Positive Living

G AT H E R I N G

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

NOV • DEC 2017 VOLUME 19 • NUMBER 5

ISSN 1712-8536

POSITIVE

A CONFERENCE DEVELOPED FOR AND BY HIV+ PEOPLE IN BRITISH COLUMBIA

MARCH 30

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APRIL 1 2018

Treatment Failure PRESENTED BY AIDS Vancouver AIDS Vancouver Island AFRO-Canadian Positive Network ANKORS DTES Consumers Board Living Positive Resource Center Positive Living BC Positive Living North REL8 Vancouver Native Health ViVa YouthCO

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Are HIV+ people at higher risk in BC’s interior?

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Affordable Social Housing?

Researching Indigenous Health

Plant-Based Diets

THRIVE MUSIC FEST

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

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Massage Therapy Naturopathic Medicine

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PAC’S FIGHTING WORDS

The challenges of social housing in BC

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COVER STORY Concerns about treatment and care in the Interior Region

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LET’S GET CLINICAL

New studies target Indigenous women’s health

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NUTRITION Is tofu right for you?

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SISTER TO SISTER

Getting to know the Oak Tree model

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THE POSITIVE GARDENER GIVING WELL Our intrepid gardener reports from his new home

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POZ CONTRIBUTIONS Recognizing Positive Living BC supporters

Positive Living Donor Profile

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VOLUNTEER PROFILE Volunteering at Positive Living BC

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SEX NOW REVISITED Stigma, Sex, and Gay Men’s Health

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BODY FAT

Understanding VAT

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LAST BLAST The Birds, bees… and a homemade outhouse.

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 | NOV •• DEC 2017

Message The Positive Living Society of British Columbia seeks to empower persons living with HIV disease and AIDS through mutual support and collective action. The Society has over 5700 HIV+ members.

POSITIVE LIVING EDITORIAL BOARD Neil Self — co-chair, Earl Sunshine —co-chair, Ross Harvey, Joel Nim Cho Leung, Elgin Lim, Jason Motz, Adam Reibin MANAGING EDITOR Jason Motz

DESIGN / PRODUCTION Britt Permien FACTCHECKING Sue Cooper COPYEDITING Maylon Gardner, Heather G. Ross PROOFING Ashra Kolhatkar CONTRIBUTING WRITERS Jeff Anderson, Lorenzo Cryer, Paul Goyan, Murray Hunt, Brandon Laviolette, Jason Motz, Angelina Namiba, Walter Petram, Dr. Neora Pick, Sean Sinden, Shelby Watson PHOTOGRAPHY Britt Permien

DIRECTOR OF COMMUNICATIONS AND EDUCATION Adam Reibin DIRECTOR OF PROGRAMS AND SERVICES Elgin Lim TREATMENT OUTREACH COORDINATOR Alan Wood SUBSCRIPTIONS / DISTRIBUTION John Kozachenko Funding for Positive Living is provided by the BC Gaming Policy & Enforcement Branch and by subscription and donations.

Positive Living BC | 803 East Hastings Vancouver BC V6A 1R8

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

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© 2017 Positive Living

from the chair

NEIL SELF

Welcome to your new home!

Calm. Bright. Open. Warm. Welcoming. Secure.

In 2014, HIV-positive members chose these words to describe the ideal atmosphere in which Positive Living BC should operate.

This vision would have seemed like a fantasy to members when we moved our operations to Seymour Street in 1992.

Back then an HIV-positive diagnosis was thought of as a death sentence and virus carriers were shunned. Our headquarters were stigmatized as a hideout for sick people preparing to die. The “AIDS Building” at the corner of Seymour and Helmcken was a place to avoid; it was not a place for PLHIV to flourish. Our headquarters never reflected who we are.

Times have changed. I invite you to visit our new headquarters at 1101 Seymour Street and see just how much closer we are to our mission today. Positive Living BC members now have an opportunity to showcase our Society as hopeful, healthy, and highly skilled.

Here are some of the features our members will be able to take advantage of: r For PLHIV whose lack of income, insurance and/or stable housing continually pushes proper dental care out of reach, we are in the process of building a dedicated dental clinic. We are currently aiming for an opening date early in the new-year. r There is a growing need for complementary health and wellness services among our members. Several P5SITIVE LIVING | 2 | NOV •• DEC 2017

hundred yoga, massage, and Reiki sessions are delivered to our members annually to enhance their HIV health. In our new home, we have dedicated space where our skilled health and wellness volunteers will help PLHIV relax, rejuvenate, and live stronger. We are no longer delivering these services in closets, offices, or other makeshift spaces. r Of course, our Members’ Lounge still exists as a private, PLHIV-only space where members are safe and free to make those ever-important social connections with their HIV-positive peers. But now the Lounge is a bright and open space with lots of windows looking onto Emery Barnes Park. And let me tell you, the place is hopping with activity since it opened in mid-September.

Avid readers, most of them members, know just how long and frustrating the construction/moving process has been.

At times, it did feel like the process might break us. So, on behalf of the staff and your Board of Directors, I thank you all for sticking with us through these tough times.

I must also thank the City of Vancouver and most importantly, Bruno Wall of Wall Financial and Bramwell Tovey for spearheading this project. Thanks to them, PLHIV in Vancouver have a real chance to thrive!5

News from the gut

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Researchers at the University of Montreal Hospital Research Centre (CRCHUM) have discovered a way to slow viral replication in the gastrointestinal tract of people living with HIV (PLHIV). This advance, published in JCI Insight, might well lead to the development of a new therapeutic strategy to supplement antiretroviral therapy (ARV), improving the control of viral replication in HIV-infected persons and preventing complications associated with chronic infection.

“We have identified a molecule that stimulates HIV replication in CD4 T cells located in the gut,” says Petronela Ancuta, a CRCHUM researcher. “We have a also started testing medications to block this replication and decrease inflammation of the intestinal mucosa. This is a promising new approach to eradicate HIV, or at least to achieve functional cure.”

“The digestive tract is an environment conducive to viral ‘reservoirs,’” added Delphne Planas, of CRCHUM. “Our research demonstrates that CD4 T cells which migrate from the blood to the gut will be modified. En route, they acquire the tools that aid the virus in infecting them.

Identifying these tools helps us understand why the gut represents a sort of sanctuary favourable to HIV, and thus have to combat these ‘reservoirs.’”

CD4 T cells migrate from the blood to the gut thanks to marker molecules expressed on their surface; some of these, called CCR6, act like a ”postal code” for cells, indicating they should direct themselves to the gut. Previously, the researchers had shown that cells expressing the CCR6 molecule are preferential targets of in-vitro

infection, and viral “reservoirs” in subjects being treated with ARV. Using biopsies of the sigmoid colon and blood of PLHIV on ARV, researchers have discovered that in the colon, the CD4 T cells that express the CCR6 postal code also contain a large amount of another molecule, mTOR that regulates metabolic mechanisms. “It is the mTOR molecule which is in part responsible for the high vulnerability to HIV of the CD4 T lymphocytes expressing CCR6 and residing in the gut,” said Planas.

For more information, see https://insight.jci.org/articles/view/93230.

Free and freaky in Germany

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A sexual history and consultation in the practice setting can contribute to counteracting the spread of sexually transmitted infections (STI). This is the result of a representative survey that questioned 2,524 people about their sexual practices and sexual contacts outside their main relationships. The report was published in Deutsches Ärzteblatt International.

Thirteen percent of respondents reported having unprotected sex outside their primary relationship, but on two percent that they always use condoms. The authors point out that only one in four who reported having unprotected sex outside of their primary relationship admitted to having had a medical examination in that context. On this background, the authors think that in the practice setting, the exploration of high-risk behaviours and provision of information on ho to prevent STI is crucial.

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In this representative survey, most women (82 percent) and men (86 percent) described themselves as exclusively heterosexual. Fifty-seven percent of respondents reported that they were in a stable relationship at the time and expressed their satisfaction with this. Forty percent of participants in stable relationships were in monogamous relationships, two percent had open relationships, and one percent reported having sex outside parties (threesomes). Fifty-six percent had not sought any agreement on contacts with outside parties.

Seventeen percent of survey respondents reported ever having had sex with a person other than their stable partner during a relationship. More men (21 percent) than women (15 percent) admitted to having had sexual partners outside their relationship. Persons who had had external sexual encounters reported a mea of 3.65 partners in addition to their primary partner.

Eight percent of men reported having had sex with an average of four female sex workers. The authors think that it is if vital importance for doctors to have knowledge of their patients’ general sexual behaviour.

They consider this an important basis for dealing adequately with problems possibly arising from such behaviours.

Download the full report, in English, from www.aerzteblatt.-international.de/int

The latest in vaccine development

pScientists at The Scripps Research Institute (TSRI) have made another important advance in HIV vaccine design. The development was possible thanks to previous studies at TSRI showing the structures

of a protein on HIV’s surface, called the envelope glycoprotein. The scientists used these structures to design a mimic of the viral protein from a different HIV subtype, subtype C, which is responsible for the majority of infections worldwide.

The new immunogen is now part of a growing library of TSRI-designed immunogens that could one day be combined in a vaccine to combat many strains of HIV. “All of this research is going toward finding combinations of immunogens to aid in protecting people against HIV infection,” said TSRI Professor Ian Wilson, Hanson Professor of Structural Biology and chair of the Department of Integrative Structural and Computational Biology at TSRI. The research was published recently in the journal Immunity, was led by Wilson and TSRI Professor of Immunology Richard Wyatt, who also serves as Director of Viral Immunology for the International AIDS Vaccine Initiative (IAVI) Neutralizing Antibody Center at TSRI. The new study was published alongside a second study in Immunity, led by scientists at the Karolinska Institute in Stockholm, which showed that the vaccine candidate developed in the TSRI-led study could elicit neutralizing antibodies in non-human primates.

“Together, the two studies reiterate how structure-based immunogen design can advance vaccine development,” said Wyatt.

HIV mutates rapidly, so there are countless strains of HIV circulating around the world.

Of these strains, scientists tend to focus on the most common threats, called clades A, B, and C. Like a flu vaccine, an effective HIV vaccine needs to protect against multiple strains, so

researchers are designing a set of immunogens that can be given sequentially or as a cocktail to people so their immune systems can prepare for whatever strain they come up against.

In 2013, TSRI scientists, led by Wilson and TSRI Associate Professor Andrew Ward, determined the structure of a clade A envelope glycoprotein, which recognizes host cells and contains the machinery that HIV uses to fuse with cells. Because this is the only antibody target on the surface of HIV, an effective HIV vaccine will have to trigger the body to produce antibodies to neutralize the virus by blocking these activities.

Building on the previous original research, the scientists in the new study set out to solve the structure of the clade C glycoprotein and enable the immune system to fight clade C viruses.

“Clade C is the most common subtype of HIV in sub-Saharan Africa and India,” explained study co-first author Javier Guenaga, an IAVI collaborator working at TSRI. “Clade C HIV strains are responsible for the majority of infections worldwide.”

The scientists faced a big challenge: the clade C envelope glycoprotein is notoriously unstable, and the molecules are prone to falling apart.

Guenaga needed the molecules to stay together as a trimer so his co-author Fernando Garces could get a clear image of the clade C glycoprotein’s trimeric structure. To solve this problem, Guenaga re-engineered the glycoprotein and strengthened the interactions between the molecules. “We reinforced the structure to get the soluble molecule to assemble as it is on the viral surface,” Guenaga said.

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The project took patience, but it paid off.

“Despite all the engineering employed to produce a stable clade C protein, these crystals (of clade C protein) were grown in very challenging conditions at 4 degrees Celsius and it took the diffraction of multiple crystals to generate a complete dataset, as they showed high sensitivity to radiation damage,” said Garces. “Altogether, this highlights the tremendous effort made by the team in order to make available the molecular architecture of this very important immunogen.”

With these efforts, the glycoprotein could then stay together in solution the same way it remains together on the virus itself. The researchers then captured a high-resolution image of the glycoprotein using a technique called x-ray crystallography.

The researchers finally had a map of the clade C glycoprotein.

In a companion study, the scientists worked with a team at the Karolinska Institute to test an immunogen based on Guenaga’s findings. The immunogen was engineered to appear on the surface of a large molecule called a liposome—creating a sort of viral mimic, like a mugshot of the virus.

This vaccine candidate indeed prompted the immune system to produce antibodies that neutralized the corresponding clade C HIV strain when tested in non-human primates.

“That was great to see,” said Guenaga. “This study showed that the immunogens we made are not artificial molecules—these are actually relevant for protecting against HIV in the real world.”

Source: www.eurekalert.org 5

By Walter Petram

The disadvantage of social housing

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ocial housing and “affordable housing” are two distinct animals. Social housing is the ideal of providing housing for disadvantaged people.

But does that make it affordable? Not a bit.

Over the last decade both provincial and city governments have not just dropped the ball, but have run out of bounds on the issue of “affordable” social housing.

Some of the BC Housing has been and is being sold off to private enterprise. Every time a corporate entity gets involved in a program or a resource, their only aim is to maximize profit; hence, housing stock is being eroded, not increased.

If you have a crystal ball or a psychic who can tell you that in five years you will be disabled, then you might get into BC Housing; the wait list is from five-six years from date of application to the date of (possibly!) moving in.

You must also have the means to be able to get to various housing projects to figure out which one you may want to reside in, or if the area makes sense for you.

How does the Province or the City believe they are doing the best they can when we have more people living on the street than before? When we have more people slipping below poverty line? The average working class wages are not keeping up with inflation, which our government reports at being 2.1 percent for the first couple of months for 2017, and 1.6 percent for the next couple of months, hence the average of about 1.85 percent.

These numbers are based on erroneous information.

For basic life necessities, I peg the inflation rate at pretty much at 5-8 percent minimum. Groceries have escalated over the last two years by over 10 percent. Basic needs

like a telephone or Internet access have increased by 10 percent. Hydro increased by five percent in 2017.

And we have not touched on rent increases, or the trend of “renovictions.” People are being displaced without consideration as to where do they go to next.

Rents have escalated from where a two bedroom suite at $1050 per month on Comox street in 1997 rents today for $1950. Meanwhile, wages have not exactly mirrored the rent increase.

More than any other group, those on disability have continually been confronted with market rent increases.

So where does that leave people? Instead of being close to the health services they need, people are being forced to move to the ‘burbs, into areas they don’t know, into unfamiliar neighbourhoods that may not even be LGTBQ+ friendly. Who wants to move from Vancouver to Surrey, Langley, or Abbottsford? Because that is the question many people, young and old alike, face today.

There has to be a better way to ensure that we do get on the right track. That way is for citizens to get engaged in the process of creating change that is in the best interests of all! Get involved in organizations or committees that are advocating change in how we deal with social housing and the availability issues surrounding being part of one when you need it. 5 Walter Petram is Treasurer on the Positive Living Society of BC’s Board of Directors.

P5SITIVE LIVING | 5 | NOV •• DEC 2017

Beyond Tofu Breaking the Protein Pattern

By Shelby Watson

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hen you hear the word protein, do you think of steak or a glass of milk? Protein is often associated with animal products, which are known to be high in this important nutrient. From building cells to a healthy immune system, protein provides the building blocks for the different structures and functions in the body. A plant-based diet reduces or excludes animal products, and is composed of fruits and vegetables, whole grains, nuts, seeds and legumes. Be it for cultural, religious, or ethical reasons, choosing to eat a more plant-based diet has many health benefits.

Research shows that people who eat a plant-based diet are at a lower risk of developing various chronic diseases. Given that HIV and some HIV medications can increase the risk of cardiovascular disease and diabetes, diets high in plant-based proteins can reduce heart disease and diabetes, and lower LDL (“lousy”) cholesterol levels.

People following balanced plant-based diets tend to eat more fruits and vegetables, which means more fibre and phytonutrients to support good health. Phytonutrients are protective compounds found in many fruits and vegetables, and act as antioxidants in our bodies. A diet high in antioxidants is beneficial for PLHIV to help fight oxidative stress caused by the virus.

Increased dietary fibre and drinking enough fluids can help to normalize digestive issues such as constipation and diarrhea.

Whether you choose to consume a vegetarian diet, or just want to add plant-based protein sources to your diet more often, there are plenty of options for you.

One versatile example is soy. Unflavoured, fortified soy milk is nutritionally equivalent to cows’ milk in terms of protein and

calcium. Tofu is made from fermented soybeans. Meat analogues, texturized soy proteins made to imitate common meat products, are another option. These can be a way to ease yourself into meatless meals—but keep in mind they can be high in sodium.

Legumes (beans, peas, and lentils) can be easily integrated into many different foods, and pack a nutritional punch of fibre, vitamins, and minerals. Add legumes to chili, curry, tacos, and soups, or blend them to add to your favourite brownie recipe. If using canned legumes, strain and rinse to reduce the amount of added sodium and pesky gas-causing carbohydrates.

Nuts and seeds are another valuable source of protein ideal for snacks, like trail mix. No time for eggs for breakfast? Put some peanut butter on your toast—just two tablespoons of peanut butter is one serving of protein. Other foods that provide protein include quinoa, spinach, bread, rice and oatmeal.

Complete proteins offer all nine of the essential amino acids that we must obtain from our diet every day. It’s true that most plant-proteins individually do not contain all the essential amino acids needed. However, eating protein from a variety of plant foods over the day can meet or exceed an individual’s protein needs.

Here’s a pro[tein] tip: replace meat with a plant-based protein once or twice a week.

Start slow, try it before you deny it, and work with foods that you like. 5 Shelby Watson is a dietetic student completing an internship with Fraser Health Authority.

P5SITIVE LIVING | 7 | MAY •• JUNE 2017

Sister to Sister The Heart of Oak Tree Clinic

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By Neora Pick ew HIV clinics are specifically designed to address the needs of women living with HIV (WLHIV). The Oak Tree Clinic, located at B.C. Women’s Hospital in Vancouver, is the only clinic in Canada established to provide province-wide care to WLHIV, using a family-centred, interdisciplinary approach.

For 23 years, the Oak Tree Clinic has been the provincial referral centre for WLHIV. The clinic has provided help to over 5,000 patients from diverse social, economic, and cultural backgrounds. Currently, over 700 patients are actively engaged in care.

Of the patients attending the clinic, 30 percent identify as Indigenous, 33 percent Caucasian, and 32 percent African or South Asian. One-third of patients are currently living with addiction, and 39 percent are co-infected with hepatitis C (HCV). The clinic has expanded to provide HCV treatment to co-infected clients.

Oak Tree’s interdisciplinary model provides care for women and their families at every stage of their life, while addressing social determinants of health with a holistic, harm reduction approach. Each healthcare provider plays a vital role in working together to coordinate comprehensive woman-centred and trauma-informed care, to achieve optimal health results for their patients. The team includes adult, pediatric, and obstetric HIV specialists, psychiatrists, gynaecologists, nurse practitioners, nurse clinicians, nurses, social workers, pharmacists, dieticians, counsellors, receptionists, administration staff, and research personnel.

Since the introduction of ARV in BC in 1996, we have had no mother-to-child HIV transmission when women were engaged in care and taking medication for more than four weeks. Through the clinic, WLHIV have access to pre-natal specialist care and free formula for their infants’ first year of life.

Pre-conception counselling for concordant and discordant couples is also available. Our gynaecological service provides full spectrum care, including colposcopy.

Mammograms and bone density screening are performed in the same building. We encourage women to bring their partners, children, and family members to the clinic for help with disclosure, education, and point of care HIV testing.

To improve access to care, our outreach team assists patients with overcoming barriers, and transportation to and from the clinic. Telehealth was implemented in 2014 to assist clients in rural areas of BC. Since 2010 we have provided quarterly HIV care and outreach to Alouette Correctional Centre for Women in Maple Ridge to prevent treatment interruptions and help link women to ongoing HIV care after release.

Our team works with community agencies to give education to multidisciplinary trainees and patients, advocate for women in multiple arenas, and conduct research related to the health, engagement, and aging of women. The team contributes to various provincial and national HIV care guidelines related to WLHIV. These strategies create the sense of a second home for the women we care for, as it builds communication and trusting relationships between patients and healthcare providers. 5

Dr. Neora Pick is the Medical Director of the Oak Tree Clinic at BC Women’s Hospital & Health Centre.

P5SITIVE LIVING | 8 | NOV •• DEC 2017

d e t i s i v e R Stigma, Sex, and Gay Men’s Health

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a follow up to his report in issue 19.2 on the Sex Now 15 survey, writer Paul Goyan posits some additional queries either not made or unspecified in the finished report. For the full report, see cbrc.net. Read Goyan’s previous article online at https:// issuu.com/positivelivingmagazine/docs/pos_living_107_online.

Sexual Health

Apparently, sexual health is only considered in terms of sexually transmitted infections (STI). The survey asked respondents whether they had been tested for STI and HIV over the past 12 months.

The results by age group indicated that about half of younger and older individuals had been tested, rising to almost two-thirds of those aged 25-34.

There was a single question in the survey explicitly about HIV. Respondents were asked about their latest test result, two percent of those under 25 responded that they were HIV-positive, which increased to 12 percent among those aged 45-59. Over one-third of those under 25 had never been tested for HIV. Over the past 12 months, five to seven percent of all age groups reported that they were diagnosed with gonorrhoea, while those with syphilis ranged from two percent (under 25) to 4 percent (35-59). A similar, but slightly lower, proportion of respondents reported having been diagnosed with chlamydia, genital warts, herpes and shigella. Between one and two percent

By Paul Goyan

of respondents over age 25 reported having hepatitis B and one percent reported having hepatitis C. It was reported that respondents in the 60 and over group were six times more likely to have had hepatitis B and more than three times more likely to have contracted hepatitis C when compared to the under-25 age group. This issue would likely merit additional study.

Sex and Drugs

The survey states that, “Substance use is often a niche group phenomenon that can appear proportionally small to a whole population yet be very influential in a local context.” It should be noted that the survey asked two questions: the first about drug use the last time one had sex; the second about drug use several times a week or more. It seems that it would be informative to have additional information on occasional drug use. Only one-quarter of respondents under 35 reported that they never binge drink, compared to 60 percent of those 60 and over. Only 10 respondents reported using any of the following several times a week: Viagra/Cialis, ecstasy/MDMA, cocaine, “G”/GHB, crystal meth, “K”/Ketamine, steroids, and crack.

Condom Use

What would a sex survey be without questions on condom use?

It turns out that condom use was highest among those under 25.

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Overall, 10 to 20 percent of respondents reported never using condoms, whereas 10 to 20 percent used them intermittently.

Between 30 percent (60 and over) and 43 percent (under 25) always used condoms, while roughly one-quarter of respondents in all age groups reported no anal sex. Between 50 and 60 percent of respondents in all age groups reported that they had not used condoms during their latest sexual encounter.

Sexual Health Knowledge

The survey notes that, “the youngest cohort was often considerably behind all knowledge indicators, consistent with reports of inadequate coverage of sexual health in high school.” The same applies to the 60 and over cohort, made up of older gay males and a significant number of bisexual males who have not come out or who came out later in life.

Health Care Participation

A majority of all age groups usually get routine medical care from a family physician, rising from 50 percent of those under 25 to 93 percent of those 60 and over. Younger persons (under 25) are more likely to rely on a walk-in medical clinic (40 percent). Only three-quarters of those under 25 have a primary care provider, whereas 95 percent of those over 60 have one.

A significant number of respondents in all age groups are not out to their provider: 43 percent (under 25), 28 percent (25-34), and 38 percent (60 and over). The survey reports that: “Bisexual men are disproportionately less inclined to come out to their doctor who also may be treating their wife and kids.”

Further research would be required to determine whether this is speculation. It could also be due to self-stigma.

Mental Health and Self-Medication

The question lacked clarity. Did “pain medications,” refer to aspirin and over-the-counter meds, or heavy-duty pain-killer drugs like oxycodone? One important gap in the survey is that absence of any questions on what physician-provided prescription drugs a person has used.

As a measure of mental health, the survey asked respondents whether they had ever discussed a range of mental health issues with a healthcare professional. It was reported that “Sex, stress, anxiety and depression appear to top the lists in every cohort.

About a third of every cohort has had enough trouble with stress to take it up with a professional.” The number of respondents ever considering or having attempted suicide was highest among the youngest age group, declining substantially over time. In those under 25, 30 percent had considered suicide, whereas only 11 percent of those 60 and over did so. Among those under 25, seven

percent had attempted suicide, declining to two percent among those 60 and over. Older men were more likely to discuss mental health issues with their physician, while younger men were more likely to speak with a mental health professional.

Overall Health

When asked to provide a self-assessment of overall health, a very high proportion of respondents in all age groups rated their general health as good, very good, or excellent, ranging from 84 percent of those under 25 to 92 percent of those 60 and over. The report notes that the Canadian Community Health Survey reports the opposite trend, “with self-assessment of overall health declining with age among males (only 44 percent of males 65 and older rated their health as very good or excellent).”

This issue warrants further investigation. Perhaps older males claim to have good health in order to fight off possible ageism and HIV stigma.

As one would expect, that number of respondents who reported at least one diagnosed chronic condition (i.e., high blood pressure, high cholesterol, diabetes, cardiovascular disease, and cancer) increased with age. Those without a chronic condition declined from 92 percent (under 25) to 72 percent (35-44) to 53 percent (45-59) to 29 percent (60 and over). The report states that: “Sex Now research has disclosed a consistent health gradient where straight men are best off, gay men worst and bisexual men somewhere between. (Trans gay men are worst off among gay men.)” No additional information or analysis is provided to back up this statement. Furthermore, it should be noted that only five percent of respondents self-identified as straight.

The Sex Now 15 survey report provides a wealth of information. Over the next six months, additional focused reports will be published further exploring various aspects of the survey. There will likely be a number of presentations on the survey results at this fall’s Gay Men’s Health Summit.

Planning is already underway for the next survey. Hopefully, it will focus on some of the realities of gay/bi males who are living with HIV. 5

Paul Goyan is a contributing writer for Positive Living Magazine.

P5SITIVE LIVING | 11 | NOV •• DEC 2017

Treatment Fail in BC’s Interior Ignoring patients at their peril

By Jeff Anderson

H

ealth professionals often feel unappreciated and unfairly criticized as they do their job and follow their training and instincts. But criticism is sometimes fair and warranted. As a patient, the right to question and doubt is often dismissed as uneducated opinion. Sometimes that brush off can kill a patient.

Recently, in BC’s Interior, medical arrogance nearly killed a young man who pleaded to be

heard. What followed was a harrowing path of denied illness, worsening health, an unnecessary illness, and perhaps permanent damage to his immune system. And all because he trusted a health care system where standards have slipped and a patient’s voice was discounted.

In late 2015, Mitch started getting what he thought was a cold. He pushed through it as best he could, until New Year’s Eve. His co-worker said he was found ‘napping’ on a warehouse floor.

P5SITIVE LIVING | 13 | NOV •• DEC 2017

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In the first few weeks of 2016, he attended health clinics in the north Okanagan with symptoms typical of pneumonia—fever, dehydration, shortness of breath, shakes, loss of appetite, loss of energy, and prodigious yellow phlegm. These can be symptoms of more than one pathology, but the phlegm, rapid weight loss, and dehydration are frequent symptoms of pneumonia, though no sputum sample was tested by the clinic for pneumonia. Still, as an obedient patient, he followed the instructions from the clinic doctor: bed rest, plenty of fluids, and cough medicine for a few weeks. Despite his compliance, his symptoms did not improve. His intuition, and his condition, told him this was not a cold.



Doctors told my mom and me afterwards that they had given up on me, but my heart started beating on its own. 

Mitch did not improve, and he later developed hives. Returning for another clinic visit, he says, “I was advised to take allergy medication. I followed orders.” And as his condition worsened, his anxiety grew.

He recalls the day of February 3rd 2016. “It felt like I was drowning. I contacted my father who immediately came to my house to take me to the hospital. I was very white, very sick looking— sunken face, muscle wasting away. I arrived late morning at the hospital’s emergency room. I was assisted and was admitted for further observation and treatment. The attending physician told me I was diagnosed with bilateral pneumonia. I informed him that I was homosexual and had had a few HIV-positive people bleed on me during my work as a first responder. I asked about getting a test for any STIs or HIV. The ER doctor informed me that it wasn’t needed. I felt that I was kind of dismissed. My dad asked me after the doctor left the room, ‘Do you really think you need that?’ I informed him that anything is possible and I just wanted all bases covered.”

Mitch responded to his situation in a reasoned and logical manner, seeking diagnosis and treatment for an illness he suspected. The ER doctor at Vernon Jubilee Hospital (VJH) dismissed his request for HIV testing. Mitch presented all of the conditions recommending an HIV test for a male under these guidelines, and yet he was not tested. (In 2014, BC Chief Medical Health Officer Dr. Perry Kendall published revised guidelines for HIV testing in BC.

These instruct health professionals to provide an HIV test whenever a patient shows symptoms of HIV infection or simply requests one.)

After a night in emergency, he was moved to a ward at VJH and given common anti-bacterial treatments for a spate of infections. Even so, his oxygen levels began to plummet, so he was hooked to oxygen to keep his levels above 90 percent.

With three major, and up to 30 less prevalent, types of pneumonia, it’s important to identify the pathology as pneumonia can lead to other infections and even death. Immune system diseases are marked by lower CD4 levels and can indicate specific pneumonias, especially in PLHIV. The first AIDS patients were diagnosed, in part, by which type of pneumonia they contracted. Back then it was PCP; today it’s often called pneumocystis jiroveci pneumonia, (PJP). After several days, Mitch was still not diagnosed with PJP. The degree of his condition and his requests for other testing should have alerted medical staff to treat unusual pneumonia symptoms or test for HIV as he requested. Despite his background as a first responder, he felt untrained about HIV or its threats. I asked Mitch how his attending doctors responded to his suggestion of HIV. They “shot it down, like I was ‘quick diagnosing.’”

Four days after he was admitted to hospital without correct diagnosis or treatment, Mitch began to slip away. His oxygen saturation dropped to 61 percent. He was rushed to the VJH trauma bay for intubation to ensure sufficient oxygen to his organs and pumped with drugs to help him relax. He fell into a coma and was placed on life support.



I remember feeling very lost, not sure what to do.

I really did not have a clue about HIV. 

“On February 9th the doctor spoke to my parents and [they] were told that they needed to authorize an HIV test as the doctors were not sure what was going on. My mom signed for it.” With that authority, the doctors at VJH decided to send the test sample to St. Paul’s Hospital in Vancouver, results from which can take up to 10 days. At that time, Mitch was unaware of an “on demand” HIV test that takes 15-20 minutes for a result. After six days in the ICU, intubated, and on a ventilator under medications like fentanyl and antibiotics, they decided to take the chance to wait up to 10 more days. Things went further downhill over the next four days. The doctors were wasting

P5SITIVE LIVING | 14 | NOV •• DEC 2017

valuable time waiting for an HIV test result they should have done days earlier.

Mitch regained consciousness. “My mom was in my room keeping me company. My night-shift nurse came in and rudely told her she was bothering me and my mom needed to leave immediately. I remember sitting up in my bed ready to go out with my mom. My mom kept me calm and obeyed the nurse. I was very upset that a nurse would kick the mother of a dying child out of the hospital at night with no way to get home. She had to walk almost an hour to get home at 1:00 AM. No other nurse had ever done that.”



Testing for HIV has had a big push, but I feel it’ is still not getting to everyone. 

By February 13th, things had worsened. “The doctor informed my mom that my condition was fading drastically and he would be bringing me out of the coma for a few minutes for mom to talk to me. As I came to, my mom said to me, ‘Mitchell, are you giving up?’ I nodded yes as one tear rolled down my face. She pleaded again and one tear roll became a full outcry. Mom said again, ‘Mitchell, are you giving up?’ I shook my head no while crying my eyes out. My numbers started to rise and the doctor knocked me out again. I still remember most of that heart-wrenching conversation.

I was told [that due to medication] I would forget, but I still have these vivid memories [that] my mom confirms are real.”

Doctors told his parents that he required ECMO (extracorporeal membrane oxygenation), a machine utilized to decrease carbon dioxide and increase oxygen in his lungs since they could no longer supply it or he might die. ECMO is available only in Kelowna and Vancouver, so he had to be moved quickly.

The Kamloops Hospital team transported him to Kelowna where the ICU doctors told his family he was in grave condition.

The pneumonia they assumed he had was so serious that he had only a 10 percent survival chance, even after attaching the ECMO. They told the family that they were not going to wait for a positive pneumonia test result to start treating me for PJP. They had to operate, now.

“Surgery was tough,” he recalls. “I bled out three times, causing my heart to stop. Doctors told my mom and me afterwards that they had given up on me, but my heart started beating on its own.”

A 45-minute procedure turned into a five-hour surgery.

Both the ECMO and the anti-PJP drugs were working and his lungs were starting to clear. Finally, his test results came back.

Mitch was HIV-positive. He was unaware that his struggles were only beginning.

“I was asking the nurse what happened to me and why I was in Kelowna. They kept telling me I was a very sick boy and would have to talk to the doctor. When he finally arrived, he said, ‘Do you know anything about HIV?’ I responded ‘Not really.’ He said ‘You are gay and you don’t know what HIV is?’ I responded, ‘Well, kinda,’ as I was very unsure of it. Then he told me I was HIV-positive.

I remember feeling very lost, not sure what to do. I really didn’t have a clue about HIV. My family came by later that day. I asked them if they knew that I had HIV? They all said yes, and my other brother came unglued. Their plan was to tell me themselves. They didn’t know how I would take that news and feared I may relapse, but I honestly took it okay. I remember at the time being more devastated with the catheter than the HIV.” A media release from Interior Health states, “Despite great advances in treatment, many people with HIV become quite ill, and some die each year because they do not test for HIV until the disease is in a very late stage. Individuals diagnosed late often take longer to respond or may not respond as well to HIV treatment. Studies from the UK, US, and Vancouver indicate that people diagnosed late in their infection have had multiple missed opportunities for earlier diagnosis in acute, community, and primary care settings.” Indeed this untenable state was created for Mitch by the health authority he trusted.

This March, Mitch had recovered from his illnesses enough to attend his first BC Positive Gathering conference. He reached out for support and networked to see how common his experience was. He told his story so others would have the courage to tell theirs and avoid needless illness and death in rural BC. Mitch found welcome support for his journey and inspiration to change the way HIV testing and education are delivered in the Interior Health Region. He has begun speaking to health colleagues and clinics in Vernon, and says, “Testing for HIV has had a big push, but I feel it’s still not getting to everyone.”5 Jeff Anderson is a personal HIV housing and food security advocate.

P5SITIVE LIVING | 15 | NOV •• DEC 2017

Sowing new soil

By Lorenzo Cryer

I

am sitting at the kitchen table sipping a black coffee from ground beans. Through the large picture window, I see a Steller’s jay visiting the bird feeder, filling its mouth with fresh sunflower seeds. I have hung a trio of sunflower heads from the rafter, so I can watch clever chickadees hang upside down as they extract a seed, flying away to consume the spoils. I have also hung a Hummingbird feeder. I enjoy the antics of the resident Anna’s Hummingbirds that call this area home. A red squirrel runs along the fence with cheeks full of hazelnuts. Between the squirrels and the jays, I rescued a few for myself.

You see I have left Vancouver for the rugged, nature-filled world of BC’s Sunshine Coast. There is wildlife everywhere. From the vultures and bald eagles that ride the currents overhead to the salmon who navigate the falls and rapids of the many creeks that snake down out of the mountains and end up at the Salish Sea. I have settled in a quaint cottage in the picturesque township of Gibsons. A new life waits. My new home has a large vegetable garden and some fruit trees. Black tailed deer are regular visitors, munching a bit of this, quite a bit of that, and then have a lie down in the flower garden. One night, a bobcat wandered out of the ravine behind me and up the driveway, under the gate, and off into the bush across the road. Someone has nailed a bat house to the power pole. Several aerial acrobats crisscross the darkening evening sky even as I write.

As part of my new job, I manage an eleven-acre property at Wilson Creek with a substantial space devoted to berries and vegetables.

Mature fruit trees bear apples and pears, along with plums and figs.

These trees are starting to bear less fruit, so next year we will create a space for a new orchard, adding many new types of fruit.

Peaches are my favourite orchard fruit. As they ripen, they give off an intoxicating fragrance. There is nothing better than a ripe peach picked fresh from the tree and warmed by the sun. (A bib is a good idea.) Unfortunately, bears, raccoons, and birds are also drawn to this bounty and some thought will have to be given to securing the crop. The vegetable garden has a ten-foot chain link fence all around it with a mild electrical charge. No harm should ever come to our animal neighbours.

I am designing a new vegetable garden that will allow for increased crops and better soil management. The existing soil is too sandy and greedily eats any good soil you bring in. The new garden will have raised planting boxes installed. The majority of boxes will be four feet by eight feet and two feet high. Each box will have weed mat lining the ground, to keep our new soil around for a bit. As part of the overall design, a three-foot wide path will surround each new planter. This will make tending the new beds much easier.

It is my hope to invite the local schools to visit our garden and learn how to build and look after an organic vegetable garden. We encourage good healthy eating habits as well as spending time outside, getting your hands dirty, and giving your body and mind a good workout. 5 Lorenzo Cryer is the owner of Dig Dug Done, a garden design business.

P5SITIVE LIVING | 16 | NOV •• DEC 2017

Giving Well to watch him and others like him go through that. Seeing all those young men in their prime dying deeply affected me. In addition to having AIDS, many died alone because of the stigma attached to being a gay man. Families and friends had deserted or alienated them, stripping them of dignity, of respect and above all, of love. That is why I walk.

Gina Deboer

T

his month, Giving Well looks not at a corporate donor, but one of the many walkers who took part in this summer’s Walk to Thrive: Gina Deboer. In fact, Gina was this year’s Top Walker, raising $7,860. Gina relates the very personal reasons that compelled her to participate, what she thought about during the event, and what she plans to do in the future to further help PLHIV. Q: How did you become involved with The Walk?

In 1986, I lost my brother to AIDS. He was admitted to St. Paul’s Hospital on different occasions with a host of symptoms— rashes that wouldn’t heal, pneumonia, and eventually wasting sickness and dementia, becoming someone I loved barely recognizable. It was horrible

Q: What was your goal when you signed up?

Initially, my goal was to honour my brother’s memory as well as others who had passed away and to raise funds to help Positive Living Society of BC continue to provide assistance to those in need of support. As I began to fundraise, my goal shifted to include education because I encountered so many people who believed that the epidemic is over due to the retroviral medications enabling PLHIV to live longer. While it is true that HIV/AIDS is no longer the death sentence it was 30 years ago, people are dealing with multiple, chronic medical conditions and are still dying from AIDS-related complications.

There continues to be new diagnosed cases. There is a lack of education about HIV/AIDS especially among our youth who are not receiving the message of prevention and treatment.

Q: Why is charity important to you?

Charity work is very important to me as it gives me an opportunity to give P5SITIVE LIVING | 18 | MAY •• JUNE 2017

A DONOR PROFILE

By Jason Motz

back. My reward is the realization that I have made a positive change in someone’s life.

Q: During the event, what thoughts were going through your mind?

I thought about my brother, the Quilt Project which I was once privileged to view and, as I had learned prior to the walk commencing, about the signs that had been posted along the walk by a Neo-Nazi group or groups, I thought about how sad it was to see such a display of ignorance and intolerance that is still prevalent today. People should be free to love whom they love and how they love, to walk in solidarity and remembrance without fear of reprisal.

Q: What did you learn about Positive Living?

I learned that Positive Living is about providing information, support, and care for HIV/AIDS affected people and their caregivers. To give hope and promote life choices that ensures a healthy and long life for all.

Q: Will we see you again next year?

To show those that are living with HIV/ AIDS they are not alone and to raise awareness—absolutely. 5

Jason Motz is the managing editor of Positive Living magazine.

Understanding VAT

S

By Brandon Laviolette

ometimes people living with HIV experience fat abnormalities related to their infection and as a side-effect of anti-retroviral treatment (ARV). Localized fat accumulation (lipohypertrophy) is commonly seen as belly fat in the abdominal compartment (visceral adipose tissue [VAT]); enlarged breasts; fat gain on the neck and shoulders (buffalo hump); and as round moveable lumps of fat under the skin sometimes called ‘fatty tumours’ (non-cancerous). This can happen in more than one area of the body simultaneously and sometimes along with fat loss in the face and limbs (referred to as lipoatrophy, or wasting disease).

Obesity caused by a sedentary lifestyle and eating excess calories from processed foods, saturated fats, and sugar are significant risk factors. Aging, genetics, alcohol intake, and some medications also play a role. General obesity and lipohypertrophy can overlap in PLHIV who are aging with traditional HIV- and ARV-specific risk factors.

Changes in body fat composition differ in men and women.

Women may see fat gain in their stomachs and breasts. Men are more likely to see fat wasting in their face, arms, buttocks, and legs. Researchers are not sure why these differences exist, but we know that there are hormonal differences that affect how fat is burned in the male and female bodies.

Some people consider these fat changes to be a cosmetic problem—however, they can cause discomfort. Fat accumulation in the abdomen can cause breathing trouble, digestive problems, and backaches; buffalo hump makes it harder to turn your neck and shoulders that affects vision, and can cause headaches or sleep difficulties for some people. Facial fat loss and body fat changes are sources of stigma impacting a person’s self-esteem or emotional well-being, which causes isolation and a tendency to non-adherence to medications (so as to minimize these side effects).

Inside the body, changes in fat accumulation affect its natural ability to manage blood sugar levels, increased serum cholesterol, and other fatty substances in the blood. This also affects co-morbidities like diabetes, fatty liver disease, and cognitive brain health. In PLHIV, fat tissue may be a reservoir for HIV that alters the localized tissue environment and promotes inflammation.

Changes in adipocytes and enhanced fat inflammation have been

reported in ARV-untreated HIV-controllers. Some HIV proteins are known to vary the adipose tissue functions and increase inflammation.

Hormonal imbalances and gut microbiome alterations in HIV-positive people also contribute to VAT accumulation. Increased energy harvested from food and changes to gut hormone secretions that tell your body to start and stop eating can affect insulin-glucose balance.

Lipoatrophy in some HIV-positive patients is mainly linked to NRTIs. Fat accumulation, including VAT, is seen as a side-effect of other drug classes. In the lab, ritonavir-boosted PIs are shown to cause cellular deterioration, oxidative stress, and inflammation.

Some ARV classes including PIs, NRTIs, and NNRTIs have been associated with development of new fat tissue in an inflammatory environment causing damage to those tissues. The INSTI ‘raltegravir’ led to similar VAT accumulation compared with PIs, but effects of other INSTIs, such as elvitegravir and dolutegravir, remain uncertain.

Obesity and VAT accumulation in HIV-positive patients is associated with chronic inflammation, insulin resistance, increased metabolic syndrome, dyslipidemia (abnormal amount of fats in the blood), oxidative stress, and is a known risk factor for type 2 diabetes. Abdominal obesity is associated with cardiovascular disease (CVD). HIV infection causes greater cardiovascular and metabolic consequences regardless of Body Mass Index (BMI) when compared with equivalent HIV-negative people.

Exercise and changes in diet can help reduce abdominal obesity in HIV-positive people. Thirty minutes of moderate-intensity physical activity at least four days per week and a balanced, reduced calorie diet are commonly recommended as ways to reduce body fat.

Some weight-loss surgeries are considered to be safe for HIV-infected patients with no significant changes in virologic control or ARV drug effectiveness. Reduced tenofovir (Truvada) concentrations in blood serum have been reported after a vertical sleeve gastrectomy (stomach staple surgery) in HIV-positive patients, but did not significantly impact CD4 counts. Bariatric surgery is considered for people with a BMI greater than 40kg/m2.

Buffalo hump can be fully or partially removed with liposuction or surgical fat removal although fat accumulation in this area may recur in some patients.

P5SITIVE LIVING | 20 | NOV •• DEC 2017

Only two medications are currently approved by Health Canada for the treatment of obesity in adults in Canada, Xenical (Orlistat) and Saxenda (Liraglitude). The U.S. Food and Drug Administration has five medications approved: Orlistat, Lorcaserin, Phentermine/Topiramate, Naltrexone/Buproprion, and Liraglutide.

For patients with excess BMI, these medications, in addition to diet, exercise, and behavior modification can lead to clinically significant weight loss (more than five percent over one year).

Common side-effects of these drugs include headache, nausea, dizziness, and constipation. Orlistat and Naltrexone/ Buproprion may cause reduced blood serum concentrations in patients treated with ritonavir-boosted atazanavir (Reyataz) and efavirenz (Sustiva).

Egrifta (tesamorelin for injection) is also approved for the reduction of excess abdominal fat in HIV-infected patients with lipodystrophy. Egrifta is a stabilized analogue of the growth hormone-releasing factor (GRF). This medication is a once-daily injection that stimulates the body’s natural production of Growth Hormone from the pituitary gland, which has been shown to reduce VAT by up to 15 percent within six months among HIV-positive patients. About twothirds of patients respond to treatment with no reduction in subcutaneous fat. Some patients experience increased fasting glucose levels that return to normal once they are treatment experienced.

One limitation of Egrifta is that VAT quantity returns to pre-treatment levels after treatment is discontinued. After six months of treatment, changes in VAT are measured by changes in waist circumference (WC) along with quality of life assessment and blood serum lipid levels. Treatment is usually discontinued if patients do not achieve significant WC reduction in six months.

Egrifta is not recommended for patients with an active malignancy or who are pregnant or trying to become pregnant.

Side-effects of Egrifta can be more severe and include: serious allergic reaction, fluid retention, blood sugar increases and diabetes, joint pain and muscle soreness, numbness and nausea. HIV infection and ARV treatments may be causing or contributing to an accumulation of unwanted body fat. Your doctor can work with you to find the best way to minimize physical changes. There are new and proven pharmaceutical treatments available that can help you get the body you deserve.

Treatment of HIV and its effects on our body needs further research to better understand how to treat obesity and lipohypertrophy in the modern ARV era. 5 Brandon Laviolette is the Treatment, Health & Wellness Coordinator at Positive Living BC.

P5SITIVE LIVING | 21 | NOV •• DEC 2017

The 4M approach Developing supports for Poz women through pregnancy

By Angelina Namiba

The

rate of vertical transmission of HIV in the UK is less than 0.5 percent due to high quality care and free HIV treatment. However, women living with HIV (WLHIV) may encounter major challenges in their journey to motherhood. The 4M Project, (My Health, My Choice, My Child, My Life) is an innovative peer-mentoring project designed to address the challenges these women face.

Coping with a new diagnosis, anxieties around starting treatment and the effects on them and their baby, or even whether to continue with the pregnancy or not are some of the issues these new mothers face. As well: testing other children, sharing their HIV status with significant others, intimate partner violence, immigration issues, housing, poverty and mental health are also concerns.

As part of 4M, we trained 46 WLHIV to be Mentor Mothers, in eight regions across the UK. To ensure meaningful involvement of WLHIV, the project was designed and delivered by a Mentor Mother living with HIV and a co-trainer who, although HIV-negative herself, is experienced in working with WLHIV. Interactive training took place over two days. Day one covered the pregnancy journey whilst living with HIV, preconception planning, pregnancy, delivery & aftercare of both mother and baby. Day two focused on peer mentoring, action planning, and creative writing.

Challenges included recruitment and retention, and concerns about attending training delivered by strangers and confidentiality.

Given the pressures faced by many voluntary sector organizations, one training session was cancelled due to the closure of a host organization through funding cuts.

To address these challenges we created flyers for organizations to circulate to potential participants, used proactive communication

and follow-up of participants, met childcare costs where needed and used social media to raise awareness of the project.

As such, we exceeded the target number of women we set out to train (46 instead of 40); the project evaluation was peer-led; we were invited to deliver extra workshops for healthcare providers; and the creative writing component of the workshop was highly rated by the participants.

Fifty-seven percent of the Mentor Mothers expressed an interest in becoming trainers to deliver Mentor Mother training. We’ve since secured funding to deliver a residential Training of Trainers workshop with Mentor Mothers to further build capacity across the UK. We have also received funding to take this project beyond the UK to work with out partners Personal Initiative for Positive Empowerment (PIPE) in Kenya and the Uganda Network of Young People Living with HIV /AIDS (UNYPA) in Uganda.

We feel this grassroots-led model is replicable and WILL benefit other marginalised women during pregnancy and early motherhood. These could include women with mental health issues, those using drugs, those living with other chronic conditions. We are keen to identify opportunities to develop this community led work beyond the field of HIV. 5 Angelina Namiba is a woman living with HIV diagnosed over 2 decades ago. She is a Project Manager and an associate of the Salamander Trust.

P5SITIVE LIVING | 22 | MARCH •• APRIL 2017

Visioning positive Indigenous women’s health

F

By Sean Sinden

or many cultures, including Indigenous people in Canada, improving health means more than merely addressing illness—health is more than the ‘absence of disease’. A new CTN study seeks to address the varying definitions of health and HIV in this social and cultural context.

Visioning Health II (CTN 302) is a culturally-grounded, arts-informed interventional study for Indigenous women living with HIV. The research builds on the work of Tracey Prentice’s PhD thesis Visioning Health I, co-developed with Doris Peltier, which found, among other things, that the process of participating in this type of intervention led to improvements in health.

“We designed Visioning Health as an opportunity to give HIV-positive Indigenous women the space and the opportunity to tell their own stories and to tell stories of strength and health, instead of the typical stories of illness; of trauma—of the barriers, the gaps, and the needs that women were being asked to tell,” said Prentice.

The intervention itself focuses on two main questions: first, what is the meaning of health and how does it intersect with gender and culture for HIV-positive Indigenous women? Second, how does the Visioning Health process influence their self-defined health?

To address these questions, the team is using culturally-grounded community-based participatory research methods, including a ‘nested’ structure, in which a descriptive study is embedded within an interventional research study.

Specifically, the study will gather qualitative data from participants about health, gender, and culture, while using both qualitative and quantitative methods to assess implementation and potential health outcomes. At seven sites across Canada, positive Indigenous women participants will be guided to reflect on and respond to the research questions through a variety of traditional and contemporary art mediums.

The impact of the intervention will be assessed and analyzed by the investigators in conjunction with the participants using collaboratively developed evaluation and assessment methods. By studying the impact of the intervention, CTN 302 can inform health promotion programs for Indigenous communities beyond women living with HIV.

The participating site in British Columbia is the Red Road HIV/ AIDS Network (red-road.org). For more information about the study, please contact Tracey Prentice (tracey.prentice@gmail.com) or Doris Peltier (dorpeltier@yahoo.ca). 5 Sean Sinden is the Communications & Knowledge Translation Officer for the CTN.

Other Studies enrolling in BC CTNPT 014

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

CTN 222

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

CTN 262

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

CTN 281

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

CTN 283

The I-Score Study BC site: Vancouver ID clinic

CTN 292A

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

CTN 292B

Treatment of high-grade anal dysplasia in HIV+ MSM BC site: St. Paul’s Visit the CIHR Canadian HIV Trials Network database at www.hivnet.ubc.ca for more info.

P5SITIVE LIVING | 23 | MARCH •• APRIL 2017

In grateful recognition of the generosity of Positive Living BC supporters Gifts received November – December 2017

$5000+

$150 - $499

LEGACY CIRCLE

HEROES

Peter Chung

$1000 - $2499 CHAMPIONS

Bramwell Tovey Don Evans Fraser Norrie Gina Best Harvey Strydhorst Jackie Yiu Kemlyn Ibrado MAC AIDS Fund Paul Goyan Paul Gross The Benevity Community Impact Fund

$500 - $999 LEADERS

Blair Smith Cheryl Basarab Christian M. Denarie Cliff Hall CUPE LOCAL 3495 Dean Mirau De-Ann McLellan Emet G. Davis Hassan El Sherbiny James Goodman Leslie Rae Megan Pilon Mike Holmwood Pierre Soucy Rebecca Johnston Robert Capar Ross Harvey Scott Elliott Sharifa Dhanani Silvia Guillemi Stan Moore Stantec Consulting Ltd. Thomas Little

Aimee Cho Barry DeVito BCGEU Blayne Jansens Bonnie Pearson Brian A. Yuen Brian Anderson Bruce Grant Capital Salvage Co. Ltd. Carmine Digiovanni Christian M. Denarie Christopher Koene Colin Macdonald Colin N. Curtis Darrin D. Pope Dena R. Ellery Dennis Parkinson Edith Davidson Elizabeth Briemberg Erik Carlson Glyn A. Townson Glynis Davisson Gretchen Dulmage James Ong Jane Talbot Jean Sebastian Hartell John Bishop Kate McMeiken Katherine M. Richmond Keith A. Stead Ken Coolen Lawrence Cryer Len Christiansen Lorne Berkovitz Mark Mees Matthew Hinton Maxine Davis Mike McKimm Pam Johnson Patricia Dyck Patricia E. Young Patrick Carr Penny Parry Ralph E. Trumpour

Ralph Silvea Rob Spooner Ron J. Hogan Ronald G. Stipp Ross Thompson Sergio Pereira Stephanie Tofield Stephen French Susan C. Burgess Thomas Fowle Tiko Kerr Tony Marchigiano Trevor Littlefield Triphonia Teta Vince Connors Wayne Avery William Granger

$20 - $149 FRIENDS

Adrian Smith Adrienne Wong Andrea Reimer Angela McGie Angie Chan Ariane Alimenti Brennan Meek Carol Kellman Chris G. Clark Chris Kean Christopher Wanuoff Daniel T. Watson Danny Nicholson Danny Robson Darlene Therburn Darren LAubser David Henderson Dawn Huff Demira Low-Kontou Dianella Knight Dida Lai Doris E. Michniewicz Elisabeth Aubie G. F. Johnson Gary Schlichter Grace Sing

P5SITIVE LIVING | 24 | NOV •• DEC 2017

Heather Inglis Jamie Dolinko Jas Brosnan Jeff Anderson John Collins John Yano Kari Hackett Kathy McAulay-Wright Ken Coolen Kenn Frisk Lilian Bocol Lilian Umurungi Linda Self Lindsay Mearns Lisa Bradbury Lisa Raichle Maureen Ryan Mike Ryan Miranda Leffler Nigel Pottle Paul J. Esau Perry Brown Peter Charles Ormsby Peter Cunningham Renata Sakamoto Richard Tsang Ronald Lai Sandra Bruneau Sharon E. Lou-Hing Shawn Barratt Shirley Hsu Stephen Finlay Tina Lam Tobias Donaldson Tracey L. Hearst Tuan Luu William Granger Zoran Stjepanovic

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

PROFILE OF A VOLUNTEER Alan does his own research, develops his own PowerPoint’s, and is very professional is his presentations. Seeing him in action is astounding as his passion for doing this work clearly radiates from him. Although often understated, Al is characteristically distinctive and charismatic.

Alan Wood, Treatment Outreach Coordinator.

*Al Hungerschafer*

What volunteer jobs have you done with Positive Living BC? My volunteer work has focused on HIV Education Programs and sharing my experience to help inform others on what it’s like to live with HIV. When did you start with Positive Living BC? I volunteered in the early 90s and became reengaged in 2013.

What is Positive Living BC ‘s strongest point?

Positive Living has a range of services for members that help us to improve our quality of lives and become community leaders.

What is your favourite memory of your time as a volunteer at Positive Living BC? Being made to feel an important part of the team for the IHHS/ SOWK Program, an interdisciplinary course that brings together students from the disciplines of medicine, social work, nutrition, dentistry and more to study HIV Prevention and Care.

What do you see in the future at and /or for Positive Living BC? I’m looking forward the future and the opportunities it will bring as Positive Living starts a new chapter in its updated location.

P5SITIVE LIVING | 25 | NOV •• DEC 2017

Where to find

HELP

If you’re looking for help of information on HIV/AIDS, the following list is a starting point.

For more comprehensive listings of HIV/AIDS organizations and services, please visit www.positivelivingbc.org/links

bA LOVING SPOONFUL

Suite 100 – 1300 Richards St, Vancouver, BC V6B 3G6  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

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

bAIDS VANCOUVER ISLAND (Victoria)

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

bAIDS VANCOUVER ISLAND (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 | NOV •• DEC 2017

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 SPECIAL UPDATE

JOIN A SOCIETY COMMITTEE!

Positive Living BC is excited to announce that we are now moved to 1101 Seymour Street (south-west corner of Seymour and Helmcken).

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”.

Board & Volunteer Development_ Marc Seguin  marcs@positivelivingbc.org  604.893.2298 Education & Communications_ Adam Reibin  adamr@positivelivingbc.org  604.893.2209 History Alive!_ Adam Reibin  adamr@positivelivingbc.org  604.893.2298 Positive Action Committee_ Ross Harvey  rossh@positivelivingbc.org  604.893.2252 Positive Living Magazine_Jason Motz  jasonm@positivelivingbc.org  604.893.2206 ViVA (women living with HIV)_Charlene Anderson  charlenea@positivelivingbc.org  604.893.2217

Come visit our new offices!

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

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

Cheque payable to Positive Living BC.

P5SITIVE LIVING | 27 | NOV •• DEC 2017

Last Blast Life lessons from the outhouse

By Murray Hunt

It

will be 50 years, December 13, 1967, since my grandpa left this mortal earth for a better place. I remember him and our times together vividly.

His name was Chauncy Murray Hunt. He moved to Canada from the United States in 1908, met my grandmother, and fathered eight children—four boys and four girls. He worked for the CN Railway but was forced to leave his machinist’s job after he lost an eye at work. A man who took his family seriously had to find different employment.

My grandparents decided to homestead in Pedley, Alberta, just east of Hinton. He provided for his family during the Depression by opening the first gas station in the area, and supplemented his income by fur trapping and hauling firewood.

My parents divorced when I was four, and I lived with my grandparents until I was 15. Grandpa understood that my father, who worked in a different part of the province, didn’t have the time to teach me the skills a young teen needs, so he took it on himself to teach me the important things in life. He sat me down one day to explain the birds and the bees, and then showed me how to use a chain saw, set a fur trap, and build log houses. He was the dominant male in my life—I felt blessed to be taught by the same man who trained my uncles and father.

Grandpa built the service station and his home from logs he had harvested from the homestead. In the 1950s he built a two-seater log outhouse for women. (He said that women liked to share the facility.) Grandma was furious at him as he spent too much time making sure the seats were smooth, comfortable, and had no slivers. He never did build a matching men’s outhouse.

He was diagnosed with Parkinson’s disease in the early 1960s, which made it difficult for him to stand. My grandma had me work with him to help him, and make sure that he was okay. It was at this time he decided to teach me how to build a log house from scratch. From the squaring of the floor to using a broad axe to cut notches in the logs, to chinking the wood between the logs

with horsehair and other guck to stop wind from blowing through.

We completed the outhouse in two weeks.

I was given the outhouse in his will and, since 1967, I kept it at my father’s home in Alberta. My father passed away 5 years ago and his home was sold. I was asked what I wanted to do with the old outhouse. What does one do with a log outhouse in the city of Vancouver? A cousin agreed to keep it on his acreage. I loaded it onto a flatbed truck and moved it myself.

Sadly, the old outhouse was destroyed in a fire. Though I have a picture of it, I remember the days when I would spend hours alone in the building doing things that teens do in private. Grandpa did not explain the full facts of life to me and though women were not of interest to me, I discovered from the Eaton’s and Sears catalogues my interests and always had a copy in the outhouse.

I miss the old outhouse, but not as much as I miss my Grandpa. I just wish he were still around so that I could have one last chance to talk with him. For 50 years, I cherished the old building and his memories.

I miss him so much and, sad to say, the old outhouse too. 5 Murray B. Hunt is a retired Schoolteacher from Toronto and a recent graduate from Langara College’s school of journalism.

P5SITIVE LIVING | 28 | NOV •• DEC 2017

THRIVE MUSIC FEST

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

Acupuncture

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THANK YOU TO OUR CARING COMMUNITY OF SUPPORTERS. YOU HELPED US RAISE $130,000 AND COUNTING. national sponsor local sponsors premium title a partnership project of

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Check our website for Wellness Clinic schedules positivelivingbc.org To BOOK your appointment email clinic@positivelivingbc.org or call 604.893.2203

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

G AT H E R I N G

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

NOV • DEC 2017 VOLUME 19 • NUMBER 5

ISSN 1712-8536

POSITIVE

A CONFERENCE DEVELOPED FOR AND BY HIV+ PEOPLE IN BRITISH COLUMBIA

MARCH 30

▾

APRIL 1 2018

Treatment Failure PRESENTED BY AIDS Vancouver AIDS Vancouver Island AFRO-Canadian Positive Network ANKORS DTES Consumers Board Living Positive Resource Center Positive Living BC Positive Living North REL8 Vancouver Native Health ViVa YouthCO

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Are HIV+ people at higher risk in BC’s interior?

Coast Coal Harbour Hotel 1180 W Hastings | Vancouver BC

positivegathering.com Space is limited. Register now!

604.893.2209 • 1.800.994.2437 info@positivegathering.com

FUNDING GENEROUSLY PROVIDED BY THE AIDS COMMUNITY ACTION PROGRAM, PACIFIC REGION, PUBLIC HEALTH AGENCY OF CANADA.

Affordable Social Housing?

Researching Indigenous Health

Plant-Based Diets