POZPLANET Magazine (March 2023)

https://www.cbc.ca/amp/1.6756429?fbclid=IwAR0rfuP3jdT7CGmENuvc4qiIu4lIZaP5ZoLvLh3cYhRFuLS53nu3Juq3yEw

During Canada's unprecedented mpox outbreak last summer, Montreal physician Dr. Antoine Cloutier-Blais noticed a concerning trend: Patients co-infected with advanced HIV were reporting lesions across their bodies, and systemic mpox symptoms.

"It was difficult at that time to confirm that suspicion with the data we had," he said. Now, new research in the Lancet medical journal backs up Cloutier-Blais' early concerns.

The paper, a case study on mpox in individuals with advanced HIV infection, details an aggressive and serious form of the illness formerly known as monkeypox at times involving skin cell death within lesions, nodules in the lungs, sepsis, and a high rate of death.

This form of mpox appears to be a "very severe skin and mucosal infection with high rates of sepsis and very severe lung complications," said study author Dr. Chloe Orkin, a professor of HIV/AIDS medicine at Queen Mary University of London, in an email to CBC News.

The researchers studied a cohort of nearly 400 patients from various countries, including Canada, who caught mpox while living with HIV and low CD4 cell counts. (CD4 cells are a type of white blood cell that help fight off infections by triggering the immune system to destroy viruses and other pathogens.)

Mortality was roughly 15 per cent in individuals with advanced HIV-related disease, the researchers wrote, while the death rate for people with the most severe immunosuppression doubled to around 30 per cent, Orkin noted.

• SECOND OPINION Mpox remains a global emergency and cluster of cases in Canada offers reminder it's still circulating

The staggering findings matter in large part due to high rates of mpox among individuals living with HIV/AIDS, who account for an estimated 38 to 50 per cent of people diagnosed with mpox.

"I think it's an important reminder of how we must not get too complacent even in the face of low case counts, because if the virus encounters a person susceptible to such severe manifestations like people living with advanced HIV, then it can be

really devastating," said Dr. Darrell Tan, a clinician-scientist at St. Michael's Hospital in Toronto, whose team contributed data for the Lancet paper.

The takeaways of her findings, Orkin said, are that health-care workers need to be trained on the high mortality rate associated with mpox and HIV-related immunosuppression.

"Every person with mpox should have an HIV test and every person with HIV and mpox should be tested for immunosuppression," Orkin continued, noting those

with advanced HIV infection should also be monitored carefully, given the significantly higher risk of death.

• Get vaccinated against mpox, public health urges people at risk after 4 reported cases in 1 day

"Access to mpox vaccines and antiviral treatments are the best way of reducing severity of disease and health authorities should ensure that people living with HIV are prioritized for vaccination and antivirals especially those with immunosuppression," she added.

In Montreal, Cloutier-Blais who was not involved with the Lancet study agreed vaccines must be an ongoing priority, and noted, reassuringly, that he now "rarely" encounters patients who haven't had at least one dose of the two-shot mpox vaccine.

"I have not seen a single [two-dose] failure and rare and mild presentations in patients who had received one dose," he added.

A doctor checks on a patient with sores caused by an mpox infection in the isolation area at Arzobispo Loayza hospital in Lima, Peru in August 2022. (Ernesto Benavides/AFP/Getty Images)

Uptake and access do remain a challenge at a global level, however.

"We certainly have patients in our care who have low CD4 counts and could be susceptible to these sorts of conditions, and uptake of [second doses] in Ontario have been disappointingly low," Tan, in Toronto, said.

"Also, there is particular risk in the many parts of the world where access to protective mpox vaccines is non-existent and where the burden of HIV is high."

• Public health, buy-in from gay and bisexual men helped get Canada's mpox outbreak under control

Demand for second doses in many major cities has dwindled, data shows, while many countries including those in Africa, and the emerging outbreak hotspot of Mexico don't have vaccines available at all.

"It is imperative that vaccines and antivirals become accessible worldwide and more global cooperation is needed here," Orkin said.

• Montreal group helps WHO rename monkeypox to 'mpox' to avoid stigmatization

Bob Leahy tells the inside story of how people living with HIV beat the professionals at their own game.

U=U is seven years old now. It’s widely accepted, and proven by research, that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV. Not that some of us didn’t have suspicions, or even weren’t convinced, before 2016. That we who were lucky enough to be undetectable (the majority of people living with HIV) couldn’t pass on the virus wasn’t then a view shared by Public Health, by AIDS Service Organizations and by regional and international bodies. Some, in fact, vigorously fought back against that notion, back then.

There is, in fact, a lot that people don’t know about how U=U, an extraordinary community-led campaign by any standards, came to be. I was lucky enough to be in at the beginning – before the beginning, in fact. I was at the time the editor of PositiveLite.com, a Canadian online magazine that often published critical analysis of the response to HIV in Canada. We were a renegade voice, disliked by funders but lauded for our ability to go behind groupthink and perceive what lurked underneath. We held knowledgeable positions on issues that often differed with the majority view. One of ours was that treatment as prevention was real, that

those on the West Coast promoting it were correct and that Ontario, who deeply mistrusted the idea of treatment as prevention, despite emerging science, had got it wrong In any event, against all odds, people living with HIV propelled the truth of U=U firmly into the mainstream. They still lead that movement. You’ve probably read their messaging, seen their speakers, read about their successes. Before I tell that story, though, here are a few things you likely didn’t know about U=U

U=U, in the early months, didn’t stand for Undetectable equals Untransmittable, but something else.

Nearly all organizations in Canada and elsewhere had insisted that people with undetectable viral loads represented a risk to others long after the science proved otherwise

Most poz guys know about U=U and believe it’s accurate; the reverse is true of negative gay guys.

The U=U movement was started by one man. U=U is now a worldwide movement with branches of the campaign in 105 countries, but Canada’s was the first federal government to endorse it.

Back to the beginning and the inside story of how U-U went from one man’s dream to that of a small body of activists determined to change the narrative around HIV. They wanted to free the hearts and minds of people living with HIV to the possibility of a life without risk of transmission. Not only that but to reduce HIV stigma, make strong arguments for treatment access for all, even to eliminate laws that criminalize HIV. Ambitious goals all, but how did they do it?

The story must start with a gay man from New York called Bruce Richman He’s a Harvard Law School graduate with a background in philanthropy. That he’s tall, dark and handsome is less important than that he’s smart, eloquent and driven. Bruce is the founder of the Prevention Access Campaign, the community-led body behind U=U still. I’ll let his 2016 words tell the story of how he became involved.

“I knew it was critical for my health when I became undetectable in 2010. But it wasn’t until 2012 after a condom broke that my doctor told me not to worry because I’m undetectable, I’m uninfectious). Having sex with a broken condom was perfectly safe? I had severe cognitive dissonance! I’d spent the last three months in fear waiting for the post-PEP test results for someone I’d been dating, who was now terrified of me. While my doctor wouldn’t put U=U in writing , he said he’d assure anyone I was dating that, while other STIs could still be transmitted and were an escalating problem, I could not transmit HIV.”

Bruce went on ““Safe” is not something I thought I’d ever equate with sex. While I fully trusted my doctor, it was a huge leap to internalize this incredible news after nine fairly isolating years of feeling toxic and dangerous. I started collecting research to prove U=U to myself and others,

often coming up against serious resistance and being treated like a liar. I was called a “danger to gay men’s holistic health” by one doctor who felt I was encouraging condomless sex ” Bruce wasn’t the only one experiencing resistance to the idea of U=U, which by the way initially stood for Undetectable equals Uninfectious, before we changed it to something more sensitive. Pushback was the underlying current of those early years. In fact, much of the AIDS establishment had been pushing back for years on the idea that treatment had dual benefits –health AND prevention of transmission. The Swiss Statement in 2008 made them batten down the hatches They continued to do so despite persuasive research that confirmed the truth of U=U. Solid research like HPTN052 and the PARTNER Study made no difference. Condoms were to continue to be worn, remained their recommendation.

In any event, in the early summer of 2016 I interviewed Bruce for PositiveLIte.com I’d read about him in POZ magazine. He impressed me immensely. Bruce’s views meshed exactly with my own for I had been a highly public supporter of treatment as prevention since 2013. Not only did Positive Lite.com publish my interview, but it also immediately signed up as a supporter of the campaign, the first organization in Canada to do so.

We immediately set out to enlarge the campaign’s base in Canada and by the end of that year had some important wins. Some of the more progressive organizations in Canada signed up –CPPN, AIDS Committee of Toronto (ACT), AIDS Committee of Ottawa, AIDS Committee of Durham come to mind. But others challenged us. Even some people living with HIV challenged us.

Those early wins were not enough, though It became readily apparent that to get more traction we needed to get CATIE on side. (CATIE is Canada’s go-to source for information relating to HIV.) The organization was and still is widely respected but in those days, it was known for being conservative. Key, it also reviewed for accuracy, prior to publication, of prevention campaigns such as those produced by the Gay Men’s’ Sexual Health Alliance (GMSH) in Ontario. Both CATIE and GMSH were still insisting that “unprotected” sex without a condom always represented a risk of transmission. It was a small risk but a risk nevertheless, they said. In fact, GMSH was about to update their thesexyouwant website indicating this, based on CATIE and the science panel’s review.

Here's where I got angry. As a GMSH committee member I objected to the proposed website content, Simply put, they had got the science wrong. But how to convince CATIE, and thus GMSH, of this?

John McCullagh, my colleague at PositiveLite.com, had become a formidable early ally We talked a lot about next steps. They came to fruition in late 2016 when he and I, together with some stalwarts from AIDS Action Now! met at the home of Darien Taylor, a long time well respected activist, to strategize. We had scones and coffee – and much talk. Out of that landmark meeting came a plan to engage CATIE in a dialogue that aimed to change their position. John, Darien and I would all write separately to Laurie Edmiston, then CATIE executive director, Laurie respected us all, I know, but would listen especially to John who at

the time was CATIE’s board chair. In any event, presented with the science as we interpreted it, she came on side. Despite her staff expressing some qualms, CATIE came out swinging strongly in support of U=U. If there ever was a turning point in the campaign in Canada. that was it.

Not that there weren’t still foes. Ontario’s AIDS Bureau, a funding arm of the Ministry of Health and Long Term care with whom I’d had a rocky relationship, was not easily convinced, but eventually caved. GMSH went ahead with a campaign that did, in fact, finally get it right. GNP+ was not happy with the U=U campaign, terming it brash and insensitive to the treatment needs of the global south. Some poz activists didn’t like the campaign either.

Our support was growing in early 2017 but there were too many naysayers – and too many people living with HIV that had yet to hear that they were no risk to others. So I invited Bruce to Canada and in April 2017 we spoke at public meetings, first at ACT in Toronto to a sell-out crowd, next at ACCM in Montreal. It was a heady few days, but never so heady as a few months later, at the International AIDS Conference in Paris. That really was where U=U literally burst onto the world stage as a group of us stormed the main stage and halted proceedings with a loud and riotous demonstration of support for U=U.

There were many subsequent celebrations as U=U’s influence grew, and that’s another story, but it was those early days that impressed most. They were challenging in the extreme but also the most rewarding work I’d ever undertaken. The voice of a group of people living with HIV has seldom been so influential, so bold Bruce often says that U=U was born in the States but grew up in Canada. He’s right, of course.

PEOPLE LIVING WITHHIV ARENOT CRIMINALS.

HIVCRIMINALIZATIONISA BARRIERTOCANFAR'SMISSION. WECANNOTENDTHEHIVEPIDEMIC WITHOUTDECRIMINALIZATION.

DOWNLOADFREESOCIALMEDIAASSETSATCANFAR.COMTOHELP SHARETHEMESSAGETHATHIVCRIMINALIZATIONMUSTEND. LEARNMOREATCANFAR.COM.

Full disclosure: I am not a trained healthcare professional so these are my opinions based on over 30 years of living with HIV and reading everything I could lay my hands on about HIV and its treatment, as well as a host of other socio-psychological issues that people living with HIV face, from research and places that report on research, like CATIE.ca and theBody.com, and from people living with HIV themselves.

A little bit of personal history for me and breast/chest feeding. As I’ve mentioned before, I was diagnosed with HIV in 1991. My son was born in March of 1990 and my daughter in July of 1988. As part of my pregnancy work up in late winter of 1990, my doctor tested me for HIV and it came back negative. So I have a probable infection window of some time between spring 1990 and when I broke up with the father of my children in May of 1991. As I was breastfeeding both of my children because my daughter was under 2, they could have become infected with HIV. I had severe mastitis, so I was quite concerned because of the elevated risk for both of them. They were tested and they both tested HIV negative.

There has been a lot of attention paid, after so many years of it being important, on breast/chest feeding for women living with HIV. We have been asking for better guidelines and research in this area for a very long time. We still have a way to go, but there is much more solid information than there has ever been for women living with HIV.

CATIE published an article on February 10th, 2023 that outlines where we are at.

https://www.catie.ca/prevention-in-focus/the-risk-of-hiv-transmission-through-breastfeedingwhat-we-know-and-dontknow?utm_source=CATIE+Email+Subscriptions&utm_campaign=5ba6ac7404EMAIL_CAMPAIGN_2022_09_07_03_23_COPY_11&utm_medium=email&utm_term=0_ae993f 6577-5ba6ac7404-45821543

For those who may not want to read the entire article (I suggest you do), here’s a summary. It starts by saying that how transmission occurs through infant feeding is not understood. Yep. We do not understand how HIV is transmitted through breast/chest feeding to infants (Note: unlike the article, I will use both breast and chest feeding rather than leaving out a whole group of people for whom the term breastfeeding does not apply). It is this lack of understanding that results in overly broad recommendations to women in more developed countries to exclusively formula feed, including Canada.

The article then attempts to describe how HIV infection happens in an infant. It states that HIV infects the immune cells of the infants’ body, which could not happen if the virus has not been transmitted. If transmission occurs, HIV infects the CD4 cells and can “hide” in the lymphatic system and some CD4 cells: “When HIV is hiding in the cells, it also can’t be killed by HIV treatment.” That is not how treatment works. It doesn’t “kill” HIV. It works by preventing the replication of HIV in the CD4 cells. When the CD4 cell dies, so do the unreplicated bits of HIV. CD4 cells are constantly dying in anyone’s body. So as long as we can prevent the replication of the HIV in someone’s body through anti-retroviral therapy, the person does not have HIV overwhelm their immune system. But let’s back up a bit. The question isn’t how HIV is replicating in an infants’ body. It’s how is transmission to the infant happening? Once transmission happens, unless the infant is on treatment, HIV will overwhelm the infants’ immune system and the infant could die. The article explains the possible routes of infection: that HIV infects the CD4 cells of the baby and goes dormant and then is re-animated when those cells are fighting an infection. But again, this presupposes that the HIV has been transmitted. It also states, “Other factors that can increase the risk of transmission include inflammation in the breast (caused by mastitis, breast abscess or engorgement); breastfeeding for a longer period of time [longer than 6 months]; and mixed feeding (feeding a baby solid food as well as breastfeeding rather than exclusively breastfeeding).”

So, what do we do to ensure that infants’ exposure to the potential of HIV infection is minimized, or eliminated? In the PROMISE study cited in the article, a study reported on in 2014, carried out in South Africa and India, they found that HIV transmission occurred in only 0.57% of babies born to women living with HIV who were on anti-retroviral treatment (ART) for HIV and breast/chest fed. Of those 7 cases, 5 of the parents were NOT undetectable. So we have evidence that if the parent is on ART that the risk of transmission is miniscule. This risk is reduced even further if the infant is on prophylaxis ART for the duration of breast/chest feeding. There have been no large studies done on infants who were receiving ART for the duration of breast/chest feeding AND the parent is on ART and undetectable. Until this happens, we just don’t know what the risk under these circumstances looks like.

The article talks about the sociological reasons that women living with HIV choose to breast/chest feed: it encourages bonding between the parent and infant, the health reasons to breast/chest feed (eg immune support) and societal pressure to breast/chest feed. Women living with HIV may also not tell healthcare providers because of “Fear of stigma, judgment and

being reported to law enforcement or child protective services”. Women living with HIV are also judged by others if they formula feed and in some cases, it could identify the woman as someone living with HIV.

Ultimately, the article states that the choice must be left up to the woman even if “the recommendation in Canada is to exclusively formula feed.” That recommendation alone is putting pressure on the woman to adhere to the recommendation, even if they believe it is not in theirs and their infant’s best interest.

In November of 2022, new guidelines were published from the Canadian Paediatric and Perinatal HIV/AIDS Research Group.

https://jammi.utpjournals.press/doi/10.3138/jammi-2022-11-03

These guidelines state: “The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission.” They however recommend that if a parent living with HIV chooses to breast/chest feed that the parent is closely monitored for ART adherence and that the infant be on prophylaxis for the entire period and for one month after stopping. They have criteria to identify which people living with HIV this recommendation would apply. “The mother should be fully adherent to ART and have sustained virologic suppression as measured by the viral load in the blood (ideally from before conception). The mother should have had regular attendance to standard follow-up visits for her pre-natal care. The mother, and where appropriate, their chosen support persons, are fully aware of the potential risk of HIV transmission with breastfeeding.” They also provide a document that should be signed by the parent that outlines these criteria.

I do not know if these guidelines have been adopted by healthcare worker oversight bodies, eg Canadian Paediatric Society.

I’m concerned. While the guidelines clearly state that a parent who chooses to breast/chest feed should not be reported to child protective services or the police, they also state that it would be appropriate under certain circumstances and that “The woman should be told that this is mandated by the HIV care provider’s legal duty to report a situation where a child’s health is being put at significant risk.” And yet, the research shows that the risk is anything but significant, especially if the parent is undetectable and adherent. And the parents’ right to choose is negated by the statement that formula feeding is recommended, which is probably where most healthcare workers’ knowledge of the issue will end.

So, what do we do? Demand better! We need good research that tells us what the routes of transmission are for infants. We need research that follows infants who are receiving prophylaxis treatment for HIV and their parent is on ART and undetectable. We need good guidelines that tell healthcare professionals to support parents living with HIV to choose what’s best for their family and their decisions need to be supported.

When I look at my situation, I’m surprised that my children weren’t apprehended because I continued breastfeeding them after my diagnosis. My decision was never discussed. I knew about the potential for transmission when I was diagnosed but once they were diagnosed as being HIV negative, I did not know that there was an ongoing risk if I continued to breastfeed. Parents living with HIV need better research, so that they have better information to make informed choices for their family.

An Outside Look at HIV

Zoe Faber gives our readers the point of views from college students on U=U & PrEP

U=U Among University Students

For this article I set out to interview five university students from a variety of backgrounds on their awareness of HIV. Out of the five people interviewed, only one of them knew what U=U was. Despite this, they were all aware of what PrEP was, even if they didn’t view themselves as at risk for HIV or impacted by it. Though advertisements for PrEP are often seen about Toronto, particularly in the Gay Village, U=U is underrepresented. While multiple Canadian studies have shown that men who have sex with men are increasingly aware of U=U, skepticism and general ignorance have harmed U=U’s efficacy. The message of undetectable equals untransmittable is an important one as it reduces stigma, a huge barrier to HIV treatment and prevention. Stigma and discrimination needlessly reduces the quality of life of those who are HIV positive. This is generally an issue with advertising. U=U is not a widely disseminated fact beyond those most at risk, which impacts the stigma related to HIV. If university educated, mostly queer folks aren’t aware of U=U, who outside of the direct circle of HIV are?

Below are the five interviews conducted and the questions they were asked.

1. How do you identify?

2. How much do you know about what it is like to be HIV positive?

3. Do you know what u=u is?

4. Do you know what PrEP is?

5. How do these things impact your life?

LOU

1. I identify as bisexual and genderqueer.

2. I don’t know much about what it is like, other than the precautions that are taken to have safe sex.

3. I do not know what u = u is.

4. I have heard of what PrEP is though I’m not sure entirely how it works.

5. I don’t think they impact my day to day, but I do think they’re important things to know about.

DIDI

1. Woman, lesbian.

2. I’m aware of the social stigma/ostracism, the institutional challenges, and the healthcare concerns/dangers.

3. Nope!

4. I believe PrEP is a drug that prevents HIV from being transmissible.

5. I rarely think that I am at risk for HIV, though it can happen to anyone. I stand in solidarity with HIV positive people.

RIA

1. Heterosexual female.

2. I know that it’s manageable with medication to the point where HIV positive individuals can live a normal healthy life.

3. No.

4. Yes, it’s an HIV preventative.

5. They do not impact my life.

MOSS

1. Queer, gender-non conforming.

2. I know that it’s still an issue today and people face a lot of stigma with it.

3. No.

4. Yeah it’s an HIV prevention medication.

5. HIV sort of impacts me, it’s something I occasionally think about but I don’t know anyone with it.

QUINN

1. I identify as a non-binary lesbian.

2. I don’t know very much about what it is like to be HIV positive but I would say I know more about what it was like during the aids epidemic because of shows and movies I’ve watched and classes I’ve taken but I don’t know much about what it is currently like to be HIV positive.

3. I learned in a class I took that it means. Undetectable=untransmittable which I’m pretty sure means it’s possible to have HIV that’s undetectable and in that case it is not possible for that person to give HIV to someone else.

4. I know PrEP is a medication that can prevent HIV, I’m not sure whether or not people take it if they already have HIV.

5. Currently it’s not something that really impacts my life or anyone close to me, i still think it’s important to have a basic knowledge about what it’s like to have HIV though and I would like to know more.

While ignorance about HIV is still prominent, there are lots of ways to increase awareness and decrease stigma. Some possibilities include asking for space on social media platforms, radio and TV, interviewing people living with HIV, as POZ-TO does, and going beyond the scope of those directly impacted to reduce stigma. Directly in Toronto there are organizations like Maggie’s, the University of Toronto’s Sexual Education Centre, and sex-positive businesses like Come as You Are, Good For Her, Men’s Room, and others that promote sexual health.

Awareness and education campaigns are crucial as they not only educate on the prevention of HIV, but inform those not generally considered at risk, reducing their likelihood of stigmatizing the HIV positive community. U=U is a critical message that can greatly reduce stigma for the HIV positive community and it must be disseminated widely.

It's already March and POZPLANET Magazine is looking at a decorated HIV Activist in Canada, a whistle blower and cancer survivor. It is our pleasure to sit down with Mr. Benjamin Miller.

AK: Hello Benjamin...how are you today and may I call you Ben?

BM: I’m good thank you. Please do call me Ben.

AK: Great. Why don't you give us a little background on yourself....what part of Canada are you from? How long have you been HIV+?

BM: I was born and raised in Montreal. I am one of the rare Anglo-Quebecers, raised in a Orthodox-Jewish family. I am fluent in French and currently, I am living in Toronto.

AK: So, I believe this is the first time we have interviewed someone who is a decorated HIV activist. Could you tell us about that and how you came to be honored by Queen Elizabeth?

BM: Thank you. I am flattered to be one of the Canadian AIDS Activists and Advocates that have been recognized by a Governor General of Canada, the late Queen Elizabeth II’s representative in Canada.

I was nominated and selected for the Queen Elizabeth II Diamond Jubilee Medal because of the years I spent working on a local, provincial, national and international level to support those living with HIV, the fight against the spread of HIV and my dedication to the rights of our GLBTQ+ communities.

AK: Very impressive....very impressive indeed. So, what organizations have you worked with and what are you working on right now?

BM: Over the years, I have been fortunate to work with many organizations. For many years, I represented youth living with HIV.

I started at 19 years old as the Coordinator of the Pride Centre at the University of Ottawa. I then started working on national projects with the Canadian AIDS Society. I was blessed to have great mentors there such as Sharon Baxter and Marc-Andre Leblanc. They opened up a world of opportunities for me.

In 1998, I was selected as part of UNAIDS “Force for Change” campaign and spoke in the Opening Ceremonies of the International AIDS Conference, representing North America’s youth. There I got to work with organisations such as MTV, the Francois-Xavier Bagnoud Foundation, the World Health Organization, the World Bank to name a few. The group of us still try and stay in touch as much as possible. Just prior to the conference I had been appointed by the Minister Rock, the Minister of Health at the time, to be a Member of the 1st Ministerial Council on HIV/AIDS.

In 2000, I authoured and presented “Youth: Victims of Ageism within the People Living with HIV/AIDS Communities for the International AIDS Conference held in Durban, South Africa. There I was able to also join panels with the Francois-Xavier Bagnoud Foundation, UNAIDS and the Nelson Mandela’s Children Fund and several others. There I was invited by MTV to be part of the Dialogue on Health, being held at EXPO 2000, in Hanover, Germany.

I was honoured when I was selected by the members the Global Network of People Living with HIV/AIDS – North America in my region to hold the position of Treasurer. I have also worked for Positive Youth Outreach as the Executive Director, the Hamilton AIDS Network as a Youth Outreach Worker and for the Canadian AIDS Treatment Exchange as their first Memberships Coordinator.

Most recently, I was a member of the National Stigma Project Steering Committee hosted by the Ontario HIV Treatment Network. I participated in training through the Positive Learning Development Institute run by the Ontario AIDS Network. I had volunteered for the Toronto People with AIDS Foundation as well. I was also part of my union executive at work for about 10 years before I left my position with the Government of Canada.

I had planned on resuming my volunteer work with the Toronto People with AIDS Foundation but I had to put that on hold to focus on my health at the moment.

AK: Now...I guess we should talk about the whistle-blowing incident. What happened and what can you tell us?

BM: Throughout my years working and volunteering in the HIV sector I have seen my share of improprieties. In two cases I could not remain silent.

The two biggest ones, were during my employment with the Hamilton AIDS Network and during the time I volunteered with the Ontario HIV Treatment Network.

After I was the victim of constructive dismissal at the Hamilton AIDS Network. My union informed the funders at all levels that they needed to step-in and review the organization or we would be pursuing legal action. I realized that the clients would be the ones to suffer and was happy that the review and restructuring took place.

My former spouse was a Director at the Ontario AIDS Treatment Network. At the time, they were given Human Resources responsibilities in addition to being a signing authority. They had no experience in Human Resources so they would ask me for assistance. Instead of asking me a question, I was sent employee information to provide some advice.

In addition, there had been members of the management that continued to be paid as consultants despite having worked there for many years. This was approved by the Board of Directors and I would assume would have had to be approved by the government funders as well. My former spouse was aware of the Code of Conduct I had to abide by while taking images of cheques they signed. I advised a member of the management team of the human resources issues and the financial issues before providing it trough public channels to the Canada Revenue Agency. My assumption is that an audit was conducted by looking at the public financial records for those years as well as the departure of some of the parties involved from the Ontario HIV Treatment Network at the time.

These improprieties haven’t appeared to make a difference to those who continue in high earning and profile positions within both medical and teaching positions.

I have faced issues in the private sector as well. Years ago, I was a Team Leader for Dell Canada. While on leave I was told not to disclose my HIV status at work as it would cause issues with fellow employees. When I left Dell, I reached out to the (RED) Project as Dell publicly supported it with a share of sales of certain products. Dell Human Resources then contacted me to advise me that they were implementing training for all management I relation to employees living with HIV.

AK: Well...like they say in NYC on the subway - "If you see something, say something". Like many who are living with HIV, do you have any other health issues? I, myself, am diabetic and had to find the right cocktail of meds to balance out my health.

BM: These days HIV is the easy part for me. Medications are much more tolerable than when I first started with AZT, DDI and DCT in 1994. Now my biggest physical issues are Diabetes, high blood pressure, severe post-chemo and diabetic neuropathy from my fingers to my elbows and my toes to my knees. I am now dealing with unexplained wasting which has already shrunk my feet and calves. I am walking again but I cannot feel my feet when I do. At the age of 40, I was diagnosed with Stage 4 Unclassified Lymphoma of the Small Bowel. My cancer was in part HIV related.

I feel I should speak about my mental health issues as I believe the stigma is even greater than HIV. In my late teens I was first diagnosed with anxiety and depression. Over the years numerous other diagnoses were presented to me. The list contains such conditions as Bipolar-Spectrum 2, PTSD Addiction Syndrome, Survivors’ Guilt and more. At the age of 41, I was diagnosed with Bulimia Nervosa which shocked me. Outpatient Eating Disorder Treatment was one of my most traumatic experiences health wise.

I am focussing on healing from my traumas from both childhood and adulthood. I have repeated issues for too long. My childhood abuses found me in multiple relationships that involved domestic violence over the past twenty-plus years.

I have been lucky to find resources and a great medical team that have helped me deal with my depression, PTSD and Bulimia especially during this new COVID era. I have been lucky to make some good friends that too have dealt with their own issues and are there to support me. The services provided to me by such places as Casey House Hospital, the Canadian Naturopathic College, SMART Recovery and the Comprehensive Treatment Clinic in Toronto have all helped me more than I could have ever hoped for over the last year.

AK: Well, I am glad you are still here with us. I hope that by speaking up you can help others who are fighting to get the treatments and meds that are needed to keep them alive. Is it true that you are taking a fight to the Minister of Revenue since the Canadian Government does not consider HIV medications to be life sustaining therapy to qualify for the Disability Tax Credit but considers insulin like I take to be?

BM: Yes, I have filed a complaint with the Human Rights Commission, but as I have not received any news as of yet I decided to go to the source. In 2022, I wrote to the Prime Minister of Canada, Justin Trudeau, and asked that he step in and acknowledge that HIV medication is actually life-sustaining therapy as no Minister of Revenue has since the 1990s. My e-mail was send to the Minister of Health, who then has sent it to the Minister of Revenue. My e-mail had indicated that the Income Tax Act provides that the Minister of Revenue defines what falls under life-sustaining therapy to qualify for the Disability Tax Credit and all associated benefits. In Canada, insulin falls under life sustaining therapy yet HIV medication that not only cost ten times as much, and are as necessary to our survival as insulin to a diabetic are not. You may qualify for disability by your Province or under the Canada Pension Plan because of health issues related to HIV. One branch of the government says you are disabled while another says otherwise.

Now that I take insulin, wear hearing aids in both ears and have mobility issues, I could apply for the Disability Tax Credit, however, I will not take it until all people living with HIV in Canada are given the same opportunity. Had I received this credit since 1994, I could have lived better than I have.

AK: I'm sure many of our readers did not know that this was happening in Canada right now. Thank you for bringing it to our attention. Before I let you go...with all that you have learned in your years of activism and working in the HIV/AIDS sector what advice would you give to someone living with HIV over the age of 45?

BM: The way I see it there isn’t one good answer to this question. I am now 47 years old but I first tested HIV+ at the age of 18 in 1994. I am too old to be youth but too young when longterm HIV survivor groups and services have an age requirement to them. We are seeing more

and more other medical issues amongst long-term survivors. Newer diagnosed people over 45 years old, may not encounter these issues for some time if at all.

What I can say from personal experience is this. One must take an active part in their health. Nobody knows when something is wrong better than you do. If you are not being heard by your medical professionals there is no shame going somewhere else for medical help. Many still face the stigma associated with HIV. When I found out I had cancer, people wanted to hug me. Would they have if they new my cancer was HIV-related?

As many of us are at this age, we have become very guarded and independent with our health issues as we don’t have a partner. There is no shame in dealing with mental health issues just as we do our physical ones. I have had to learn to let people into my life and let my guard down more than I ever have before. Many of us have a chosen family stronger than our blood ties. I believe that all people living with HIV/AIDS should treat each other as a Brother and Sisterhood that is nurturing amongst ourselves.

AK: Well, we really appreciate you talking with us today. It has been very educational and informative. I hope that you and I get to work on a campaign or project. Thank you for your service to our community.

Listen to the mix here: https://www.mixcloud.com/djrelentlessny/ear-candy-march-2023

Download the video of this mix here: https://krakenfiles.com/view/PjtUUsyjYg/file.html

Check out DJ Relentless’ Mixcloud page: https://www.mixcloud.com/djrelentlessny

Check out DJ Relentless’ HearThis page: https://hearthis.at/djrelentlesstoronto

It's already March and we've got a lot to talk about in this month's mix. From Taylor Swift to Sam Smith to P!nk to Meghan Trainor...there's a lot of new music coming out and we've got some great remixes. And I don’t know about you but I kinda feel like all the wild weather is Mother Nature bitch slappin’ us for all the greedy idiots who kept sayin’ “Global Warming” was a hoax for the past fifteen years.

So…let’s get started shall we?

Up first to start our mix is a little Pop diddy by Anne-Marie called “SAD BITCH”. As the world grows less and less optimistic and continues to highlight the worst of us, this song seems right on brand. We’ve got to start looking at some puppy videos or somethin’! All the videos of fights on planes and bad behavior in public are rotting our brains! No wonder she is a SAD BITCH!

Our second selection is “Lavender Haze” by Taylor Swift. Now, I’m gonna be honest. If it weren’t for the music video, I wouldn’t have paid any attention to this song. It’s generic at best. But because Taylor is in bed with trans model and activist Laith Ashley I have to give props to her for really standing with our LGBT Community. You see…someone at the top of the Pop food chain like her does not have to do anything like this. So, it makes my cold heart warm up to her even more. I was very critical of her back during the Kanye-Kim phone call scandal over his “Famous” video and did not trust her at all. And because I sided with Katy Perry over the stolen dancer controversy which led to “Swish Swish” Taylor’s name was mud with me. And I don’t even remember what Mean Girls thing happened between her a Demi Lovato. But it seems like all of these situations played themselves out and Kanye and Demi were revealed as the real villains. And Taylor must have apologized because Katy was in the “You Need To Calm Down” video.

So, Taylor….I owe you an apology. Apparently the Swifties saw what I couldn’t see. You’re really a good person and an ally.

Funny thing happened….I have been searching through my old CD library for a DFA Bootleg House Mix of “So Sick” by NeYo and out of nowhere in my video pool the Dan Bravo Remix comes through. I still haven’t found that bootleg but this is a really nice downtempo 103 BPM remix. I like it.

Now…I know I’,m late to the party but it’s better to get there than never arrive at all. I’m late to finding the Saucy Santana songs. This probably because I limit myself to only a few hours of internet a day. I have a husband who is online all day everyday and I’m trying to be a living example of how to responsibly use the internet. And the pandemic really made me re-evaluate my time.

So, our fourth track is Saucy’s collaboration with Madonna called “Material Gworrllllllll!”. I figured this would give me an opportunity to talk about a tweet that appeared on Madonna’s Twitter account that said “Look how cute I am now that swelling from surgery has gone down. LOL”

Um…my alter-ego Jade Elektra has a line in her song “1-800-READ-A-BITCH” that says “I’m gon’ give you the same advice I gave Madonna. Stay in until yo’ face heal.” Almost every time she has a facelift, I feel like she rushes out and it’s too soon. But after a few months she sorta looks like herself again. Now, I know her true fans and a lot of women are gonna “cancel” me for saying that but…who da fuck am I? No one! This is my opinion and I am not Don Lemon. I don’t work for a big corporation and I don’t answer to stockholders. So, I can say whatever I want. And believe or not, I’m a lifelong fan. Her birthday is the day before mine.

But back to “Material Gworrllllllll!”….it’s a hot little track.

After watching Sam Smith and Kim Petras win their Grammy for “Unholy” I had a new appreciation for Sam. I always liked his voice but when he allowed Kim to have her moment as the first transwoman to win a Grammy it showed that this moment was more about the historic impact on future LGBT generations. And like everything on the internet someone always has to dispute the history.

Many people brought up Wendy Carlos as being the first transwoman to win a Grammy back in 1970. The only problem with that is she won three Grammys under her dead-name and was not out as a transwoman back then. And although Honey Dijon technically won a Grammy for Beyonce’s album, Kim received her award before Beyonce’s win for “Renaissance” that evening. So while Honey made history as well that night, Kim was the first transwoman to win a Grammy in Pop Music….period.

So, Sam actually makes two appearances in this month’s mix. Our fifth track is “Gimme” featuring Koffee & Jessie Reyez. This saucy hot Moombahton flavored Pop song has all of what is needed for a Pop hit today. I will definitely be playing this in my sets. But I hope all the chatter and memes on social media won’t derail Sam’s status in the Pop charts. While his body positivity is in line with Lizzo, I don’t think that he will fair as well as she has in public opinion. If he is defiant and stands

unscathed by internet comments, he will set a precedent for all shapes and sizes for non-binary srtists.

Our sixth selection is the Beat Thrillerz Remix of “Obsessed” by Addison Rae. I had to look up who she was because the name meant nothing to me. Apparently she was ranked as the highest paid TikTok personality in 2020 by Forbes Magazine.. But how important is that ranking when social media influencers come and go so quickly. I’m not understanding how something so fleeting in title and the scheme of things can even be listed by such an accredited publication. The remix is alright. In my opinion, this will be forgotten as soon as you hear it.

Up next is “Pack A Lunch” by PROF featuring Redman. It’s been a while since a Hip Hop track has caught my attention. I think I like this one because PROF sounds and reminds me of The Scatman from the 90s (if he was to do a more Urban sound). He doesn’t sound like every other Trap at 70 BPMs Hip Hop artist these days and that’s refreshing.

Our eighth track is “Dale Dembow” by Yomel El Melosa featuring Poeta Callejero. For some reason, the artist was listed backwards in my video pool. I get really bothered when people running sites slack off on their duties and do a half ass job of

listing credits and information. So, SmashVision…ya’ll are some lazy millennials sometimes. Do ya fuckin’ job! Give credit where it is due. If this was your work, you would be upset if someone mislabeled it.

Enty-ways….I don’t speak Spanish but I know when I hear a banga and “Dale Dembow” is definitely a banga!

And here is the second appearance of Sam Smith in our mix… “I’m Not Here To Make Friends” featuring Calvin Harris and Jessie Reyez. I’m not really clear on the placement of Calvin Harris in this credit. As a recording artist I just feel like if you are the producer or remixer your name should be in those lanes. Stay in your lane. You wouldn’t have a track without the vocalist. I mean…if you sang or rapped on the record then by all means you should be in the credits. If this was Calvin Harris’ track featuring Sam & Jessie then that would make sense but his name does not need to be in this one.

What’s great about this song is how unapologetic it is in its homosexuality. I’m looking forward to some remixes. The one I heard so far is just not complimentary to the lyrics and feel of the track. I’m not even going to name the remixer because I don’t want him to get any credit or references from my writing.

Now, from one gay artists to another….Jake Shears. While Sam Smith is revelling in his gayness, I kinda feel from Jake’s new music video for “Too Much Music” he is going back in the closet. We all know that Jake is gay. I used to work with one of his ex’s at The Hangar in the Greenwich Village. So, to watch him romance a woman is a little jarring. Perhaps he is going the Sandra Bernhard route by keeping the closet door open. And by doing so you are saying that you can play either on screen. But anyway….the song is just okay. It’s not as catchy as “Meltdown”.

I recently did an 80s mix that featured the Beakdance classic, “Din Da Da” by George Kranz. So, imagine my surprize when I heard “This Instant” by Sophia Fresh featuring T-Pain which samples it. I found this track to be kinda refreshing because it doesn’t sound like anything else that’s out right now.

Back in 2019, I fell in love in with the music video for Chaka Khan’s “Like Sugar”. The was already amazing but the video (which doesn’t feature her at all) had a great ensemble of dancers styled in very colorful 70s-esque clothes. Well, now there is a new Joi N Juno Remix. Finally…there’s a House mix. Love it!

So before last month, I had never heard of Armani White. Now it seems he has a new single every other week. Our thirteenth selection is “GOATED” featuring Denzel Curry This one is okay. Not as catchy as last month’s “BILLIE EILISH”.

A few years ago, I dubbed Pitbull & Nicki Minaj as the King and Queen of Whoredom… meaning that they would do a guest spot on anybody’s record. Well, I think Ed Sheeran is vying for their titles. Our fourteenth selection is the Jacked Remix of “My G” by Aitch featuring Mr. Sheeran. I kinda like Aitch’s flow but I think I should really find the original mix and judge this one from that. This remix is okay but somehow, I feel like the rap doesn’t really fit this remix.

Two years ago, I reviewed “Fierce” by Angelica Ross, Mila Jam, and House music legend & DJ Ultra Naté. I praised it then but wished that there had been an actual music video to accompany the release. Well…I finally got my wish. The single has been re-issued and there a lovely video with a message of supporting our Trans sisters and brothers. It’s time we stand up to the bullying and discrimination. Because no one has and protections rights until EVERYONE has rights and protection. It’s just that simple.

On the actual video, it starts with Anthony Preston speaking about giving your support in stopping the hate crimes against Trans people. It is a pandemic of hate crimes being committed against our Black and Brown Trans Women. The entire project is dedicated to the loving memory of “Miss Byrd”. It’s time we STOP KILLING TRANS PEOPLE for living their truths.

Our sixteenth selection is “Hectic” by Jodie Harsh. As soon as I heard this track it took me back to my old days of dancing at the Limelight in NYC back in the 90s. There’s something about the bouncy vocal and the energy of it that makes me think of wild abandon and being carefree. Unfortunately, it’s just a lyric video. I would have loved to see what imagery they would have used to bring this track alive.

So for anyone who came up in the 90s with Alanis Morissette’s “Jagged Little Pill” album, you eventually found a bonus track on the CD called “Uninvited”. There were bootleg mixes done of her version. Then in 2007, the Freemasons did a cover and it did very well. Well, Dave Audé has gotten Leann Rimes to cover it and has released a new version. It’s okay. She sings it well. I’m just not sure we needed another version of this one. But perhaps it will introduce a whole new generation to the song and that would be a good thing.

The eighteenth track is the Craig Welsh Remix of “Trustfall” by P!nk. I just recently watched a sit-down interview with Stephen Colbert and was very impressed. She was very personable and seemed genuine. She spoke of her father’s death and the message behind her recent work. I generally always support her because she is one of those artists that speaks the truth and is not afraid of losing her fan base. In fact…her advocacy for Women and LGBT rights only strengthens her fan base.

Okay…the new Adam Lambert is a song called “Getting Older”. Interesting lyrics and video but right before this came out there were two video singles that dropped. A cover of the 80s Bonnie Tyler classic “Holding Out For A Hero” and a cover of the 90s Duran Duran hit “Ordinary World”. Well, the Bonnie Tyler cover was too fast for my taste and this mix. But the Dario Xavier Remix of “Ordinary World” worked in a pinch. I’m beginning to think that Adam is feeling a little nostalgic these days. I’ve always loved his vocals and I hope that with his new album comes at least a couple of fun Dance tracks. Yes, he excels with a good ballad, but a good House remix always lends some freshness to his sound.

And speaking of fun Dance tracks….the twentieth track in our mix is the Freejak Remix of “Drugs From Amsterdam” by Mau P. Now, I do not endorse drug use at all. But because I have been a working DJ since 1980, I started in radio with my uncle Herb King at WMNF 88.5 in Tampa, Florida. I finally started DJ-ing in the nightlife scene in 1985. From Tampa to New York City to Toronto…I have played in many spaces. And I have even spun in Amsterdam as well. I have seen just about anything you can image at the various bars, clubs and venues I have spun for. And it would be foolish to think that there would be no drug use in the party scene. That being said…this is a hot track!

I have never been a huge Shakira fan. I can kinda take her or leave her. So, when “Music Session Vol. 53” with Bizarrap came into my pool I didn’t rush to listen or see the video. Then one of my fans of my video edits wrote me and asked if I would do a remix and video for this track. I gave it a listen and told him “no”. I gave him some suggestions of what version of the track I would play if I had to and the DJ Mag Guaracha Remix would be it. And as a working DJ it is not about your personal taste if you are being paid to keep folks entertain. So, I always recommend finding a version of a song that you can live with. ‘Cuz if it’s popular on the charts, someone is gonna come up and request it.

And to close out our March 2023 EAR CANDY mix is the Joey Corry Remix of “Made You Look” by Meghan Trainor. Anytime my husband hears her name he repeats it like a coked-up Valley Girl. He is not a fan. She doesn’t really bother me…I kinda like her. To me, she was the UK version of Lizzo before Lizzo hit it big.

I’ve listened to the original version of “Made You Look” and boy am I grateful for this remix. The original version is pure Cotton Candy Pop. And unless you’re spinning for a wedding reception or a kid’s party, this just won’t do. But Joey gave it a functional Club vibe. Only thing is, he didn’t use the full vocal. So, if you play it for a true Meghan Trainor fan they’ll probably complain and ask where are the lyrics?

Well, that’s it for this month’s mix. See ya in April. And be sure to download your FREE copy of the video version of this mix in the links at the beginning of this article. And check me out on Twitch here: https://www.twitch.tv/relentlessthedj