Positive Living Magazine

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ISSN 1712-8536

JANUARY • FEBRUARY 2020 VOLUME 22 • NUMBER 1

PharmaNet & ARVs

Trans-friendly Care

The Perks of Iron

I N S I D E

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A CUP OF TABOO

Addressing the undo stigma of STI tests

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COVER STORY

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NUTRITION

Everything you ever needed to know about iron deficiency

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MOTOR DYSFUNCTION A cure seems tantalizingly & HIV close to reality, but challenges remain

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LET’S GET CLINICAL

CTN study on the barriers facing HIVpositive trans people

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PHARMANET RETHINK

Opinion: When it comes to ARVs, PharmaNet is behind the times

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GIVING WELL

HEU proud to support Study reveals the scope of education and care for mobility issues common PLHIV to PLHIV

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

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VOLUNTEER PROFILE Volunteering at Positive Living BC

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PAGE U=U

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The message that U=U is getting around

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STRANGE MUTATIONS

Harnessing the immune system in the fight against HIV

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LAST BLAST

Ministry of Health optimistically calls the epidemic nearly over

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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 | JAN •• FEB 2020

GPositive things

to remember about HIV today

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 Glen Bradford, Wayne Campbell, Brandon Laviolette, Joel Nim Cho Leung, Jason Motz, Adam Reibin, Glyn Townson MANAGING EDITOR Jason Motz DESIGN / PRODUCTION Britt Permien COPYEDITING Maylon Gardner, Heather G. Ross PROOFING Ashra Kolhatkar CONTRIBUTING WRITERS Jaylene Acheson, Hesham Ali, Wayne Campbell, Jason Hjalmarson, Sean R. Hosein, Anna McRae, Jason Motz, 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.

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© 2020 Positive Living

By Jason Motz

A

nother decade draws to a close.

But 2020 is more than a new calendar year; for many of you reading this it is another year of being a survivor. Seeing as this is the time of year people are open to reflection and forward thinking, let’s take a quick look at where things stand in 2020 on the HIV front. There really is so much to be excited about.

A 90-90-90 is working!

We may be off the mark for UNAIDS targets (90 percent of PLHIV diagnosed, 90 percent on antiretroviral therapy (ART), and 90 percent in viral suppression — all by 2020), but not by much. We’re at 79-78-86, globally; nothing to sneeze at.

What might have seemed improbable in 2014, has nevertheless turned the tide.

S Milestones are being met

From New York to Zanzibar, 90-90-90 targets are reported to have been met, if not surpassed. In the case of NYC, they are two years ahead. (Specifically, 93-90-92.)

There may be disparity gaps from country to country, but each success is something to build hope on.

D

TasP, locally born, universally acclaimed

The BC-born Treatment As Prevention (TasP) initiative has been instrumental in the crusade against HIV/AIDS. TasP has shown tremendous results here in BC (See P5SITIVE LIVING | 2 | JAN •• FEB 2020

page 28 for more). Brazil, China, France and more countries have all successfully adopted TasP. Doesn’t it feel good to live so close to the epicentre of HIV research?

F

New infections are falling

According to a recent report by Joint United Nations Programme on HIV/AIDS (UNAIDS), “Annual new infections, which indicate whether an epidemic is growing or ebbing, reduced to 1.7 million in 2018, down from 1.8 million the year before.”

G A Tale of Three Trials

Three HIV vaccine trials — HVTN 702, Imbokodo, and Mosaico — have reached the efficacy trial stage, leaving one lead HIV researcher feeling hopeful. Dr. Susan Buchbinder, director of the Bridge HIV research program at the San Francisco Department of Public Health, said: “it takes quite a bit to actually be promising enough in the earlier stages of trials to move you forward into an efficacy study.” 5

Jason Motz is the Managing Editor of Positive Living magazine.

Replication sites for HIV virus

The invisible US Hispanic/ identify underlying drivers of increasing Latino HIV crisis new HIV infections among Hispanics/

Faculty of Medicine and the CHU de Quebec-Universite Laval Research Center may have discovered where in the body HIV takes refuge during antiretroviral treatment.

A study using animal models shows that the virus may hide in lymph nodes in the spleen and gut. Researchers think those lymph nodes are the staging ground from which the virus prepares to relaunch the infection after treatment has stopped.

The researchers used macaques infected with simian immunodeficiency virus (SIV), a close cousin of HIV. They found that during antiretroviral treatment, two types of cells in the spleen and gut lymph nodes act as reservoirs replication sites for the virus. These cells belong to the family of CD4 T lymphocytes, the preferred target of HIV. “These cells are involved in mounting the immune response,” said Professor Jerome Estaquier, team lead. “We don’t know why the viruses taking refuge in these cells are able to escape antiretroviral drugs. They may have a mechanism that limits the flow of drugs or eliminates them faster. To improve treatment, we’ll need a better understanding of what allows these cell populations to escape antiretroviral drugs.”

The team focused on the tissues and lymph nodes that harbour CD4 T cells.

Other organs of the body that are not linked to the lymph system may also serve as reservoirs for HIV. Source: Eurekalert.org

Union Address, President Trump promised to reinforce national efforts to end the US HIV/AIDS epidemic by 2030. However, the national public health agenda has neglected the accelerating HIV/AIDS crisis in Hispanic/Latino communities. Progress in the fight against HIV is reflected in aggregate data for the United States, but data released by the Centers for Disease Control and Prevention (CDC) raise alarming concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanics/Latinos.”

So begins a peer-reviewed commentary published in the November 14, 2019, edition of the American Journal of Public Health and principally authored by Professor Vincent Guilamo-Ramos of the NYU Silver School of Social Work.

The article notes that the federal government is seeking to put an end to HIV transmission in the US in little more than a decade. But, it states, while the number of estimated annual new HIV infections in the US has declined overall by 6 percent since 2010, it has increased among Hispanic/ Latino populations by 14 percent or more.

The alarming trend is best understood by considering the specific Hispanic/Latino populations most heavily affected by HIV/ AIDS, such as Hispanic/Latino gay and bisexual men 25-34 years old, who experienced the largest increase in estimated annual new HIV infections of all groups reflected in CDC surveillance data.

Dr. Guilamo-Ramos draws from his research in Latinx communities to

p Researchers at Universite Laval’s

p “In his February 5, 2019, State of the

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Latinos most at risk, discusses current national efforts to fight HIV across the demographic, and underscores gaps in the national response.

Consideration of these underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration’s 2030 HIV/AIDS goals— with specifically focused investment in: (1) HIV stigma reduction in Hispanic/ Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.

Source: https://www.eurekalert.org/ emb_releases/2019-11/ nyu-tiu111319.php

Unruly T cells and HIV vaccines

p Inducing strong responses from T

helper (TH) cells—long seen as a desirable goal for HIV vaccines—and using multiple antigens can hamper the effectiveness of vaccine candidates for HIV, according to an analysis of macaque experiments and a multicenter, phase one trial. The results from both studies highlight how investigators will need to carefully account for the effects of activated TH cells in their efforts to create a workable vaccine for HIV. Many vaccine candidates for HIV aim to induce strong and durable antibody responses, often by stimulating responses from CD4 TH cells.

However, recent research has called this assumption into question: some studies indicate HIV-specific CD4 T cells are more easily infected by the virus, and a previous trial showed that a vaccine candidate increased the risk of acquiring HIV among some individuals.

Venkateswarlu Chamcha and colleagues studied immunization data from four previous studies in macaques and discovered that a vaccine for SIV only granted strong protection to animals that had a lower frequency of vaccine-specific T-helper type-1 (TH1) cells. Specifically, they observed that vaccine induced CD4 T cells migrated to mucosal tissue in the colon and cervix, where they persisted and expressed a higher amount of CCR5, a coreceptor that HIV exploits to enter immune cells. The authors theorize that the stimulated cells could be abrogating vaccine protection by providing new targets for the virus to infect.

Source: http://www.aaas.org/

men (MSM), people between the ages of 20-29, and people who use injection drugs.

Diagnosis rates did rise among transgender people and men who report both having sex with men and injection drug use.

“Until we see equitable progress among New Yorkers from all walks of life, we must double down on our efforts to fight the institutional racism, sexism, homophobia, transphobia, and other forms of stigma that put people at greater risk of HIV infection and, for people with HIV, put care and treatment further out of reach,” said Dr. Oni Blackstock, Assistant Commissioner for the Health Department’s Bureau of HIV. “We cannot end the epidemic among New Yorkers without ending the epidemic among all New Yorkers.”

For more information read the HIV surveillance report 2018: https://www1. nyc.gov/assets/doh/downloads/pdf/dires/ hiv-surveillance-annualreport-2018.pdf Sources: The Advocate

Fewer New Yorkers diagnosed with HIV in 2018

HIV drug exposure in womb may increase child risk of microcephaly

Annual Report (released in November), 1,917 people were newly diagnosed with HIV in New York City in 2018, down 11 percent from the previous year.

“The historic decline in the number of new HIV diagnoses marks another milestone in our decades-long fight against the epidemic in New York City,” said Deputy Mayor for Health and Human Services Dr. Raul Perea-Henze.

Drops in new HIV diagnoses were largest amongst men who have sex with

(ART) containing the drug efavirenz were two to two and a half times more likely to have microcephaly, (small head size), compared to children born to women on regimens of other antiretroviral drugs, according to the National Institutes of Health. The children with microcephaly also had a higher risk for developmental delays, compared to children with normal head size.

Researchers analyzed data from a follow-up study of more than 3,000 infants

p According to the 2018 HIV Surveillance pChildren born to women on HIV therapy

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born to women on HIV therapy during pregnancy. In this earlier study, the children’s head circumferences were measured periodically from 6 months of age through 5 to 7 years of age.

For the current study, investigators used two classification systems to rank the children’s head growth. The first classification system combined standards developed by the US Centers for Disease Control and Prevention for children under 3 years of age with Nellhaus charts, an older set of standards for children over 3 years of age.

For the second classification system, the researchers consulted Nellhaus charts from birth to age 18.

Based on Nellhaus standards, children whose mothers were on regimens containing the drug efavirenz were more than twice as likely to have microcephaly, compared to children whose mothers were on other regimens. According to the combined Nellhaus-CDC standards, children exposed to efavirenz in the womb were around two and a half times as likely to have microcephaly.

Children with microcephaly according to Nellhaus standards also scored lower on standardized tests of child development at ages one and five years.

Of the 141 children exposed to efavirenz in the womb, 14 had microcephaly, compared to 142 of 2,842 who were not exposed to efavirenz. The researchers noted that exposure to all other types of HIV therapies was not associated with a higher risk of microcephaly.

Source: http://www.nichd.nih.gov/ 5

A

UP of taboo

Who really has safer sex?

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By Jaylene Acheson or way too many adults, STI is a dirty word. They turn away when they hear the words STI check, for whatever their reason. I see this a lot when I go for a run-of-the-mill STI test. People’s faces look away when I turn around, they look at anyone or anything but the femme who just said that little acronym. Why is our culture so focused on the aspect of a “safer” (or “less promiscuous”) way of living? And why is the habit of getting their sexual health checked seen as dirty?

This judgemental mentality is likely based on the idea that if you are getting an STI test, you’re not in a monogamous relationship. Whether you live a single life with random hookups, or you are in a consensual non-monogamous (CNM) relationship, the traditional cultural values that we are taught about sex do not mix well with these ways of living and loving.

Westerners are taught from an early age that too much sex is bad or risky; abstinence and fewer partners is the best way to protect yourself.

Most of us were taught that only monogamy keeps us safe; but the results of a 2015 Ball State University study revealed something else. Comparing the sexual practices of both monogamous and CNM people, researchers found that CNM people not only reported a higher condom use with both their primary and non-primary sexual partner(s), but that they also got tested for STIs more often. About one quarter of those monogamous people had had sex outside of their closed relationship—often without using any safe sex barriers, such as condoms.

Even though on paper monogamy and a limit on sexual partners seem like a good bet, it also provides an unquestioned barrier that the idea of STI safety and monogamy is something

that does not mix. And, sure, if partners followed the one form of sexual relationship that we usually see being presented as the “correct” one (i.e. having intercourse for the first time with each other and only having intercourse with that same person for the rest of their lives), the need for STI testing would be low.

However, lots of people are straying away from that relationship timeline, either by choosing a CNM lifestyle, or a monogamous person having further sexual exploration before choosing to have one permanent partner. So, I ask, how long ago did you get together with your monogamous partner? Even though you promised each other your fidelity in this present moment, have you taken time to consider the moments of fun you both experienced before the relationship?

Back to the head turners at the clinic. I make sure I do not turn my head away. I keep a warm smile on my face, showing them that my visit doesn’t mean it’s a concerning one. What it means is I am a person with an existent (and exciting) sex life that I practice safely. I keep it that way by showing up for my STI test every three months, a good recommendation for those with multiple partners.

So next time you’re in line for an STI test, show people you’re not scared or embarrassed, and the others may follow your lead. 5 Jaylene Acheson is a sex coach who works with individuals and couples towards a fulfilling sex life through sexuality empowerment workshops. Find her on Instagram and Facebook: @femmeforth.

P5SITIVE LIVING | 5 | JAN •• FEB 2020

It began decades ago...

A community came together.

YOU are that community.

Let’s

build a

healthy future.

TOGETHER.

A mineral for fighting fatigue

By Anna McRae

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eople living with HIV who have a lower CD4 count sometimes have low levels of other blood cells. This may be caused by damage to the bone marrow where blood cells are produced. HIV can infect bone marrow directly or disrupt levels of growth factors that help bone marrow cells develop. Bone marrow may also be affected by some drugs, especially anti-HIV drug zidovudine (AZT, Retrovir), which can cause anemia (lowered number of red blood cells) and neutropenia (lowered number of white blood cells).

Anemia has many causes unrelated to HIV and drug treatments. Iron deficiency is a common cause of anemia. Iron deficiency anemia occurs when the storage of iron is so low that hemoglobin levels fall below normal. Signs of anemia include feeling tired and weak, difficulty maintaining body temperature, pale skin, and glossitis (an inflamed tongue).

Iron is a mineral found in our red blood cells, attached to hemoglobin. Iron helps hemoglobin carry oxygen throughout the body helping with cell growth and maintaining the immune system. Food contains iron in two forms: heme and

non-heme iron. Heme iron is more easily absorbed into the body and is found in meat, fish, and poultry.

Non-heme iron is not absorbed as well and is found in dried beans, whole and enriched grains, nuts, and some fruits and vegetables. Non-heme iron absorption can be increased when eaten with heme iron sources and vitamin C sources (citrus fruits, cantaloupe, bell peppers, strawberries, tomatoes and broccoli). The tannins in coffee and tea may decrease iron absorption, so have these beverages after meals. Calcium supplements and dairy may also decrease iron absorption, so eat calcium-rich and iron-rich foods separately to enhance absorption.

The best absorbed form of supplemental iron is ferrous iron salts (ferrous fumarate, ferrous sulfate, and ferrous gluconate). Side effects from iron supplements may include constipation, diarrhea, dark coloured stool, nausea, vomiting, and abdominal pain. Taking supplements with food or in divided doses may help limit these symptoms. Getting enough fibre in your diet and drinking enough water can also help to manage constipation from iron supplements.

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If you are concerned about your iron status, ask your doctor to check your blood iron levels or check with your dietitian to see if you get enough iron in your diet.

When excessive amounts of iron are consumed, the buildup of iron can cause organ damage, resulting in liver cirrhosis and heart failure. Because of the risk of toxicity, it is important to take iron supplements only when prescribed by a physician.

To get iron from your diet, include lean meats, poultry and fish (heme iron), beans, lentils and nuts (non-heme iron).

Include a variety of fruits, vegetables, and whole grains—spinach, fortified cereals, and fortified instant oatmeal are good sources of non-heme iron. Remember to include a source of vitamin C, such as citrus fruit or red bell pepper, to improve the absorption of non-heme iron. You can also cook foods in a cast iron pan to increase the amount of iron in your meals. 5 Anna McRae is a Clinical Dietitian, St. Paul’s Hospital and the John Ruedy Clinic/Providence Crosstown Clinic.

Gay, bisexual men increasingly agree: HIV ‘undetectable equals untransmittable’

A

By NIH/National Institute of Allergy and Infectious Diseases new study of nearly 112,000 men who have sex with men (MSM) in the US has found increasing acceptance of the U=U message in this population. Overall, 54% of HIV-negative participants and 84% of participants with HIV correctly identified U=U as accurate.

“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” said Anthony S. Fauci, Director of National Institute of Allergy and Infectious Diseases (NIAID). “The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world. This public health message has the power to reduce stigma, protect the health of people living with HIV and prevent sexual transmission of HIV to others.”

Researchers found U=U acceptance had increased over time by comparing the data to findings from a similar study by the same group that analyzed data collected in 2016 and early 2017. Among the 12,200 sexual minority men surveyed at that time, only 30% of HIV-negative participants and 64% of participants living with HIV agreed that U=U was completely or somewhat accurate.

In the current study, HIV-negative participants who reported seeking HIV testing and prevention services, as well as those taking daily PrEP, were more likely to believe U=U was accurate. These findings suggest that U=U acceptance correlates to more frequent interactions with HIV prevention services. Among respondents with HIV, those who reported excellent adherence to ART were more likely to agree that U=U is accurate compared to those who reported “less than excellent” adherence or not being on ART at all.

Researchers led by H. Jonathon Rendina, at Hunter College of the City University of New York, collected data from secure online surveys promoted on social media and mobile dating apps from November 2017 through September 2018. By analyzing the responses of self-identified sexual minority men, researchers found that approximately 55% of participants responded “completely accurate” or “somewhat accurate” to the question: “With regard to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan Undetectable = Untransmittable is?”

Acceptance of U=U was far stronger among participants who self-reported to be living with HIV (84%) compared to HIV-negative participants (54%) and those who did not know their HIV status (39%).

Among those who agreed that U=U was “completely accurate,” only 31% and 39% believed transmission risk is zero when the insertive or receptive partner, respectively, has undetectable virus.

However, acceptance of U=U was associated with lower perceived risk of HIV transmission through any form of condom-less anal sex.

“A growing number of sexual minority men believe that U=U is accurate, but our data suggest that most still overestimate the risk of HIV transmission from an undetectable partner, which may be because people have trouble understanding the concept of risk,” said Dr. Rendina. 5 Study results were published online in the Journal of Acquired Immune Deficiency Syndromes.

P5SITIVE LIVING | 8 | JAN •• FEB 2020

PharmaNet is behind the times when it comes to ARVs

By Hesham Ali

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imes have changed and as we continue to evolve as a community, we should review and update our position vis-a-vis many issues. While acknowledging and honouring the past, we should be able to move forward. I firmly believe in that statement.

Approximately 30 years ago, at the time when the first ART medications became available, the ministry of health created PharmaNet. The purpose was to centralize all community pharmacies in order to better monitor prescription usage. And more importantly, to allow pharmacists to check for medication interactions and contraindications to ensure patient safety. The database has several security features including tracking whenever an authorized health care provider accesses a patient’s profile.

The system tracks why the authorized provider accessed the profile. The provider must have a valid reason as defined and regulated by the administrator. The system also stores the time and date of access for future reference. Your pharmacist cannot just browse a patient’s PharmaNet account out of curiosity or to

just check what’s on the account. The same applies to other health care providers allowed to use the system, such as emergency room physicians, specialists, etc. The PLHIV community advocated for the exclusion of ARVs from PharmaNet to protect all PLHIV and to ensure privacy for PLHIV in rural areas or in small communities that may have just one pharmacy. HAART medications were not included on the PharmaNet database. The ministry of health reluctantly agreed at the time.

Back in the mid-90s, the number of ARV medications were limited to a handful. Fast forward to the present day and the number of available ARV medication combinations exceeds 45— and counting. The reality of living with HIV right now is completely different from the mid-1990s. Not only in terms of medical care but also in terms of other factors including more available support, and more education. As a result of effective treatment, PLHIV are now living longer lives.

As we age, we see increases in other comorbidities such as cardiovascular disease, cancers, etc. PLHIV are taking other

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medications to deal with other health issues. The issue of polypharma, or concurrent use of multiple medications, now comes into play as more medications are prescribed to treat health conditions such as heart disease. With the overall complexity of available ARV medications, the addition of other medications into the equation requires increased vigilance for drug interactions and contraindications to ensure safety. This affects safe prescribing as some doctor’s clinics and all hospitals access PharmaNet to inform their decisions regarding the choice of medications.



Continuing to hide ARVs from PharmaNet perpetuates treating HIV as a secretive, shameful illness. 

The ability of pharmacists to ensure safe dispensing of medications is greatly limited under the present situation of ARV exclusion from PharmaNet. Pharmacists are truly the last line of defence when it comes to checking for drug interactions and contraindication and they should not be excluded from having access to crucial information.

Pharmacists are trained to catch and intervene in drug-related problems. But they can only help if they have the necessary information. Unfortunately, we have an entire generation of pharmacists who are not familiar with ARVs. The PharmaNet system does have a built-in alert for drug interactions and pharmacists have access to databases to check specific medication.

Not all physicians are familiar with HIV medications, whether they are in family practice or specialized practice like cardiology or surgery. They could prescribe a medication that is counter-indicated to the patient’s current ARV regimen. Only a pharmacist can intercept this and ensure the patient’s safety. There have been documented cases where such incidences have happened with serious drug interactions that have harmed the PLHIV involved.

Currently the only pharmacists who can see both the ARVs and PharmaNet are St. Paul’s hospital’s specialist pharmacists.

Although they check for drug interaction and contraindication this only happens at the time of ARVs dispensing meaning that this important safety check may only happen every two or three months or longer. A lot could happen with regards to the patient’s health in the period between ARV dispensing. We should not rely on just a one encounter or one pharmacist being extra vigilant heading into the future.

Another area of great concern is hospitalization. When a patient is admitted to a hospital, authorized health care providers will access

PharmaNet to order and verify current medications on the patient’s account that need to be continued during the hospital stay. ARVs are not included on PharmaNet resulting in unintended treatment interruption. This is aggravated if the hospital cannot get the prescribing physician to send over another script and if the hospital is unaware that the patient needs ARVs. The current situation is causing real harm to PLHIV in terms of drug interactions and contraindications as well as unplanned treatment interruptions.

The main objection from some PLHIV to include ARVs on PharmaNet has centred on privacy issues particularly for PLHIV in smaller communities. Stigma and discrimination are real. For PLHIV in rural areas stigma is compounded by the reality of living in a small community where everyone knows or is related to everybody else. There is also the unfounded fear that insurance companies could have access to PharmaNet records without consent. The fact is, even with consent, no insurance company or private party can access PharmaNet directly; The regulation is very specific as to who is granted access.

While not discounting these concerns, it’s important to remember that pharmacists and all support staff working at a pharmacy must adhere to the same high privacy standards as health care providers and their support staff when it comes to access to information regarding HIV status. I do not believe that our response should be to pretend that we can ensure an absolute privacy for everyone no matter the unintended consequences—that’s an unrealistic position.

Our response should be to increase the resilience capacity in the community and for anyone living with HIV to cope with whatever situation may occur regarding privacy while emphasizing the absolute right to keep health issues private. Should the worst-case scenario happen, one should be able to respond in a healthy way and be prepared to deal with the situation. In terms of fighting stigma, continuing to hide ARVs from PharmaNet perpetuates treating HIV as a secretive, shameful illness. This is a form of internalized HIV phobia.

And as an agency we should be working to educate and empower PLHIV and not feed into the stigma.

The potential unintended disclosure of HIV status/privacy breach should be balanced with the wider interest of PLHIV who could be harmed by medication interaction or contraindication or unplanned treatment interruption. I used to support the exclusion of ARVs from PharmaNet; but the strength and merit of the arguments for inclusion convinced me otherwise. It is time to include ARVs on PharmaNet. We are fortunate that we can change as HIV becomes a manageable chronic condition. It should be treated as such. No shame, no stigma, no going back. Let’s have ARVs on PharmaNet and keep moving forward! 5 Hesham Ali is a Peer Navigator with Positive Living BC.

P5SITIVE LIVING | 11 | JAN •• FEB 2020

When released, drop into our offices in either Vancouver or Surrey to be connected to a peer navigator, get linked into a variety of programs and services, as well as referrals to community case management services and health care.

POSITIVE LIVING BC

POSITIVE HEALTH 4th Fl. – 1101 Seymour Street, SERVICES CLINIC

JRC — ST. PAUL’S HOSPITAL

Vancouver BC V6B 0R1

5th Fl. – Burrard Building 1081 Burrard Street, Vancouver BC V6Z 1Y6

Jim Pattison Outpatient Care & Surgery Centre 3rd Fl. – 9750-140th Street, Surrey BC V3T 0G9

Contact the POPLine to request information about: • Anti-retroviral treatment information, side effects management, disease progression, disclosure strategies and criminalization • Peer counseling for people newly diagnosed with HIV • CHF updates POPLine: Federal 1.877.900.2437 Provincial 604.525.8646 P5SITIVE LIVING | 12 | JAN •• FEB 2020

Hidden Possibilities In pursuit of a functional cure

By Wayne Campbell

H

IV cure—these two words trigger deep emotions for many HIV-positive people. Will this be possible in my lifetime? How long will it be before my doctor can prescribe something to me?

What does a cure look like? There are plenty of questions, but few answers.

What does it even mean, this word “cure”? The term refers to strategies that eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease.

The Foundation for AIDS Research (amfAR) says that a cure for HIV/AIDS must meet three criteria; a person must be able to live a normal, healthy lifespan; will no longer require HIV medications; and will be unable to transmit the virus to others. Only a “sterilizing” or eradication cure would eliminate the virus from the body and meet the above criteria. An HIV cure must be effective, safe, simple, affordable, and scalable.

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continued next page

So far, only two patients with HIV appear to be free of the virus.

(See our cover story on The Berlin Patient, Timothy Brown, last issue.) But their treatments were drastic: the patients required a full-on bone marrow transplant that replaced vulnerable immune cells with HIV-resistant ones. Wiping out HIV wasn’t even the reason for the treatments—both had blood cancers that didn’t respond to chemotherapy and required a total blood stem cell reset — becoming HIV-free was a happy side effect. For the 40 million people globally living with HIV, bone marrow transplants are not a practical solution.

A “functional cure,” sometimes referred to as long-term viral suppression off HIV medications or sustained viral remission, would suppress viral load, keeping it below the level of detection without the use of HIV medications. The virus would be undetectable on the most sensitive tests available, but traces of the virus may remain in latent reservoirs in the body and could lead to a reinfection. Just like cancer, a person in remission may be undetectable for years only to rebound with a strain of virus dormant in their body. There have been approximately 100 short-term remissions noted in medical papers.

HIV persists in the body by forming a reservoir. The HIV reservoir refers to a collection of ‘resting,’ or latent HIV-infected cells. HIV may not be in the bloodstream, but it can still hide in a reservoir. At some point, HIV may re-activate, return to the bloodstream, and infect other cells.

There are several known reservoirs, including immune cells in the gut, lymphoid tissue, blood, brain, genital tract, and bone marrow. It is unclear when reservoirs are established, but recent research suggests that it could be as early as three days after initial infection.

Research also suggests that the earlier a person receives HIV treatment, the smaller the size of their reservoirs. Early treatment may also prevent reservoirs from forming in some areas of the body. It is important to keep the reservoir size small because people with larger reservoirs experience greater and more persistent immune activation.

However, there are some cases where the body’s immune system could suppress the virus for a while after ARVs were stopped. This period is called remission. Remission can last for months, and in rare cases, years. Not everyone experiences remission; in fact, it is quite rare and therefore each case is studied carefully. (There have been approximately 100 patients who have experienced short-term remissions as noted in medical papers.)

One of the top priorities of the HIV field is the search for therapeutic interventions that can lead to sustained antiretroviral

therapy–free HIV remission. Although many HIV-infected persons will experience rapid viral rebound after ARV interruption, there are rare individuals, labelled post-treatment controllers (PTCs), who demonstrate sustained virologic suppression for months or years after halting treatment. These individuals are considered the model of durable HIV control, with direct implications for HIV cure research. However, understanding of the mechanisms behind the capacity of PTCs to control HIV remains imperfect. This is in part due to the scarcity of PTCs identified through any one clinical trial, and in part because of the limited range of studies that have been performed in these individuals.

It has been shown that treating the virus within the first 48 hours of exposure can reduce the size of the HIV reservoir hidden in the body. This method, known as early ARV initiation, is suitable for certain people (e.g., newborn babies of HIV-positive mothers), but will not work for everyone. In infants born to HIV-positive mothers who started ARVs within 6-12 months of birth had reduced mortality rates and a smaller HIV reservoir.

However, many people do not get access to HIV treatment early enough and many people do not realise they have HIV until months after they are first exposed. This is another reason why it is important to go for an HIV test regularly so that you always know your status and can act quickly if you do become infected.

Overall, researchers feel that ARVs alone will not make a cure strategy; Instead, ARVs might make up part of a cure package.



ARVs alone will not make a cur ARVs alone will not make a cure strategy. Instead, ARVs might make up part of a cure package. 

One promising intervention for achieving ARV-free remission is broadly neutralizing antibodies (bNAbs). These powerful proteins can block nearly all HIV strains from infecting human cells in the laboratory and facilitate the killing of cells that have already been infected. While bNAbs develop naturally in some people with HIV, they usually do so either in amounts too small to provide a significant benefit or too late after infection to control the rapidly replicating and mutating virus. Studies are now underway of animals and people who have been taking

P5SITIVE LIVING | 14 | JAN •• FEB 2020

ARVs to determine whether periodic infusions or injections of bNAbs can keep HIV suppressed after ARVs are halted.

Ongoing research will determine the magnitude to which viral reservoirs can be emptied by combining antiretroviral treatment with novel medicines that flush HIV from its hiding places.

The idea is to force the hidden, infected cells to become active so that the body’s own immune system or ARVs can destroy the last remnants of the virus. This method is known as ‘Shock and Kill.’

So far, attempts to reduce the HIV reservoir in this way have used a group of agents called HDAC (histone deacetylase) inhibitors. These drugs, used in cancer treatment, can stimulate HIV production in latently-infected cells. Several small studies in PLHIV have found that a short course of treatment with an HDAC inhibitor had little effect on the levels of HIV DNA detectable in cells.

There is hope in the form of immunotherapy. There are three broad approaches to immunotherapies: (1) ‘knocking out’ genes in the virus that allow it to enter and infect immune cells; (2) ‘knocking in’ genes to our immune cells that make them resistant to infection; and (3) cutting out the genetic pieces of HIV that have become integrated into the DNA of infected immune cells.

The first strategy looks to disable HIV and make it unable to enter cells in your body by editing the genetic code of the virus. The genes that code for or provide the manufacturing instructions for HIV’s ability to enter cells would be deleted or ‘knocked out.’ Thus, HIV would remain in the body, but it would be unable to infect cells in your body or in someone else’s.

The second approach involves adding, or knocking in, genes to a person’s immune cells that would protect them against HIV. We know what those protective genes look like because some people are naturally born with them. These people are protected by their inability to produce a receptor called CCR5 on the outside of their immune cells that HIV needs to enter and infect the cells.

The Block-and-Lock technique takes the opposite approach to Shock and Kill. This method aims to trap HIV in its reservoir cell so that it can never be reactivated. While the virus is still present in the body, it is trapped away so that it cannot escape its host cell and cannot be replicated.

Scientists are testing drugs’ abilities to effectively trap HIV in a host cell without disrupting the genetic material of uninfected cells. Ideally, a drug would lock HIV away then

deplete the reservoir so there was no possibility of the virus returning.

As research moves forward in this field, there will be a couple of ethical dilemmas that will need to be addressed.

The first problem researchers have is how to get an accurate measure of the latent reserves. There are several assays that exist, but how precise the measurement is, is being debated.

Without a precise number, the Shock and Kill and Block-andLock methods may not achieve the needed viral remission.



HIV may not be in the bloodstream, but it can still hide in a reservoir. 

The second major dilemma, having no effective test for detecting latently infected cells, a structured treatment interruption will remain the only way of testing HIV cure interventions. If you stop your ARVs, you risk renewal of HIV production and replenishing your viral reservoirs. This results in a viral rebound, potential disease progression, and the possibility for HIV transmission.

It is essential to form a dialogue between community, healthcare providers, and researchers to develop ways to ease the risks to the patient, their sexual partners, and to any unborn children during a structured treatment interruption.

Close monitoring of patients during any treatment interruption with clear plans for restarting ARVs need to be part of cure intervention trials.

A cure for HIV is not yet in sight, but researchers believe it will be feasible soon. A functional cure is unlikely to be a single, one-size-fits-all approach. Instead, it will be a combination of methods and tailored strategies. You will likely be maintaining your current ARV therapy while you attempt to tailor your sustained viral remission attempt. 5

Wayne Campbell is Treatment Outreach Coordinator at Positive Living BC.

P5SITIVE LIVING | 15 | JAN •• FEB 2020

Motor dysfunction among some HIV-positive people

In

By Sean R. Hosein

the early 1980s, when the HIV pandemic was recognized, doctors soon began to document the impact of this virus on the brain. As explained in a previous CATIE News bulletin, HIV can affect important brain functions such as memory and thinking clearly (such changes are part of a cluster of problems called HIV-related neurocognitive disorder—HAND).

However, today these problems are usually minimal in the average HIV-positive person in Canada and other high-income countries thanks to effective HIV treatment (ART).

The virus can also have an impact on what scientists call motor functions – muscle coordination, reflexes and muscle strength – which affect people’s ability to move, including their ability to walk. To explore motor function and HIV infection in the current era, scientists at several centres in the US collaborated in a study of 354 people who had long-standing HIV infection. Such studies are important because as HIV- positive people age, they will probably experience an accumulation or layering of factors, such as cardiovascular and metabolic conditions, that can adversely affect brain health.

The scientists found that nearly 70 percent of participants had some degree of motor dysfunction; in most people this was mild.

However, in nearly 30 percent of the participants with motor dysfunction, this problem was classed as “severe” by the scientists.

Issues such as cardiovascular disease and a history of AIDS-related complications affecting the brain were linked to an increased risk of motor dysfunction. There was less of an association between neurocognitive issues such as HAND and motor dysfunction.

The present study is important because it paves the way for additional studies where HIV-positive people will be monitored over the long term to better understand the drivers of motor dysfunction and to find out if interventions can stabilize or reverse it.

Study details

Participants were recruited from four USbased clinics in the following cities: Galveston, Los Angeles, New York and San Diego.



In nearly 30 percent of the participants with motor dysfunction, this problem was classed as “severe” by the scientists. Participants underwent extensive assessments with a focus on neurocognitive and motor functions. The medical records of participants were also scrutinized for a history of HIV-related complications that could affect the central nervous system, or CNS (i.e., the brain and spinal cord). Here is a list of some of those complications: CNS lymphoma; CNS toxoplasmosis; CNS tuberculosis; cryptococcal meningitis; CMV (cytomegalovirus) encephalitis; neurosyphilis, and PML (progressive multifocal leukoencephalopathy).

P5SITIVE LIVING | 16 | JAN •• FEB 2020

Participants’ history of cardiovascular disease was also reviewed as this can affect brain health.

The average profile of participants when they entered the study was as follows: age 60 years; 73 percent men, 27 percent women; current CD4+ cell count – 538 cells/mm3; length of HIV infection – 24 years; distribution of viral load readings: undetectable viral load (less than 50 copies/mL) – 82 percent; viral load between 51 and 999 copies/mL – 10 percent; viral load greater than 1,000 copies/mL – seven percent (percentages do not add up to 100 percent because of rounding).

The scientists described the study participants as “medically complex.”

Results

In their analysis, the scientists found that motor dysfunction was “common,” occurring in 69 percent of participants. However, the researchers noted that in most of these people it was mild, with 29 percent of motor dysfunction diagnoses being what they termed “severe.”

The distribution of motor dysfunction was as follows: abnormalities in walking – 54 percent; abnormal coordination of muscles – 39 percent; reduced strength – 25 percent; abnormal reflexes – 24 percent.

Motor dysfunction associated with walking was in part driven by injury to the nerves in the feet and legs, a condition called peripheral neuropathy.

HAND

Some of the assessments done in the study were for neurocognitive impairment.

The scientists found that the distribution

of neurocognitive impairment was as follows: symptom-free neurocognitive impairment – 16 percent; and cognitive impairment with symptoms – 46 percent.

A total of eight percent of participants had HIV-related dementia and seven percent of participants had had one or more previous episodes of HIV-related CNS complications.

Intersection with cardiovascular disease

Cardiovascular disease can affect the health of the brain. Arteries supply oxygen-rich blood and nutrients to the brain.

If the supply of blood is reduced because of cardiovascular disease, then brain health can decline.

The scientists found that participants who had normal neurocognitive function or symptom-free neurocognitive impairment tended to have lower rates of cardiovascular disease – between 21 percent and 25 percent. In contrast, participants who had symptoms of cognitive impairment tended to have higher rates of cardiovascular disease – between 30 and 39 percent.

According to the scientists, “demographics, musculoskeletal [issues], alcohol use and other immunovirological variables were not associated with [HIV-related motor dysfunction].”

Bear in mind

In this group of medically complex people, scientists found that motor dysfunction was common. This problem manifested itself most frequently with walking, followed by muscle coordination and muscle strength.

Motor dysfunction was associated with cardiovascular disease and with prior CNS complications related to HIV infection.

The researchers think that injury to the brain caused by ongoing cardiovascular disease adds yet another layer of motor impairment to that caused by HIV. They

stated that “there is precedent for such layering of CNS diseases in other neurodegenerative conditions [such as Alzheimer’s disease and vascular dementia].”

The scientists noted that their study’s findings are not applicable to younger HIV-positive people.

About this study’s design

The scientists collected data from one point in time for each participant. Studies like this one are cross-sectional in nature.

Cross-sectional studies are good at finding associations, but because of built-in limitations they can never prove what scientists call “cause and effect.” That is, cross-sectional studies cannot prove what causes a problem. However, such studies can find associations between a disease and possible causes. Studies of more robust designs can then be undertaken to uncover the causes of a problem and evaluate ways to address it. Cross-sectional studies are a good first step in trying to understand a biomedical issue and can be done more cheaply than several other types of studies.

For the future

More research needs to be done on HIV-related motor dysfunction. The scientists of the present study think that this problem “may be the end result of neurologic multimorbidity, akin to the systemic multimorbidity that has become an increasingly recognized feature of [chronic HIV infection in the current era].”

Such research could lead to early identification of the drivers of HIV-related motor dysfunction and ways to prevent, stabilize or reverse muscle problems. 5 This information was provided by CATIE (Canadian AIDS Treatment Information Exchange). For more information, contact CATIE at 1.800.263.1638 or info@catie.ca P5SITIVE LIVING | 17 | JAN •• FEB 2020

Giving Well public health care. I have held in many positions at my HEU local, and have served several terms as president of the Kamloops and District Labour Council. I was on CUPE (Canadian Union of Public Employees) National’s political action committee, and on the B.C. Federation of Labour’s political action committee. I am dedicated to electing progressive governments who respect workers and value the work we all do to contribute to our society and within our communities.

PL: Why is giving back to the community important for the HEU ?

For

this month’s Giving Well, Barb Nederpel explains the charitable rationale behind the Hospital Employees’ Union (HEU), title sponsor of the 2019 Vancouver AIDS WALK, and a little on the HEU’s progressive background.

Positive Living: Tell me about yourself.

What’s important to know about you?

Barb Nederpel: My name is Barb Nederpel.

In 2018, I was the first woman elected president of the HEU. A former Licensed Practical Nurse (LPN), I have also worked on health care’s frontlines as a care aide and records clerk. Since 2012, I have served on HEU’s Provincial Executive in the role of 1st vice-president and 2nd vice-president, and as a member of the union’s bargaining committee. I am an advocate for workers’ rights, social justice, human rights, and

BN: HEU has a long history as a strong, democratic, socially-conscious union, and is a passionate defender of Canada’s universal public health care system. In solidarity with labour and community allies, HEU is committed to social justice and advancing labour and human rights on a global level. Our union was one of the first in Canada to negotiate same-sex spousal benefits and the first to elect an openly gay president—Victor Elkins in 2012. We went all the way to the Supreme Court of Canada in the 1990s to secure the right to organize and certify First Nations health care workers living on- or off-reserve Since the 1990s, HEU has supported efforts to raise money and awareness about HIV/ AIDS. In past years, our union has participated in skydiving fundraising events and formed an HEU Team for the AIDS Walk.

One year, we had a team of about 30 HEU P5SITIVE LIVING | 19 | JAN •• FEB 2020

A DONOR PROFILE

By Jason Hjalmarson

members and staff—who also promoted our Living Wage Campaign—as part of our AIDS Walk activism, and our Pride festivities.

PL: Tell me a little more about the HEU’s history?

BN: The HEU is the oldest health care union in BC, representing more than 50,000 members working for public, non-profit, and private employers. And as the BC health care services division of CUPE, HEU is part of the biggest union in Canada. work in all areas of the health care system—hospitals, residential care, community group homes, outpatient clinics, labs, community social services, and First Nations health agencies—providing both direct and non-direct care services.

PL: Why is HIV an important issue for the HEU? BN: There were 37.9 million PLHIV globally in 2018, including 1.7 million children under the age of 15. The AIDS Walk not only raises money for PLHIV, but it also awareness about the disease. We need better education, support, and care for PLHIV. We can make a difference. 5

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

contact peer navigation services

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Floor • 1101 Seymou r St • Vancouver • BC V6B 0R1

Immune system can be coaxed into selecting key antibodies to fight HIV

R

By Duke University Medical Center

esearchers have cleared a major obstacle in the development of an HIV vaccine, proving in animal models that effective, yet short-lasting antibodies can be coaxed into multiplying as a fighting force against the virus.

“The reason we don’t have a vaccine is because the immune system doesn’t want to make the kind of antibodies that are needed to neutralize the virus,” said co-senior author Barton F. Haynes, director of the Duke Human Vaccine Institute. “This study [proves] we can engineer the immune system to create an environment where the right antibodies can be made.”

The researchers built on years of studies that identified how and when broadly neutralizing antibodies (bNAbs) arise in people with HIV infections, and what stops the antibodies from growing to negate the virus.

One problem lies in the immune system, which identifies some bNAbs as a danger and shuts down their production. Another issue is that the neutralizing antibodies require rare changes in their genetic make-up that are seldom made during a crucial B-cell diversification process.

The researchers traced those relevant mutations. Then they engineered an HIV protein, targeting a site called the V3 glycan region of the virus envelope, that preferentially bound to antibodies that have the unlikely but necessary mutations.

Using mouse models that express human neutralizing antibody precursors, the researchers demonstrated that their immunogen could coax a lineage of B-cells to undergo the odd mutations that result in bNAbs. “Our ability to make mouse models that express human bNAbs has provided powerful new model systems in which we can iteratively

test experimental HIV vaccines”, said Frederick Alt, director of Boston Children’s Program in Cellular and Molecular Medicine.

A second line of bNAbs—binding to a different region of the virus’s outer envelope called the CD4 binding site that has long been a focus of HIV research—also went through strange mutations. After the researchers reconstructed this antibody’s history, they built a second immunogen.

Tested in non-human primates, it also selected for the necessary mutations, which led to the growth of potent CD4 binding-site neutralizing antibodies.

“We have identified the mutations we need, which the immune system won’t easily make, and can select for them in a vaccine that targets that mutation,” co-author Kevin Saunders said. “We have shown that we can overcome this major roadblock and can select for the right mutational changes in these bNAb precursors when they are starting to get better and better at neutralizing activity.”

Haynes said the research shows the intricacies of eliciting broadly neutralizing antibodies for HIV. And while an HIV vaccine still needs more work, the findings already have wider applications.

“This strategy of selecting specific antibody nucleotides by immunogen design can be applied to other infections for which vaccine development has been difficult,” Haynes said.

These insights have direct implications for cancer immunotherapies and treatments for autoimmune disorders. Both require strategies that precisely turn the immune system on or off without triggering a harmful cascade of unintended consequences. 5

P5SITIVE LIVING | 21 | JAN •• FEB 2020

TEACHHing care providers about trans-inclusive HIV care

By Sean Sinden

A

new CTN-supported study is creating a workshop for care providers to improve their knowledge and reduce stigma related to treating HIVpositive trans people.

“Transgender women have much higher rates of HIV compared to cisgender adults,” said Dr. Carmen Logie, principal investigator of the project. “This is due to several forms of marginalization, including structural and social inequities.”

Inequities like poor HIV prevention, resources and services tailored to meet trans women’s needs, not to mention poverty and transgender stigma.

Healthcare and social service providers lack knowledge about trans health issues specific to the HIV cascade of care.

Compounding the matter is the fact that there are no high-quality interventions aimed at providers to better their knowledge on providing trans- specific HIV care in Canada.

In response, Dr. Logie and co-lead Yasmeen Persad from The 519 community centre and Women’s College Hospital’s Trans Women HIV Research Initiative (TWIRI), are working with the CTN 317 team to develop the Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH) Workshop.

The workshop was developed through a collaborative and trans-led approach. The team held initial focus groups with trans

women to get their feedback and recommendations on early forms of the workshop, and to point out areas that needed to be covered. Exact subjects included in the workshop are trans-inclusive language, human rights, social and structural inequities, transphobia, and stereotypes.

TEACHH Workshop is being pilot tested in Vancouver through the following sites: Atira Women’s Resource Society, the Dr. Peter Centre, the Options for Sexual Health Clinic, AIDS Vancouver, and Vancouver Coastal Health.

Participants in the pilot phase complete a structured interview before and after the workshop. This allows researchers to test participant knowledge, attitudes, and trans competency so to note any changes following workshop participation.

The final phase will be to mobilize the knowledge gained during the study through community events, information handouts, and expand the workshop to more care providers across Canada.

For more information about the TEACHH Workshop, or are interested in participating in the study, please contact Dr. Logie at carmen.logie@utoronto.ca. 5 Sean Sinden is the communications and knowledge translation officer for the CTN. P5SITIVE LIVING | 23 | JAN •• FEB 2020

Other Studies enrolling in BC CTNPT 030

Feasibility of crystal meth interventions among GBMSM BC Sites: St. Paul’s, University of Victoria

CTNPT 036

Novel Assay for Syphilis BC Site: BCCDC Provincial STI Clinic

CTN 283

The I-Score Study BC site: Vancouver ID clinic

CTN 291-2

Preterm Births in HIV+ Pregnancies BC Site: BC Women’s Hospital

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

The Engage Study BC Site: St. Paul’s Hospital Visit the CIHR Canadian HIV Trials Network database at www.hivnet.ubc.ca for more info.

For a full list of donors visit positivelivingbc.org

$5000+ LEGACY CIRCLE Peter Chung

$1000 - $2499 CHAMPIONS Malcolm Hedgcoc Joss De Wet Paul Gross Fraser Norrie Blair Smith Don Evans

$500 - $999 LEADERS Brian Descoteauxs Michael Holmwood Stanley Moore Dean Mirau Pierre Soucy Cliff Hall Emet Davis Rebecca Johnston Christian Denarie James Goodman Cheryl Basarab Mike McKimm Brian Lambert

$150 - $499 HEROES Byron Cooke Katherine Richmond Brian Yuen Len Christiansen James Ong Lorne Berkovitz John Bishop Lawrence Cryer Jean Sebastian Hartell Mark Mees Ralph Silvea Vince Connors Glynis Davisson Jeff Anderson Ross Thompson Jamie Rokovetsky Darrin Pope Sergio Pereira William B Granger Maxine Davis Todd Hauptman Gretchen Dulmage Keith Stead Ronald Stipp Dena Ellery Bonnie Pearson Ken Coolen Michael Pangan

Jane Talbot

HansKrishna Von Hagen

Ross Harvey

Angela McGie

George Schwab

Tracey Hearst

Penny Parry

Lisa Bradbury

Susan Burgess

Andrea Reimer

Barry DeVito

Catherine Jenkins

Ron Hogan

John Yano

Patricia Dyck

Jason Hjalmarson

Tom McAulay

Agung Fauzan

Wayne Avery

Christine Leclerc

Stephanie Tofield

Adrian Smith

Stephen French

Heather Inglis

Glyn Townson

Adrienne Wong

Edith Davidson

Lisa Raichle

Rob Spooner

Lindsay Mearns

Dennis Parkinson

Tobias Donaldson

Colin McKenna

Chris Kean

Patricia E. Young

Miranda Leffler

Carmine Digiovanni

Christopher Clark

Sheryl Burns

$20 - $149 FRIENDS Allen Hovan Zoran Stjepanovic Ha Thu Nguyen Kirsten Bowles Sarah Chown Sharon Lou-Hing Colin McKay

P5SITIVE LIVING | 24 | JAN •• FEB 2020

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

Mark has been a great support to Positive Living. He works in both the CHF department and the Reception desk. He steps up to help cover shifts when needed and provides a lot of strength to the team.

Ken Coolen, Peer Engagement Coordinator

*Mark O’Hara*

What is your volunteer history with Positive Living?

I served on the Board of Directors, a Society registrar, performed with Theatre Positive, helped with the CHF, Lounge, Polli and Esther’s, and work on the reception desk.

How would you rate Positive Living BC?

9 out 10. There is always room for improvement

What is your favourite memory of your time at Positive Living BC?

My trial-by-fire with Theater Positive and the production of “Dancing with My Dead Lover.”

What do you see in the future for Positive Living BC?

I’d like to see the development of services/programs for our aging and elderly membership.

What is Positive Living BC ‘s strongest point?

They put their members first.

P5SITIVE LIVING | 25 | JAN •• FEB 2020

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 | JAN •• FEB 2020

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

New drop-in times for The Lounge, iCafe and Polli & Esther’s Closet

The Lounge at Positive Living BC has changed!

Daily 10AM – 1PM

Members are welcome to join us for structured, social & educational activities between

1– 4 PM on select days.

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P5SITIVE LIVING | 27 | JAN •• FEB 2020

Last Blast BC nears the end of the AIDS epidemic

B

By The Ministry of Health

ritish Columbia marks record-low cases of HIV and AIDS as the crisis transitions from epidemic to chronic disease management.

“As we commemorate World AIDS Day, it’s important to look to the progress we have made against a formidable disease,” said Adrian Dix, Minister of Health. “With the success of the Treatment as Prevention strategy (TasP), BC is seen as the having the world’s gold standard to profoundly reduce HIV transmission and transition the crisis from a serious epidemic to a manageable chronic disease.”

The BC government has long been a pioneer in addressing the health of people with HIV and AIDS by offering the groundbreaking TasP, developed by the BC Centre for Excellence in HIV/ AIDS (BCCfE). BC is the only province to implement the TasP strategy, and the only province to see a consistent decline in new HIV cases. TasP has been adopted by China, Brazil and Panama.

“Since the first AIDS patients presented to St. Paul’s Hospital in Vancouver–struggling against stigma and marginalization–community, researchers and clinicians worked tirelessly to advance evidence-based research to inform BC’s HIV treatment policies,” said Dr. Julio Montaner, executive director and physician-in-chief, BCCfE. “This included pioneering effective treatment and supporting widespread availability of antiretroviral therapy. We are now reaping the rewards of this province’s continued commitment to provide the best possible treatment and care for those living with HIV as we set a standard for the rest of the world.”

The overall number of new HIV infections in BC is continuing to decline. In 2018, there were 205 cases, a decline from 437 cases in 2004.

“Since the turn of the century, we’ve made incredible progress in our fight against HIV and AIDS,” says Dr. Bonnie Henry, provincial health officer. “Research conducted by Dr. Julio Montaner and his team at the BCCfE has accelerated our efforts to reduce the impacts of what was once a death sentence, and this work has been crucial to the progress of not only our provincial efforts, but efforts around the world to end HIV and AIDS.”

To further advance the goal of eventually eliminating the disease, the BCCfE has established a research laboratory at 647 Powell St. in Vancouver to support ongoing HIV/AIDS research for people living in Vancouver’s Downtown Eastside and beyond.

Together with other programs of the BCCfE, this new laboratory works to support PLHIV while also collecting vital research to establish innovative new techniques to eliminate the disease.

Helping to prevent the transmission of HIV, government expanded public funding for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) on Jan. 1, 2018. As a result, approximately 4,500 people at higher risk of HIV infection have qualified for coverage of this potentially lifesaving treatment, adding a new resource to the centre’s TasP. This is an increase from 2,000 in June 2018 and 3,300 in March 2019.

The Province’s STOP HIV/AIDS program receives approximately $20 million of annual funding. Separately, government supports a three-year, $322-million contract with the BCCfE for the delivery of the HIV Drug Treatment Program, including HIV PrEP. 5

P5SITIVE LIVING | 28 | JAN •• FEB 2020

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