolen

Catherine Jenkins Angela McGie Tracey Hearst

Jason Hjalmarson Christine Leclerc Adrian Smith

Heather Inglis Chris Kean

Miranda Leffler

Adrienne Wong Lisa Raichle

Lindsay Mearns

Tobias Donaldson Christopher Clark

$20 - $149 FRIENDS Zoran Stjepanovic Jackie Yiu

Joel Leung

Hans Krishna Von Hagen Sharon Lou-Hing Lisa Bradbury

P5SITIVE LIVING | 24 | MAY •• JUNE 2019

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 “Since I started working with Chris at Reception, I have been impressed by his attention to detail and going the distance for our members. Chris excels in finding out exactly the right information for questions he’s asked on regular basis. This is crucial as our amazing reception volunteers—like Chris—are often the first contact and first impression of the Society for our members. Great work, Chris” Mike Hedges, Director of Operations

*Chris Clark*

When did you start with Positive Living BC?

Around 1998 until 2000. I returned in 2017. Why did you pick Positive Living BC?

I wanted to give back to an organization I had come to feel a part of. How would you rate Positive Living BC?

I feel appreciated as a volunteer and like I am helping the members as opposed to helping the staff. What is Positive Living BC’s strongest point?

I like the fact that it is still member driven.

What is your favourite memory as a volunteer?

I remember when they used to have extravagant banquets at the Boathouse Restaurant after every AIDS WALK. Of course, that was when there were more participants, donations, and sponsors. What do you see in the future for Positive Living BC?

My crystal ball shows a much leaner organization. If it happens for the right reasons, it will be good. If it happens because of apathy, it will be disappointing and disgraceful.

P5SITIVE LIVING | 25 | MAY •• JUNE 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 | MAY •• JUNE 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!

2ND THURSDAY EACH MONTH | 2 pm | 2nd Floor Meeting Room June 13, 2019

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”.

July 11, 2019

Board & Volunteer Development_ Marc Seguin

August 8, 2019

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

Sept 12, 2019

Reports to be presented >> PHSA Quarterly Reports | Director of Program and Services | Standing Committees | Events Attended

Oct 10, 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)

 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_ Wayne Campbell  604.893.2252

 waynec@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 | MAY •• JUNE 2019

Last Blast Addressing historic trauma in Indigenous healthcare By Sadeem Fayed and Alexandra King

Why

do Indigenous people in Canada carry such an unfair burden of hepatitis C? It is estimated that hepatitis C among Indigenous people is five-times higher than non-Indigenous Canadians. Indigenous women represent almost half of all hepatitis C cases in their communities, a greater proportion than among the non-Indigenous Canadian population. Indigenous youth (24 years and under) represent 70-80 percent of hepatitis C infections among Canadian injection drug users (IDU). These disparities are rooted in colonialism, including our colonial history, ongoing neo-colonialism, and systemic racism. Little attention has been paid to the role of colonialism in the hepatitis C epidemic. In new research, we describe how colonialism causes historic trauma, creating risk injection drug use and hepatitis C. Mainstream views on hepatitis C refer to Indigenous people as a high-risk group. This narrative is inaccurate and leads to severe misunderstandings. It singles out Indigenous people based on ethnicity and incorrectly depicts Indigenous identity as synonymous with drug use and hepatitis C. This perspective ignores colonialism as risk factor for hepatitis C, and as a result, typical interventions focus only on drug use and disease, failing to address the root cause. Colonialism leads to historic trauma and IDU is a response, which explains why IDU is more common among Indigenous people in Canada, but this reality is neglected in westerncentred views. A reconciliatory approach targets historic trauma and addresses it as the underlying cause of hepatitis C and IDU. This approach includes improving the engagement of Indigenous people in healthcare and harm reduction services. Historic Trauma Informed Care (HTIC) is a conceptual model that treats drug use and hepatitis C as symptoms of historic trauma. HTIC targets historic trauma to address the colonial roots of these health challenges.

We envision a three-pronged approach to HTIC: 1. Historic trauma prevention shifts the focus from drug use to historic trauma. Drug use is approached as a normal adaptive response to historic trauma rather than a primary risk. Instead, the focus is on prevention of re-traumatization within the context of hepatitis C care. 2. Historic trauma harm reduction focuses on strengthening resilience against existing historic trauma, through methods such as promoting cultural approaches to coping and stabilization within hepatitis C care. 3. Wellness promotion addresses hepatitis C infection as just the biological dimension of historic trauma response. It focuses instead on healing from historic trauma and wellness rather than just hepatitis C. Changing our thinking and actions about hepatitis C in an Indigenous context is what reconciliation is all about. A reconciliatory approach means prioritizing Indigenous communities, including youth and women. Without attending to historic trauma, the cycle of drug use and hepatitis C will endure. For more, see “In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care” in the Canadian Liver Journal. 5 Sadeem Fayed is a member of the Indigenous Wellness Research Group. Dr. Alexandra King is an internal medicine specialist and researcher with a focus on HIV/AIDS and hepatitis C.

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