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inside<br />
333<br />
features<br />
q<br />
treatment<br />
information<br />
333<br />
05 3FIGHTING WORDS<br />
The <strong>BC</strong> government has made a string of funding cuts. The Coalition to Build a Better <strong>BC</strong><br />
is taking action.<br />
06 3ACCOLAIDS<br />
Awards gala honours heroes in <strong>BC</strong>’s AIDS movement.<br />
08 3EPIDEMIOLOGY<br />
Is rectal mucus a source of HIV transmission?<br />
12 3CRIMINALIZATION OF HIV<br />
Current Canadian cases related to HIV non-disclosure<br />
14 3GIRL TALK<br />
kPreparing for a successful pregnancy.<br />
kOne HIV-positive woman’s story of her pregnancy.<br />
16 3PREVENTION<br />
Important services from <strong>BC</strong>PWA for people who are newly diagnosed with HIV.<br />
40 3LAST BLAST<br />
Air travel can be death-defying or life-confirming—it just depends on your perspective.<br />
q09<br />
q20<br />
REVITALIZATION AT <strong>BC</strong>PWA<br />
<strong>BC</strong>PWA is changing with the times, with several initiatives aimed at ensuring we’re<br />
serving all individuals in our diverse community equally.<br />
HIV AND AGING<br />
The intersection of HIV and aging is an emerging area of concern.<br />
17 3CONFERENCES<br />
Report on an HIV/AIDS summit at the University of British Columbia.<br />
23 3TREATMENT RESEARCH<br />
Phase II results for the new GS 9350 booster hold promise for a four-in-one pill.<br />
24 3ANTIRETROVIRALS<br />
Not all AIDS drugs have stayed with us over the years. Some didn’t go the distance.<br />
27 3NUTRITION<br />
kSome tips to use food and nutrition to support you when quitting smoking.<br />
kLooking back at the role of nutrition in HIV treatment over the years.<br />
31 3OPPORTUNISTIC INFECTIONS<br />
PML is a rare disease of the central nervous system that affects<br />
immunocompromised people.<br />
32 3LET’S GET CLINICAL<br />
Clinical trials: beyond virology.<br />
33 3STRAIGHT FROM THE SOURCE<br />
Report from the 2010 Conference on Retroviruses and Opportunistic Infections.<br />
36 3POSITIVE GATHERING 2010<br />
This year’s conference focused on our shared commitment to healthy self-preservation.<br />
<strong>Living</strong> <strong>Positive</strong> is published by the British Columbia Persons With AIDS Society. This publication may report on<br />
experimental and alternative therapies, but the Society does not recommend any particular therapy.<br />
Opinions expressed are those of the individual authors and not necessarily those of the Society.<br />
MayqJune 2010 <strong>liv</strong>ing5 1
think5<br />
opinion&editorial<br />
The British Columbia Persons With AIDS Society<br />
seeks to empower persons <strong>liv</strong>ing with HIV<br />
disease and AIDS through mutual support<br />
and collective action. The Society has over<br />
4800 HIV+ members.<br />
<strong>Living</strong> <strong>Positive</strong> editorial board<br />
Denise Becker, Lorne Berkovitz – chair,<br />
Wayne Campbell, William Christiansen,<br />
Doug Mitchell, Derek Thaczuk,<br />
Neil Self, Tova Diva, Glyn Townson<br />
Managing editor Jeff Rotin<br />
Design / production Britt Permien<br />
Copyediting Christina Thiele<br />
Proofing Rob Gair, Carl Bognar<br />
Contributing writers<br />
Willie Blackmore, Cheryl Collier,<br />
Dr. Marianne Harris, Diana Johansen,<br />
Cécile Kazatchkine, Shannon Lee,<br />
Leslie Leung, Nicole Lewis,<br />
Suzanne MacCarthy, Chuck Osborne,<br />
Ron Rosenes, Laura Vicol<br />
Photography Britt Permien<br />
Director of communications & education<br />
Adam Reibin<br />
Director of advocacy and prison outreach<br />
Adriaan de Vries<br />
Director of health promotion<br />
Elgin Lim<br />
Subscriptions / distribution<br />
John Kozachenko, Joe LeBlanc<br />
Funding for <strong>Living</strong> <strong>Positive</strong> is provided by the<br />
<strong>BC</strong> Gaming Policy & Enforcement Branch<br />
and by subscription and donations.<br />
<strong>Living</strong> <strong>Positive</strong> <strong>mag</strong>azine<br />
1107 Seymour St., 2nd Floor<br />
Vancouver <strong>BC</strong> V6B 5S8<br />
TEL 604.893.2206 FAX 604.893.2251<br />
EMAIL <strong>liv</strong>ing@bcpwa.org<br />
<strong>BC</strong>PWA ONLINE www.bcpwa.org<br />
© 2010 <strong>liv</strong>ing5<br />
Permission to reproduce:<br />
All <strong>Living</strong> <strong>Positive</strong> articles are copyrighted.<br />
Non-commercial reproduction is welcomed.<br />
For permission to reprint articles, either in<br />
part or in whole, please email <strong>liv</strong>ing@bcpwa.org<br />
Get your vote on<br />
at our AGM<br />
by Glyn Townson<br />
last year’s Annual General<br />
AtMeeting (AGM), <strong>BC</strong>PWA<br />
members voted in favour of a new<br />
system of mail-in balloting that has<br />
revolutionized our standard voting<br />
procedure for <strong>BC</strong>PWA business.<br />
Whereas we once saved all special<br />
resolutions until the AGM and<br />
relied on the handful of members<br />
who were present to cast deciding<br />
votes, mail-in balloting allows us to<br />
motion special resolutions at any<br />
time of the year and trust their<br />
approval or refusal to a broader,<br />
more representative range of <strong>BC</strong>PWA<br />
voting members.<br />
I personally put this special<br />
resolution forward on behalf of<br />
the board of directors because we<br />
strongly believe this system will<br />
produce long-term and meaningful<br />
benef its for our community. Our<br />
Society is now comprised of more<br />
than 4,800 members; last year, less<br />
than 100 members showed up to<br />
our AGM. That they should decide<br />
the direction of our business simply<br />
isn’t fair.<br />
While your attendance at our<br />
AGM this August is still vital<br />
(see the inside front cover of this<br />
issue for details), I urge you all to<br />
familiarize yourselves with the new<br />
mail-in balloting procedures outlined<br />
in this issue of <strong>Living</strong> <strong>Positive</strong> and<br />
to respond, thoughtfully, when you<br />
receive your voting packages later<br />
this spring. Remember, <strong>BC</strong>PWA is<br />
your Society—you’re obliged to guide<br />
its success.<br />
Of course, your input to <strong>BC</strong>PWA<br />
isn’t limited to voting on special<br />
resolutions. We’re always open<br />
to member feedback about our<br />
programs, services, and resources. In<br />
particular, we’re extremely interested<br />
to hear your thoughts and suggestions<br />
on the i<strong>mag</strong>e-building work we’ve<br />
been doing over the past year. What<br />
do you think of our redesigned<br />
website at www.bcpwa.org? Can you<br />
f ind all the information you need<br />
there? And how do you feel about<br />
our new front desk management? If<br />
you’ve visited our Vancouver off ice<br />
recently, have you noticed greater<br />
eff iciency when you check in at the<br />
reception desk? We’d love to know.<br />
Please email us at info@bcpwa.org.<br />
I’ll be reading! 5<br />
Glyn Townson is the<br />
chair of <strong>BC</strong>PWA.<br />
2 <strong>liv</strong>ing5 MayqJune 2010
Canada cuts funding<br />
to international AIDS<br />
vaccine project<br />
Canada has pulled the plug on funding<br />
to one of the largest AIDS vaccine<br />
development agencies in the world.<br />
Between 2001 and 2008, the Canadian<br />
International Development Agency<br />
contributed nearly $80 million to the<br />
International AIDS Vaccine Initiative<br />
(IAVI), one of the biggest backers of HIV<br />
vaccine trials in the developing world.<br />
In 2009, Canada contributed nothing<br />
to the organization and said funding<br />
was under review. There was no money<br />
again in this year’s federal budget and<br />
no decision on whether IAVI will ever<br />
receive Canadian funding again.<br />
In 2007, when Canada announced its<br />
own Canadian HIV Vaccine Initiative<br />
(CHVI), Canada committed that the<br />
CHVI “would not compromise Canada’s<br />
international support of AIDS vaccines.”<br />
The CHVI is a $139-million, five-year<br />
joint venture between Canada and the<br />
Bill and Melinda Gates Foundation. It<br />
was announced to great fanfare in February<br />
2007. But three years later, less than $9<br />
million has been spent on CHVI,<br />
including almost $700,000 on a proposed<br />
$88-million vaccine production facility<br />
that was scrapped last month.<br />
Source: Canwest News Service<br />
HIV and hepatitis C crisis in<br />
federal prisons<br />
A report released by the Correctional<br />
Service of Canada (CSC) in early April<br />
reveals an HIV prevalence rate in<br />
federal prisons that rivals those of many<br />
countries in sub-Saharan Africa and is<br />
greater than the HIV prevalence rates in<br />
all other regions of the world.<br />
At 4.6 percent, the rate of HIV infection<br />
in federal prisons is 15 times greater than<br />
that in the community as a whole. As for<br />
hepatitis C in federal prisons, the 31 percent<br />
rate of infection is 39 times greater than<br />
the population as a whole. In both cases,<br />
incarcerated women and especially Aboriginal<br />
women—of whom 11.7 percent are infected<br />
with HIV—are disproportionately infected<br />
with HIV and hepatitis C.<br />
“About half the prisoners surveyed<br />
reported sharing used needles or syringes<br />
to inject drugs, and about one-third<br />
reported sharing a needle with someone<br />
who has HIV, hepatitis C or unknown<br />
infection status,” said Sandra Ka Hon Chu,<br />
senior policy analyst at the Canadian<br />
HIV/AIDS Legal Network. “This clearly poses<br />
a risk of HIV or hepatitis C transmission, a<br />
risk that could be remedied with prisonbased<br />
needle and syringe programs.”<br />
China repeals ban on<br />
HIV-positive visitors<br />
China has scrapped a 20-year-old travel<br />
ban that barred people with HIV and<br />
AIDS from entering the country just days<br />
ahead of the opening of the Shanghai<br />
Expo, which hopes to welcome millions<br />
of overseas visitors.<br />
China’s cabinet, the State Council,<br />
said in a statement posted to its website<br />
that the government passed amendments<br />
on April 19 revising the Border Quarantine<br />
Law as well as China’s Law on Control of<br />
the Entry and Exit of Aliens. The changes<br />
were effective immediately.<br />
The decision follows similar moves by<br />
the US and South Korea to eliminate<br />
travel restrictions for people with HIV.<br />
Both lifted their bans on visitors with<br />
HIV on January 1, 2010.<br />
Source: The Associated Press<br />
MayqJune 2010 <strong>liv</strong>ing5 3<br />
Victoria still waiting for needle<br />
exchange site<br />
After two years without a f ixed<br />
needle-exchange site, Victoria can’t<br />
sit back and wait for health officials<br />
to develop an Island-wide distribution<br />
model, says Victoria Councillor<br />
Philippe Lucas.<br />
“There’s absolutely no reason and<br />
no excuse for us to wait for an Islandwide<br />
model to be put in place before<br />
this municipality takes action in trying<br />
to reduce the spread of disease and<br />
improve the public health of our region,”<br />
Lucas said.<br />
The Vancouver Island Health Authority<br />
(VIHA) is looking at a number of<br />
potential sites to establish an Island-wide<br />
distributed needle exchange program.<br />
At Lucas’s urging, council has asked<br />
city staff to compile past reports on<br />
harm reduction initiatives and consult<br />
with stakeholders such as drug user<br />
advocacy groups, VIHA, AIDS Vancouver<br />
Island, and police to produce a<br />
report on potential courses of action<br />
and costs.<br />
Source: The Victoria Times Colonist<br />
photo Mike Verbergt<br />
Pharma firm sees quick<br />
FDA approval<br />
Montreal’s Theratechnologies Inc.,<br />
developer of tesamorelin to treat excess<br />
abdominal fat in HIV/AIDS patients, is<br />
confident US regulators will approve the<br />
drug’s US launch for late this year.<br />
CEO Yves Rosconi said a US Food<br />
and Drug Administration panel of experts<br />
will review the new drug application<br />
(NDA) for tesamorelin without further<br />
modifications on May 27 in a public<br />
process. The panel’s recommendation<br />
will go immediately to the FDA. “We<br />
continued on next page
think it will be favourable so the<br />
regulators can give the green light on<br />
July 27, the final action date, for the US<br />
launch,” Rosconi said.<br />
Theratechnologies’ partner for the US<br />
market is EMD Serono, a unit of Germany’s<br />
Merck KGaA pharmaceutical giant.<br />
Source: The Montreal Gazette<br />
Drug users must be helped to<br />
halt AIDS spread: UN<br />
Countries in eastern Europe and central<br />
Asia face spiraling AIDS epidemics if they<br />
fail to help people who inject drugs and<br />
stop the spread of infection, according to<br />
the head of the United Nations agency<br />
for HIV/AIDS.<br />
Michel Sidibé told Reuters that countries<br />
such as Russia, Ukraine, and others<br />
could halt or buck the global downward<br />
trend in new HIV infections if they ignored<br />
the threat posed by drug users and failed to<br />
introduce effective harm reduction steps.<br />
“HIV infection has slowed down<br />
globally, but it is expanding in this region<br />
of eastern Europe and central Asia,” he<br />
said. “We’re not seeing anything like this<br />
in any other region of the world.”<br />
Sidibé said of the 3.7 million people in<br />
the region who inject drugs, a quarter<br />
have HIV.<br />
Sidibé warned that newly emerging<br />
and growing pockets of HIV spread<br />
among drug users could propel a wave of<br />
infections and undermine gains in curbing<br />
sexual transmission of the disease.<br />
A report published last month showed<br />
that more than 90 percent of the world’s 16<br />
million injection drug users are offered no<br />
help to avoid contracting HIV.<br />
Source: Reuters India<br />
Bananas enlisted to help stop<br />
spread of HIV: Study<br />
A simple fruit that many of us eat every<br />
day could soon prove to be a powerful<br />
new inhibitor of HIV, and lead to new<br />
treatments to prevent sexual transmission<br />
of the virus.<br />
Bananas, according to new research of<br />
the University of Michigan Medical<br />
School, might be good for you in an<br />
exciting new way.<br />
Lectins, naturally occurring chemicals<br />
in plants, are drawing the interest of scientists<br />
because they can stop the chain<br />
reactions that lead to a variety of infections.<br />
In laboratory tests, BanLec, the<br />
lectin found in bananas, was as effective<br />
as two current anti-HIV drugs, according<br />
to a news release from the school.<br />
Based on the findings published in<br />
the Journal of Biological Chemistry, BanLec<br />
may become a less expensive new component<br />
of applied vaginal microbicides,<br />
researchers say.<br />
Source: Canwest News Service<br />
HIV rise in Saskatoon<br />
The number of newly diagnosed HIV<br />
cases in Saskatoon jumped again in 2009,<br />
prompting warnings from the health<br />
region’s top physician that action is<br />
needed so the outbreak doesn’t become<br />
unmanageable.<br />
There were 94 new cases of HIV in<br />
the Saskatoon Health Region in 2009, up<br />
22 per cent from 77 a year earlier. The<br />
number is also up 141 per cent from five<br />
years earlier, in 2005, when there were 39<br />
new cases.<br />
The increase is partly attributable to<br />
more aggressive screening for HIV in the<br />
4 <strong>liv</strong>ing5 MayqJune 2010<br />
city after the region increased its followup<br />
with newly diagnosed cases in 2005-06<br />
to find out who they may have<br />
interacted with.<br />
But there has also been an increase<br />
in transmissions. The increase in HIV<br />
cases has been associated most closely<br />
with intravenous drug use, and that<br />
trend is continuing.<br />
Source: The Star Phoenix 5<br />
photo: Glenn Anderson<br />
Volunteers at “Yellow Mellow,” <strong>BC</strong>PWA’s annual<br />
volunteer recognition event which took place on<br />
April 29, 2010 at the Hotel Chateau Granville<br />
in Vancouver.
The<br />
FIGHTING WORDS<br />
Fighting back<br />
The <strong>BC</strong> government has made a string of funding cuts.<br />
The Coalition to Build a Better <strong>BC</strong> is taking action by Glyn Townson<br />
<strong>BC</strong> government is on a cutting spree. And those<br />
funding cuts are going to hurt PWAs, among many<br />
other groups in the province. It’s time to take action—and<br />
that’s exactly what the Coalition to Build a Better <strong>BC</strong> intends<br />
to do.<br />
Last spring, the <strong>BC</strong> government made serious funding cuts<br />
to non-profit arts programs throughout the province. How<br />
does this travesty affect our HIV-positive community? Most<br />
directly, <strong>BC</strong>PWA benefits from a long-standing affiliation with<br />
the Vancouver Queer Film Festival, through which we receive<br />
free promotional and networking opportunities at the festival’s<br />
wide-reaching annual events.<br />
Then last summer, British Columbians were shocked to<br />
learn of our newly re-elected Liberal government’s plans to<br />
implement the harmonized service tax (HST) and the emptiness<br />
of associated campaign trail assurances that <strong>BC</strong>’s finance structure<br />
was steadfast and true.<br />
How will the HST impact our HIV-positive community<br />
more than others in our province? Our good health and<br />
longevity relies on sustained access to a range of products and<br />
services not covered by the Medical Service Plan—or any other<br />
insurance provider, for that matter. Whether we are employed,<br />
retired, or making ends meet with a socially assisted income;<br />
HIV-positive British Columbians can’t afford to sacrifice our<br />
complementary healthcare necessities for increased taxes.<br />
Last fall, <strong>BC</strong>’s Ministry of Health announced devastating<br />
cuts to the administration budgets of community-based health<br />
organizations (CBHOs) funded through the Vancouver Coastal<br />
Health and Fraser Health Authorities. Though <strong>BC</strong>PWA operates<br />
outside of this government funding strategy, these cuts still impact<br />
us. <strong>BC</strong>PWA does its best to meet the ever-changing needs of our<br />
diverse community, but we don’t have the resources to be all things<br />
to all HIV-positive people. Instead, we serve our community best<br />
as part of a network of CBHOs whose collective efforts provide<br />
our province with a full continuum of HIV/AIDS care. Our success—<br />
and the <strong>liv</strong>elihood of HIV-positive British Columbians—is<br />
interdependent with the success of our CBHO partners.<br />
The last straw came this past March, when the <strong>BC</strong> government<br />
announced severe amendments to the terms that govern<br />
MayqJune 2010 <strong>liv</strong>ing5 5<br />
disability income eligibility and payments. Truly, the demographics<br />
of our community are changing and an increasing number of<br />
us are now consistently employed. But none of us can ignore<br />
the significant percentage of our HIV-positive peers who rely on<br />
disability income for such basic needs as clean, bottled water.<br />
How can our already<br />
cash-strapped HIV-positive<br />
community affect<br />
meaningful and immediate<br />
change in an environment<br />
where our own government<br />
compromises our every<br />
effort to survive?<br />
So the big, overarching question is: how can our already<br />
cash-strapped HIV-positive community affect meaningful and<br />
immediate change in an environment where our own government<br />
compromises our every effort to survive?<br />
We can’t do it alone.<br />
Early this year, <strong>BC</strong>PWA was invited to join the Coalition<br />
to Build a Better <strong>BC</strong>. This grassroots initiative combines the<br />
strengths of a diverse range of community organizations<br />
impacted by the <strong>BC</strong> government’s unwieldy, irresponsible<br />
system of funding cuts and policy amendments. By the time<br />
this issue of <strong>Living</strong> <strong>Positive</strong> is published, we’ll have already<br />
facilitated a “teach-in” at the Vancouver Public Library and a<br />
large-scale rally at the Vancouver Art Gallery.<br />
If you missed either event, don’t worry; the Coalition is<br />
committed to its long-term campaign for public awareness<br />
and active opposition to the <strong>BC</strong> government’s strategy for<br />
community funding. I encourage you to check www.bcpwa.org<br />
and <strong>BC</strong>PWA’s eNews for updates about the Coalition’s events<br />
over the coming months. 5<br />
Glyn Townson is the chair of <strong>BC</strong>PWA.
On<br />
Shining stars<br />
Awards gala honours heroes in <strong>BC</strong>’s AIDS movement<br />
April 18, the 9th annual AccolAIDS awards gala<br />
took place at the Vancouver Convention Centre.<br />
The event recognized the outstanding contributions of individuals<br />
and organizations in <strong>BC</strong>’s HIV/AIDS movement.<br />
INNOVATIVE PROGRAMS AND SERVICES<br />
Chee Mamuk Aboriginal Program<br />
The Chee Mamuk Aboriginal Program of the <strong>BC</strong> Centre for<br />
Disease Control was created in response to the disproportionate<br />
numbers of new HIV infections among <strong>BC</strong>’s Aboriginal<br />
population. Three exceptional women—Melanie Rivers, Jada-<br />
Gabrielle Pape, and Felicia Tebb—are behind Chee Mamuk,<br />
working with tireless devotion to create and implement innovative<br />
programming that effectively reduces HIV transmission in the<br />
most vulnerable communities. Every program is grounded in<br />
culture and tradition, creating a supportive environment that<br />
engages every participant.<br />
Chee Mamuk’s initiatives extend beyond awareness workshops<br />
and aim to create the capacity for change within the<br />
communities themselves. Chee Mamuk has ensured that<br />
Aboriginal individuals and communities are prepared to win<br />
the fight against HIV/AIDS.<br />
PHILANTHROPHY<br />
The Printing House<br />
The Printing House (TPH) actively supports HIV/AIDS<br />
organizations throughout <strong>BC</strong>. For nearly a decade it has chosen<br />
Vancouver’s AIDS WALK for LIFE as one of its signature<br />
charities, donating an average of $10,000 a year. In addition<br />
to funds, TPH donates printing services and encourages<br />
employee participation in AIDS WALKS all over Canada.<br />
One of the many projects organized by TPH is its annual<br />
seasonal greeting card campaign, which donates 100 percent<br />
of the proceeds to registered Canadian charities. In 2009, the<br />
funds went to programs that “feed Canada,” including the Dr.<br />
Peter AIDS Foundation Health Program. Over the years, a<br />
number of AIDS related charities throughout Canada have<br />
benefited from TPH’s fundraising efforts and community<br />
philanthropy activities.<br />
KEVIN BROWN PWA HERO AWARD<br />
Monique Desroches<br />
Monique Desroches is a familiar face in the HIV/AIDS community,<br />
lending her story to the media in order to challenge stereotypes,<br />
break down stigma, and promote women’s issues across Canada.<br />
She has served as a pacific regional representative to the Canadian<br />
AIDS Society Board, as well as the <strong>Positive</strong> Women’s Network<br />
(PWN) representative at the Pacific AIDS Network. Desroches<br />
is currently co-chair of the PWN Board of Directors, leading the<br />
organization’s provincial initiatives.<br />
On a personal level, Monique has made it her mission to<br />
provide support and guidance to women with HIV. Her<br />
indomitable spirit, affable sense of humour, and eternally<br />
positive attitude in the face of multiple adversities have<br />
helped others cope with their own personal struggles.<br />
SOCIAL/POLITICAL/COMMUNITY ACTION (tie)<br />
Micheal Vonn<br />
Staunchly committed to defending the rights of people <strong>liv</strong>ing<br />
with HIV/AIDS, Vonn has been tireless in her advocacy and<br />
public awareness endeavors. As policy director of the <strong>BC</strong><br />
Civil Liberties Association, she works to protect the personal<br />
health information of HIV-positive individuals through initiatives<br />
such as the Right to Privacy Campaign. Vonn has joined with<br />
several HIV/AIDS organizations to form <strong>BC</strong>’s Big Opt Out,<br />
an active awareness campaign against centralized electronic<br />
health data, or eHealth. She’s been instrumental in educating<br />
people on their rights in regards to disclosing their HIV status.<br />
Since joining the HIV/AIDS community as a volunteer at<br />
AIDS Vancouver, Vonn has used her legal savvy and personal<br />
determination to call for change and empower the vulnerable.<br />
She’s an influential advocate, speaker, writer, and educator<br />
who has done much to publicize issues relevant to HIV/AIDS.<br />
6 <strong>liv</strong>ing5 MayqJune 2010
Jennifer Evin Jones<br />
For the past 15 years, Jones has lent her legal expertise and<br />
innovative spirit to the HIV/AIDS movement, demonstrating<br />
a sophisticated knowledge and sensitivity to the complex<br />
issues of discrimination and stigma. As head of the advocacy<br />
department at <strong>BC</strong>PWA, she challenged provincial disability<br />
policy, which led to an increase in supplemental income for<br />
many people <strong>liv</strong>ing with HIV/AIDS. As executive director of<br />
YouthCo AIDS Society and the Vancouver Friends for Life<br />
Society, she designed and implemented innovative programming<br />
aimed at addressing critical gaps in community services.<br />
Currently, as executive director of the Pacific AIDS Network,<br />
Jones has been integral in shaping its vision and building<br />
formal relationships with key players in the HIV/AIDS<br />
community. She has demonstrated the vision, leadership,<br />
and iron will needed to influence change and promote<br />
cooperation in the fight against HIV/AIDS.<br />
HEALTH PROMOTION AND HARM REDUCTION<br />
Dr. Silvia Guillemi<br />
Dr. Guillemi is a physician at the John Ruedy Immunodeficiency<br />
Clinic (IDC) at St Paul’s Hospital and a consulting physician<br />
at the Dr. Peter Centre. As clinical coordinator of the IDC,<br />
she’s actively involved in enhancing primary HIV care<br />
programs and improving patient access to both medical and<br />
support services. In 2000, Dr. Guillemi initiated a tireless<br />
crusade to overhaul the IDC and is largely responsible for<br />
the exceptional and comprehensive treatment the clinic now<br />
provides for PWAs.<br />
Dr. Guillemi organizes regular educational sessions for staff<br />
at St Paul’s Hospital and arranges preceptorships for visiting<br />
healthcare professionals. She also directs the skills enhancement<br />
program in HIV/AIDS at the University of British Columbia<br />
(U<strong>BC</strong>) and co-coordinates the <strong>BC</strong> Centre for Excellence in<br />
HIV/AIDS’ (<strong>BC</strong>-CfE) biannual Antiretroviral Updates. Her<br />
unrelenting mission towards improved care for PWAs reveals<br />
itself through the effective management of the disease in medical<br />
facilities throughout <strong>BC</strong>.<br />
SCIENCE/RESEARCH/TECHNOLOGY<br />
Dr. Richard Harrigan<br />
Dr. Harrigan is the director of the research laboratory at the<br />
<strong>BC</strong>-CfE and is among the world’s leading experts in<br />
HIV/AIDS. Under his direction, the lab performs the vast<br />
majority of Canada’s HIV drug resistance testing and is<br />
regarded as the most outstanding HIV/AIDS research centre<br />
in Canada. Dr. Harrigan’s research focuses on drug efficacy,<br />
drug resistance, and the human and viral parameters that<br />
influence HIV disease progression. His innovative HIV drug<br />
resistance testing program is modeled throughout the world.<br />
Recently Dr. Harrigan conducted a study that indicates a<br />
dramatic decline in drug resistance within <strong>BC</strong>’s HIV population.<br />
These findings result from the development and application<br />
of innovative treatment and drug management strategies based<br />
on his lab’s findings. His primary goal of helping doctors<br />
make better decisions for their patients continues to inspire<br />
his research and lead to new discoveries.<br />
LIFETIME ACHIEVEMENT AWARD (tie)<br />
Irene Goldstone<br />
Goldstone has accomplished much over the course of her<br />
long and impressive career, first as a nurse and later as an<br />
educator and program director. In 1982, she was appointed<br />
director of medical nursing at St. Paul’s Hospital where she<br />
was involved in developing the HIV/AIDS program. In 1992,<br />
she joined the <strong>BC</strong>-CfE as director of professional education.<br />
Goldstone later joined the U<strong>BC</strong> faculty where she teaches an<br />
HIV/AIDS elective in nursing and assists in the de<strong>liv</strong>ery of an<br />
interprofessional HIV/AIDS course.<br />
Goldstone’s commitment to improving the <strong>liv</strong>es of those<br />
<strong>liv</strong>ing with HIV/AIDS is well respected throughout the<br />
community. The passion she brings to the classroom has<br />
inspired many, while her compassionate and understanding<br />
manner with her patients has impacted countless others. Her<br />
strong leadership and insistence on excellence has helped to<br />
ensure that top quality care is available to people with HIV/AIDS—<br />
today and well into the future.<br />
Diana Johansen<br />
As a dietitian at the Oak Tree Clinic at <strong>BC</strong> Women’s Hospital<br />
and Health Centre, Johansen has dedicated the last 16 years of<br />
her life to promoting the health of women and children with<br />
HIV/AIDS through improved nutrition and by advocating for<br />
their enhanced care. She played a key role in implementing<br />
the monthly nutrition supplement benefit and the free formula<br />
benefit for infants born to HIV infected mothers. She developed<br />
the <strong>BC</strong> nutrition guidelines for HIV and has contributed to<br />
various national and international manuals.<br />
Johansen has also been a leader in education, helping to<br />
teach the interprofessional HIV/AIDS course at U<strong>BC</strong> and<br />
conducting workshops for healthcare professionals in the<br />
Caribbean. She founded the Vancouver Dietitians in AIDS<br />
Care practice group to create opportunities for professional<br />
development. Her active presence within the HIV/AIDS<br />
community and long list of contributions towards health<br />
promotion will ensure her continued relevance. 5<br />
Shannon Lee is the communications<br />
assistant for AccolAIDS 2010.<br />
MayqJune 2010 <strong>liv</strong>ing5 7
The bottom line<br />
Is rectal mucus a source of HIV transmission?<br />
by Chuck Osborne<br />
rectal mucus a source of HIV transmission? There have<br />
Isbeen few studies conducted on rectal secretions and HIV<br />
plasma load, but the limited data does point to the probability<br />
that rectal mucus has a higher concentration of HIV than<br />
other bodily fluids such as blood or semen.<br />
Rectal mucus is a natural-forming substance that occurs when<br />
the bowels contract to allow smooth passage of stool. In most people,<br />
this only happens in small amounts. Most rectal mucus discharges<br />
are benign, but there are many conditions that can cause abnormal<br />
or excessive discharge. Amongst these could be hemorrhoids, anal<br />
fissures, prolapses, and warts. Crohn’s disease, colitis, rectal ulcers,<br />
anal tuberculosis, or any number of sexually transmitted infections<br />
(STIs), as well as some AIDS-defining illnesses, could also be responsible.<br />
It’s also normal that rectal mucus can consist of a litany of<br />
fluids, the most evident being blood.<br />
The US Centers for Disease Control and Prevention do not<br />
specifically list rectal mucus as a source of HIV transmission,<br />
and very few other agencies mention this fluid by name; however,<br />
the general reference to vaginal or anal fluids presumably<br />
includes anal mucus.<br />
The US Centers for Disease<br />
Control and Prevention do not<br />
specifically list rectal<br />
mucus as a source of HIV<br />
transmission, and very few<br />
other agencies mention this<br />
fluid by name.<br />
Nevertheless, scientists have been aware that rectal fluids<br />
can be a source of infection since Dennis Osmond’s report<br />
from the University of California, San Francisco, in 1998.<br />
There appear to be only two studies of note that have<br />
attempted to measure levels of viral load in rectal mucus.<br />
The first, conducted in 2000 by investigators at the Center for<br />
AIDS & STD at the University of Washington in Seattle, found<br />
only one man out of 54 participants with blood plasma viral<br />
loads below 50 copies/mL who had detectable HIV virus in<br />
rectal secretions. The other study, conducted in 2004 by<br />
Zuckerman et al, again at the University of Washington,<br />
compared viral loads in the blood, semen, and mucosal lining<br />
of the rectum in 64 gay men in the US and Peru. Viral loads<br />
tended to be higher in rectal mucus.<br />
Bodily fluids and their risk factor<br />
in HIV transmission<br />
HIV is not present in:<br />
• Urine<br />
• Feces<br />
• Vomit<br />
• Sweat<br />
HIV is present in negligible (non-infectious) quantities in:<br />
• Sa<strong>liv</strong>a (only detected in a very small number of people)<br />
• Tears<br />
• Blister fluid<br />
HIV is present in sufficient (infectious) quantities in:<br />
• Rectal lubricating secretions (in very high concentrations)<br />
• Blood and blood products<br />
• Semen and pre-ejaculate (pre-cum)<br />
• Vaginal/cervical secretions or juices<br />
• Breast milk<br />
Zuckerman’s study fails to note that of 63 patients, only 27<br />
were on antiretroviral therapy and only 18 had undetectable<br />
viral loads. The study also doesn’t address how long the viral load<br />
was non-detectable before biopsy, or the type of antiretrovirals<br />
participants were taking.<br />
We know from many other studies that some people can have<br />
undetectable viral load in their blood but detectable viral loads in<br />
either genital secretions or sperm. Scientists believe that this may<br />
be more likely to happen in people who have STIs or even<br />
asymptomatic herpes (that is, herpes with no visible symptoms).<br />
The bottom line is that when engaging in anal sex, it’s<br />
always wise to use precautions. 5<br />
Chuck Osborne is a volunteer with <strong>BC</strong>PWA’s<br />
Prevention and Treatment Information Programs.<br />
8 <strong>liv</strong>ing5 MayqJune 2010
Cover Story<br />
<strong>BC</strong>PWA is changing with the times<br />
by Adam Reibin<br />
Changes are afoot here at <strong>BC</strong>PWA. If you’re a<br />
regular participant in our programs, services,<br />
and events, you’ve no doubt noticed several<br />
changes in our methods of operation over the past two<br />
years. If you connect to us only through our external<br />
communications resources, recent enhancements to<br />
our published content and graphic style should make<br />
the new trends in our Society’s direction just as obvious<br />
to you. If this issue of <strong>Living</strong> <strong>Positive</strong> is your first<br />
introduction to <strong>BC</strong>PWA, welcome; you couldn’t have<br />
chosen a more exciting time to get involved.<br />
New audiences are at the core of <strong>BC</strong>PWA’s efforts<br />
to transform. Why? Because we’re committed, by our<br />
mission, to “enable persons <strong>liv</strong>ing with AIDS and HIV<br />
to empower themselves through mutual support and<br />
collective action.” This statement is no less relevant to<br />
our community today than when <strong>BC</strong>PWA members<br />
crafted it in 1990.<br />
continued on next page<br />
MayqJune 2010 <strong>liv</strong>ing5 9
Cover Story<br />
So, when the <strong>BC</strong>PWA staff and board of directors realized that<br />
the culture of our own membership didn’t reflect rising HIV<br />
infection rates among almost every demographic region and<br />
population in our province, we had to reevaluate our approach.<br />
In so doing, we reconfirmed our commitment to HIV-positive<br />
British Columbians at large—not just those individuals <strong>liv</strong>ing<br />
with HIV/AIDS who are our longest standing members, or the<br />
few members who show up at our Annual General Meetings<br />
(AGMs), and clearly not the founding members who have long<br />
since passed.<br />
HIV/AIDS culture in our province is constantly evolving,<br />
and <strong>BC</strong>PWA has a responsibility to serve all individuals in our<br />
diverse community equally.<br />
The status quo won’t work anymore<br />
Be sure, by attracting new populations to our organization, we don’t<br />
intend to displace, disrespect, or deny service to anyone who is<br />
already connected to <strong>BC</strong>PWA. But for us to offer future generations<br />
of HIV-positive individuals the same opportunities we’ve always<br />
promised by our mission, we can’t continue with our status quo.<br />
Anecdotal evidence of <strong>BC</strong>PWA’s failings is disheartening,<br />
particularly when we hear it from our volunteers, staff, and<br />
board members. Raised eyebrows and rolled eyes are common<br />
i<strong>mag</strong>es in stories from those whose public affiliation with<br />
<strong>BC</strong>PWA has often been rebuked by peers—especially in the gay<br />
community, where a substantial number of middle-class,<br />
professional males have claimed that our Vancouver facility’s<br />
predominant street culture is dangerous and unwelcoming.<br />
Several staff members have admitted that they rarely identify<br />
their employer to outsiders, because they’re tired of defending<br />
the organization. Most alarming are tales of HIV care providers<br />
and newly diagnosed individuals who have told <strong>BC</strong>PWA staff—<br />
in no uncertain terms—that they deliberately avoid <strong>BC</strong>PWA<br />
because they feel our focus is only relevant to HIV-positive<br />
injection drug users and older gay males.<br />
Identifying areas for improvement<br />
Results from a more formalized analysis of <strong>BC</strong>PWA’s cultural<br />
relevance have been no more encouraging. In the fall of 2008,<br />
we partnered with a student intern from the University of<br />
British Columbia’s Community Based Research program<br />
(School of Social Work) to assess awareness and opinions of<br />
<strong>BC</strong>PWA among HIV care providers and populations most<br />
at-risk for HIV transmission.<br />
Targeted surveys de<strong>liv</strong>ered online and on-the-street, as well<br />
as in-person interviews with key healthcare professionals, all<br />
confirmed our worst suspicions: at-risk populations were<br />
mostly unfamiliar with <strong>BC</strong>PWA, or misinformed about our<br />
services; healthcare providers generally felt that our methodology<br />
lacked innovation; and portions of both groups indicated that,<br />
if presented with the option, <strong>BC</strong>PWA wouldn’t be their first<br />
choice for HIV/AIDS service and support.<br />
The sum of our research—anecdotal and formal—was that<br />
the following operational components were the biggest deterrents<br />
to new people connecting with <strong>BC</strong>PWA:<br />
q Our name<br />
q Our focus on socially marginalized HIV-positive populations<br />
q Our public representation, including our brochures, posters,<br />
logo, and website<br />
q Our front-of-house service<br />
Accordingly, our staff and board have worked diligently to<br />
address these areas of concern over the past two years. While<br />
our course of action is constantly challenged by our limited<br />
resources, the results of our efforts are mounting. And we’re<br />
proud to share our progress.<br />
Changing our name<br />
Highly active antiretroviral therapy (HAART) has reduced the<br />
prevalence of AIDS in <strong>BC</strong>. Indeed, most HIV/AIDS specialists<br />
in our province advise their patients—especially those who are<br />
newly diagnosed—that combining HAART with a healthy lifestyle<br />
can delay this late stage disease for decades, if not altogether.<br />
Considering that most individuals in our community don’t<br />
identify as persons <strong>liv</strong>ing with AIDS, but rather as persons<br />
<strong>liv</strong>ing with HIV, there’s little wonder why many choose not to<br />
connect with us.<br />
The solution to this problem seemed simple—initially. At last<br />
year’s AGM, our vice chair, Ken Buchanan, presented a motion<br />
to change our Society’s registered name to the “HIV Society of<br />
<strong>BC</strong>.” The motion didn’t pass a majority vote, but it was close.<br />
So close, in fact, that the board will follow-up with a revised<br />
name change motion later this year. Our intention is to present<br />
members with several new name options crafted in accordance<br />
with the feedback we received from them at last year’s AGM.<br />
Whether or not this new motion passes, make no mistake:<br />
we’re determined that a majority of voting members will soon<br />
accept this important step in increasing accessibility to our<br />
services. As Buchanan stated in his motion last year, “<strong>BC</strong>PWA<br />
changed the disease. It’s time we changed with it.”<br />
Developing more socially relevant programming<br />
When <strong>BC</strong>PWA was founded, most of our members were subsisting<br />
on disability pensions, many had retreated from active social<br />
involvement, and they were suffering from debilitating treatment<br />
side effects. Basically, they were <strong>liv</strong>ing life in preparation for an<br />
early death. To enable and empower them—as our mission<br />
dictates—meant that <strong>BC</strong>PWA’s efforts focused on advocating for<br />
fair social benefits, housing and care, researching and relaying<br />
complex treatment information, and providing access to daily<br />
basics such as food and clothing.<br />
<strong>BC</strong>PWA still offers all of those services because a portion of<br />
our members relies on them. But the majority of our members<br />
now require an entirely new system of support to maintain the<br />
healthy, active, social lifestyle promised by HAART. Here are<br />
10 <strong>liv</strong>ing5 MayqJune 2010
Cover Story<br />
just some of the programs we’ve developed over<br />
the past two years to meet the needs of everdiversifying<br />
populations in our community:<br />
Am-BIG-You-Us: A monthly trans community<br />
mix ‘n’ mingle for transgendered HIV-positive<br />
individuals, open to all cross dressers, transsexuals<br />
(both MTF and FTM), and other gender<br />
variant individuals.<br />
Suits: This monthly dinner for HIV-positive gay<br />
working men takes place at various Vancouverarea<br />
restaurants on the last Monday of each<br />
month. The event offers HIV-positive gay working<br />
men a chance to foster a sense of community,<br />
meet other professionals, network, and provide a<br />
positive, active influence on our culture.<br />
Ou+doorsmen: This monthly social group<br />
is designed for gay HIV-positive men who<br />
enjoy being active in the outdoors. Activities<br />
planned for this year include Grouse zipline,<br />
ice skating, hiking at Mount Gardiner and<br />
Killarney Lake Loop on Bowen Island,<br />
curling, kayaking, and more. The program is<br />
intended to promote a healthy, active HIVpositive<br />
lifestyle in our community.<br />
Opposites Attract: Both a workshop and<br />
retreat, this program engages serodiscordant<br />
couples—gay, straight, or other—in facilitated<br />
discussions, presentations, and group work, as<br />
well as outdoor fun, indoor games, and relaxation.<br />
The weekend is designed to strengthen, affirm,<br />
and enhance their relationships.<br />
HIV Complementary Care Clinic: At this<br />
in-house program, provided in partnership<br />
with the Boucher Institute of Naturopathic<br />
Medicine, HIV-positive individuals can receive<br />
a free consultation on their health and treatments<br />
from naturopathic students under the<br />
supervision of a licensed naturopath.<br />
Revitalizing our public representation<br />
<strong>Living</strong> <strong>Positive</strong> readers will no doubt agree that<br />
<strong>BC</strong>PWA has always maintained a high standard of<br />
design. We’re confident that the look of all our<br />
communications tools is consistently eye-catching,<br />
engaging, and modern. But the consistency of<br />
our public identity ends there. Each part of our<br />
organization seems to have defined its own brand<br />
rather than a collective one for <strong>BC</strong>PWA.<br />
However, we can only revitalize <strong>BC</strong>PWA’s<br />
reputation if audiences connect it to the highquality<br />
programs that our staff provides. To tie<br />
our public identity together, a common graphic<br />
theme is developing within all our promotional<br />
and educational materials. So far we’ve<br />
introduced this graphic subtly, but as we release<br />
more materials over the next few months—including<br />
a new letterhead, envelopes, business cards—our<br />
distinct new style will become more apparent.<br />
Our new graphic template is most evident in<br />
the new version of our website, www.bcpwa.org.<br />
The colours, fonts, and graphics found there<br />
form the basis of how <strong>BC</strong>PWA’s brand will look<br />
in the future. The reorganization of information<br />
on our website is a further sign of our intent to<br />
make <strong>BC</strong>PWA more accessible to outside audiences.<br />
Take a look at the website and let us know if<br />
we’re meeting that goal.<br />
Enhancing our front-of-house service<br />
Of course, increased accessibility through our<br />
programs, services, and design is only part of<br />
the equation. Our primary access point is our<br />
front office; this is where outsiders learn to<br />
navigate the complexities of our organization.<br />
Until recently, this essential part of our business<br />
suffered from a lack of staff resources. As a<br />
result, our ability to connect to our community<br />
suffered as well. However, we now have a fulltime<br />
member services coordinator, and we’re<br />
confident that the increased level of consistently<br />
well-informed and professional service at the<br />
front desk is in line with what audiences will<br />
expect by our new graphic identity and<br />
improved programming.<br />
As <strong>BC</strong>PWA moves even further toward a<br />
stronger identity and better service de<strong>liv</strong>ery for<br />
our community, we invite <strong>Living</strong> <strong>Positive</strong> readers<br />
to be an active part of this change. What do you<br />
think of our new look? Are we meeting your<br />
needs with our new suite of programs and services?<br />
Do you have any suggestions of what we might<br />
do better? Let us know by email at<br />
info@bcpwa.org. 5<br />
More information about our programs<br />
Visit www.bcpwa.org for more information<br />
about our programs and how to get involved.<br />
Adam Reibin is <strong>BC</strong>PWA’s director<br />
of communications and education.<br />
MayqJune 2010 <strong>liv</strong>ing5 11
In the courts<br />
Current Canadian cases related<br />
to HIV non-disclosure<br />
by Cécile Kazatchkine<br />
Since the Supreme Court of Canada’s 1998 decision in<br />
R. v. Cuerrier, not disclosing your HIV-positive status<br />
can amount to “fraud” that renders a partner’s consent<br />
to sex legally invalid, thus transforming consensual sex<br />
into an aggravated sexual assault under the Criminal Code.<br />
However, your legal duty under criminal law to disclose<br />
your HIV-positive status only arises before engaging in an<br />
activity that represents a “significant risk of serious bodily<br />
harm” (the courts have accepted that HIV infection is a<br />
serious harm).<br />
It’s the act of exposing a sexual partner to a significant risk<br />
of infection, without disclosing your HIV-positive status that is<br />
the crime. People can be, and have been, convicted even when<br />
their sexual partner wasn’t infected.<br />
It remains difficult to identify which specific situations<br />
require disclosure under criminal law. In the Cuerrier case,<br />
the Supreme Court didn’t define the notion of “significant<br />
risk” of HIV transmission. It clearly stated that vaginal or<br />
anal unprotected sex represents a significant risk, but left<br />
room for interpretation of other sexual activities, such as<br />
safer sex (for example, vaginal or anal sex with a condom)<br />
or oral sex (with or without a condom).<br />
In Cuerrier, the majority of the Supreme Court indicated<br />
that condom use might reduce the risk of HIV transmission so<br />
that it’s no longer significant, but they didn’t make an explicit<br />
ruling on this issue. Also, science has evolved since 1998. It’s<br />
become increasingly clear that an undetectable viral load<br />
dramatically reduces the risk of HIV transmission, but what<br />
this means for the legal duty of people <strong>liv</strong>ing with HIV to<br />
disclose still isn’t clear.<br />
Several cases raising these issues are currently before<br />
Canadian courts and may provide additional guidance to<br />
identify what sexual activities do or don’t require disclosure.<br />
R. v. Wright<br />
Wright was convicted by a jury in a <strong>BC</strong> trial court on two<br />
counts of aggravated sexual assault for failing to disclose his<br />
status to two complainants before having unprotected sex.<br />
Neither of them was infected with HIV.<br />
In November 2009, the <strong>BC</strong> Court of Appeal dismissed his<br />
appeal. The Court said that, in the absence of specific evidence<br />
regarding Wright’s viral load, a 0.5 percent average risk of transmission<br />
for unprotected vaginal sex was sufficient evidence for a trial jury to<br />
conclude that there was a significant risk of HIV transmission to<br />
therefore convict him. However, the Court also recognized that if<br />
viral load at the relevant time was known, it would be “very relevant”<br />
to the determination of criminal liability. This decision may allow a<br />
“viral load defence” when the accused’s viral load is undetectable<br />
and thus dramatically reduces the risk of the transmission.<br />
In terms of condom use, the Court refused to accept that<br />
it would automatically remove the requirement to disclose.<br />
Instead, the Court ruled that it’s a question of fact in each case<br />
to determine whether the use of condoms has reduced the risk<br />
of HIV transmission below the “significant risk” threshold.<br />
An application for leave to appeal to the Supreme Court<br />
is pending.<br />
R. v. Mabior<br />
In July 2008, a Manitoba trial court convicted the accused on<br />
six counts of aggravated sexual assault for failing to disclose his<br />
12 <strong>liv</strong>ing5 MayqJune 2010
HIV-positive status to his partners. Mabior had vaginal intercourse<br />
with multiple women—one of whom was underage—without<br />
disclosing his HIV status. Condoms were used on some<br />
occasions, but not on others. During the relevant times,<br />
Mabior’s viral load varied from low to undetectable. None of<br />
the complainants in this case became infected with HIV.<br />
This judgment is the first case since Cuerrier to analyze in<br />
detail the meaning of “significant risk.” In this case, the trial judge<br />
relied heavily on the evidence of the Crown’s medical expert and<br />
ruled that condom use alone wouldn’t be enough to remove the<br />
duty to disclose—there must also be an undetectable viral load.<br />
The trial judge’s decision suggests that there would need to be<br />
“complete elimination” of any risk of HIV transmission, or close<br />
to it otherwise, disclosing HIV-positive status is required.<br />
This is at odds with judgments in several other cases, where<br />
courts either explicitly stated, or seem to have implicitly accepted,<br />
that using a condom would mean there’s no duty to disclose. The<br />
trial judge’s decision has been appealed. The Canadian HIV/AIDS<br />
Legal Network intervened, arguing that people who use condoms<br />
for vaginal or anal sex shouldn’t be criminally prosecuted for not<br />
disclosing their HIV-positive status. Where the risk is similarly low<br />
or lower because of a person’s undetectable viral load, there also<br />
should be no prosecution. The decision is pending.<br />
R. v. DC<br />
In February 2008, the Court of Quebec found DC, an HIV-positive<br />
woman, guilty of sexual assault and aggravated assault for not<br />
informing her sexual partner JLP that she was HIV-positive<br />
before they had sex.<br />
DC and her ex-partner had a four-year relationship before she<br />
successfully brought assault charges for domestic violence, for which<br />
JLP received an unconditional discharge after being convicted. He<br />
later brought charges against her, alleging that they had unprotected<br />
sexual intercourse several times before she disclosed her HIV status.<br />
According to DC, they had only one sexual encounter before she<br />
disclosed and a condom was used. At the relevant time, DC had an<br />
undetectable viral load. JLP was not infected with HIV.<br />
The trial judge declared that neither JLP nor DC were reliable.<br />
He found that DC had unprotected sex with JLP once before<br />
she disclosed her HIV status. He relied on evidence from DC’s<br />
physician, whose notes indicated that DC had consulted her<br />
about the risk of HIV transmission if a condom broke.<br />
The trial judge’s decision is confusing. The judge states that<br />
there’s a duty to disclose HIV status prior to sex, whatever the<br />
risk of HIV transmission (contrary to the “significant risk” test<br />
from Cuerrier) but also acknowledges that there should be no<br />
conviction when a condom is used. Also, despite the fact that<br />
DC’s viral load was undetectable at the relevant time and that<br />
the Crown’s expert described the risk of transmission as close<br />
to zero, he nonetheless convicted her.<br />
The decision is currently under appeal. The Legal Network<br />
and COCQ-Sida, Quebec’s provincial AIDS network, have<br />
joined forces to intervene.<br />
MayqJune 2010 <strong>liv</strong>ing5 13<br />
In Canada, charges for<br />
HIV non-disclosure before<br />
having otherwise consensual<br />
sex have escalated from<br />
common nuisance to<br />
aggravated sexual assault<br />
and now to murder.<br />
R. v. Aziga<br />
In April 2009, an Ontario jury convicted Aziga of two counts<br />
of first-degree murder, ten counts of aggravated sexual assault,<br />
and one count of attempted aggravated sexual assault in relation<br />
to sexual encounters he had with 11 women without disclosing<br />
his status. Of the seven women who tested HIV-positive, two<br />
subsequently died of cancer said to be related to their HIV<br />
infection. At this writing, Aziga’s sentencing is still pending,<br />
following a psychiatric assessment. An appeal may follow.<br />
The case and its outcome are disturbing for several reasons. In<br />
terms of the aggravated sexual assault charges, Aziga was convicted<br />
of at least one count for not disclosing his HIV status before<br />
engaging in unprotected oral sex, and of at least one count in<br />
relation to unprotected oral and vaginal sex while wearing a<br />
condom. There is an implication that oral sex alone constitutes a<br />
“significant risk” of HIV transmission under criminal law. This<br />
doesn’t reflect scientific evidence on oral sex and it means that<br />
people can be convicted when there is, at best, a marginal risk of<br />
harm. It’s also at odds with a number of other court decisions.<br />
Aziga appears to be the first person convicted of murder for not<br />
disclosing his HIV status. Murder charges require specific intent.<br />
The prosecution argued that Aziga’s failure to tell the women<br />
“about his HIV status before, during, and after he had unprotected<br />
sexual activity with them so they could obtain medical treatment,<br />
is evidence of the intent to kill [them].” This appears to have<br />
been the extent of the evidence regarding Aziga’s intent.<br />
Since Cuerrier, charges in Canada for HIV non-disclosure<br />
before having otherwise consensual sex have escalated from<br />
common nuisance to aggravated sexual assault, and now to<br />
murder. There is a risk that the Aziga case may be used as a<br />
precedent to pursue murder and attempted murder charges,<br />
but that remains to be seen. 5<br />
Cécile Kazatchkine is a policy analyst at the<br />
Canadian HIV/AIDS Legal Network.
Girl Talk<br />
Healthy bundles of joy<br />
What HIV-positive women can do to prepare for a successful pregnancy<br />
by Laura Vicol<br />
-positive women have to grapple with many decisions<br />
HIVand life challenges when embarking on the wonderful<br />
journey of childbearing. Obtaining specialized HIV care and<br />
support during pregnancy is very important for the health of the<br />
mother and can ensure the birth of a healthy, uninfected baby.<br />
Women starting their care early, receiving intensive<br />
pregnancy-related health counselling and HIV therapy, have<br />
enjoyed safe pregnancies and healthy, uninfected babies.<br />
If you’re HIV-positive and considering childbearing, prepare<br />
for the pregnancy well in advance of becoming pregnant. For<br />
example, before getting pregnant, start taking prenatal vitamins.<br />
Review your antiretroviral regimen with your healthcare providers<br />
to ensure your medications are safe during pregnancy.<br />
Get a nutritional assessment. Address your ongoing primary<br />
healthcare issues.<br />
Once you’re pregnant, take a prenatal multivitamin<br />
containing at least 0.6 mg of folic acid. Most prenatal<br />
vitamins have an average of 0.6 – 1 mg of folic acid along<br />
with other important vitamins and minerals. Eat a balanced<br />
diet, rich in a variety of nutrients—this is good for your own<br />
health and for the development of a healthy baby. Eat a<br />
variety of fresh, wholesome foods that are high in iron,<br />
folate, proteins, and vitamins.<br />
Healthy eating doesn’t mean you need expensive or special<br />
foods. The most important aspect during your pregnancy is to<br />
make healthy choices in the foods you buy and prepare. For<br />
some women, this may only mean integrating more fruits and<br />
vegetables into your diet or getting used to eating breakfast<br />
regularly. Work closely with a registered dietitian who is experienced<br />
in HIV care and pregnancy.<br />
Research data indicates that the risk of HIV transmission<br />
from mother to child increases with injection drug use (such as<br />
heroin), use of other substances like cocaine, cigarette smoking,<br />
and unprotected sexual intercourse with multiple partners.<br />
There are also unique considerations related to the use of<br />
antiretroviral medication before and during pregnancy. The<br />
choice of HIV medication is always made based on the unique<br />
needs of each HIV-positive woman. Avoid certain medications,<br />
such as efavirenz (Sustiva) during the first trimester of your<br />
pregnancy and when you’re trying to get pregnant; clinical data<br />
indicates an increased risk for birth defects related to these<br />
medications. Also avoid other medications such as nevirapine<br />
(Viramune), didanosine (Videx) and stavudine (Zerit), or take<br />
them with great care, because these medications can have potential<br />
unwanted side effects and toxicities in pregnant women.<br />
Pregnancy represents a major change in your self-i<strong>mag</strong>e,<br />
priorities, behaviour patterns, relationships with others, problem<br />
solving, and coping skills. Compounded with the multiple<br />
challenges you face as a person with HIV underscores the need<br />
for support, housing, adequate nutrition, and stable general<br />
health in order to achieve the best possible outcomes. 5<br />
Laura Vicol is a family nurse practitioner at the<br />
Oak Tree Clinic at <strong>BC</strong> Women’s Hospital and<br />
Health Centre.<br />
Oak Tree Clinic<br />
Oak Tree Clinic, located at <strong>BC</strong> Women’s Hospital and Health<br />
Center in Vancouver, provides HIV-related medical care to<br />
women and children, as well as pre-pregnancy planning and<br />
pregnancy care to HIV-positive women. In <strong>BC</strong>, all pregnant HIVpositive<br />
women are referred to Oak Tree, which serves as a<br />
provincial referral centre for obstetrical care in HIV. Over 400<br />
pregnant HIV-positive women have received care and have de<strong>liv</strong>ered<br />
uninfected infants at the clinic since 1996.<br />
Staff also provides medical advice to primary care providers,<br />
specialists, and midwives in communities throughout the<br />
province. Oak Tree’s multidisciplinary team provides ongoing<br />
support in specialized HIV care, obstetrical, gynecological,<br />
dental, pharmaceutical, and primary care. The clinic also has a<br />
registered dietitian, social worker, and addiction counsellor.<br />
14 <strong>liv</strong>ing5 MayqJune 2010
Pain and anguish—and bliss<br />
One HIV-positive woman’s story of her pregnancy by Lynn<br />
My name is Lynn and I’m HIV-positive. I never would<br />
have i<strong>mag</strong>ined giving birth at the age of 39. Not to<br />
mention my health status. I don’t exercise regularly<br />
like I should. However, I eat healthy, meditate, do holistic<br />
therapies, and am very spiritual. From what I experienced, it is<br />
possible nowadays for an HIV-positive woman to give birth and<br />
not transfer the disease to the baby. But not without great pain<br />
and anguish. I was astonished.<br />
The Oak Tree Clinic played a very important role during<br />
my pregnancy. All their hard work and recommendations were<br />
amazing. Upon deciding to have a baby, I spoke with three<br />
obstetricians, a paediatrician, a gynaecologist, a dietitian, two<br />
pharmacists—even the receptionists. One of the doctors<br />
explained that the rate of mother-to-child transmission was<br />
down to one percent, and the fact that only one patient at Oak<br />
Tree had given birth to an HIV-positive baby in the last 15 years.<br />
I was still skeptical and my mind was racing to seek further<br />
knowledge. There must be other risk factors, I thought. Yes,<br />
there were, but there were ways to reduce them, such as totally<br />
complying with my medicine regime to lower my viral load and<br />
raise CD4 count. And having a caesarean section.<br />
Everything was going good until the third month of my<br />
pregnancy. I developed cholestasis, which is an overproduction of<br />
bile that flows into the skin and causes severe itchiness. It’s the<br />
most annoying, aggravating condition I ever experienced. I couldn’t<br />
sleep in any one position for long and suffered from chronic<br />
insomnia, anxiety, and depression. Then I got hypertension—<br />
my blood pressure was so high, I was bedridden at home with<br />
nurses coming in to do checkups. The cholestasis and hypertension<br />
became critical to the life of the fetus and my own life.<br />
I stuck to a strict regime of HIV medications at the proper<br />
time each day. I had to take vitamins K, C, E, calcium, plus I<br />
had meds for cholestasis to reduce the itching. Taking meds<br />
and vitamins took up a lot of my day. It was quite rigorous. I<br />
took HIV meds with breakfast, vitamins with lunch, cholestasis<br />
and anxiety meds at dinner, then HIV meds again at bedtime.<br />
Plus two daily baths to ease the itchiness. That was the only<br />
time I got out of bed, due to my high blood pressure.<br />
Eventually I was hospitalized. I had chronic insomnia, so I<br />
walked around the hospital halls a lot. The straps wrapped<br />
around my tummy to monitor the fetus’s heartbeat were so<br />
aggravating to my skin that the nurses and I developed a<br />
strategy where I would hold the instruments myself. But I<br />
could only stand the straps for 15 minutes whether they got<br />
their measurements or not, otherwise I’d have a panic attack.<br />
My blood pressure would rise, which was also detrimental to<br />
the fetus. So the nurses would have to stop and try again later.<br />
It was a very distressing and aggravating pregnancy. Not the<br />
usual happy, shiny hair, glowing cheeks, shining and bright<br />
pregnancy. No way.<br />
Taking meds and vitamins took<br />
up a lot of my day. I took HIV<br />
meds with breakfast, vitamins<br />
with lunch, cholestasis and<br />
anxiety meds at dinner, then<br />
HIV meds again at bedtime.<br />
I was hospitalized for eight weeks in total. The emotional<br />
fear was excruciating; I was scared for my fetus. By 36 weeks I<br />
couldn’t take the itchiness. I broke down and cried to the<br />
nurses. I prayed to Great Spirit to help me, and one hour later<br />
my water broke.<br />
After my baby girl was born, my pure blessing, she had to<br />
take AZT for six weeks as a precaution, and then get a blood<br />
test again. Waiting is nerve-wracking. I brought my baby girl to<br />
Oak Tree to show everyone, I am such a proud mother.<br />
Oak Tree took very good care of us, physically, mentally,<br />
and emotionally, and I’m very grateful to them. No matter how<br />
much I suffered it was all worth it for I have a beautiful baby<br />
girl who is healthy and vibrant. We’re very happy and owe it to<br />
Oak Tree and <strong>BC</strong> Women’s Hospital and Health Centre. God<br />
bless them. 5<br />
Lynn is a member of <strong>BC</strong>PWA.<br />
MayqJune 2010 <strong>liv</strong>ing5 15
Prevention<br />
The first steps<br />
Important services from <strong>BC</strong>PWA for people<br />
who are newly diagnosed with HIV<br />
by Chuck Osborne<br />
If<br />
you’ve recently been<br />
diagnosed with HIV,<br />
you’re probably wondering<br />
what to do next. Coming<br />
to terms with your diagnosis<br />
often starts with taking<br />
control and learning as<br />
much as you can. You can<br />
overcome anxieties and<br />
fears and actively participate<br />
in your own recovery by<br />
asking questions.<br />
<strong>BC</strong>PWA’s Health<br />
Promotion Department can help you with real answers to<br />
these questions by offering a number of important services<br />
that are part of its continuum of care for newly diagnosed.<br />
If you want to tell someone how you feel or express<br />
your emotions and don’t know who will listen, our Peer<br />
Counselling Hotline is available from 10:00 am – 8:00 pm<br />
daily at 604.908.7710; if you <strong>liv</strong>e outside the Lower Mainland,<br />
you can call toll-free at 1.800.908.7710. Trained counsellors<br />
will lend a supportive ear in a confidential manner—they can<br />
also follow-up with resources if needed.<br />
When you’re ready to increase your HIV knowledge base,<br />
you can attend our workshop series entitled HIV Fundamentals.<br />
This peer-facilitated series will help you better understand<br />
the new realities of having HIV, disease progression, treatment<br />
information, disclosure, and self-care. You can also get<br />
support from newly diagnosed peers.<br />
If you need to access primary health care, our HIV Care<br />
Registry can help you locate a doctor or clinic. We can put<br />
you in touch with appropriate HIV/AIDS resources or other<br />
agencies to meet your individual needs. We can also assist in<br />
your doctor-patient relationship by helping you ask the right<br />
questions to get meaningful answers.<br />
Becoming a member of <strong>BC</strong>PWA has many benefits such<br />
as the Complementary Health Fund, where you can receive<br />
up to $55 per month for your non-prescription HIV-related<br />
healthcare needs, which can include such things as water,<br />
vitamins, nutritional supplements, and gym passes. For stress<br />
relief and general relaxation, every Wednesday we offer gentle<br />
yoga. Also on Wednesdays, students from the Boucher<br />
Institute of Naturopathic Medicine are on-site to attend to<br />
your physical needs.<br />
We also offer many other support services, including<br />
weekend retreats, complimentary tickets to various events,<br />
and other social networking opportunities. We can refer you<br />
to other <strong>BC</strong>PWA departments if you need help with housing<br />
or addictions issues. Don’t be afraid to drop by for a haircut<br />
or take home something nice from our “gently used”<br />
clothing store.<br />
The goal of our continuum of care model is to take HIVspecific<br />
services and together create a plan that is best suited<br />
to you and your needs, thereby providing you with<br />
optimism, answers to questions, and a better quality of life.<br />
For more information, or if you have any questions about<br />
any <strong>BC</strong>PWA services, call 604.893.2200. 5<br />
Chuck Osborne is a volunteer with<br />
<strong>BC</strong>PWA’s Health Promotion Program.<br />
<strong>BC</strong>PWA<br />
Advocacy<br />
gets<br />
results!<br />
The <strong>BC</strong>PWA Society’s Advocacy Program continues to work<br />
hard to secure funds and benefits for our members.<br />
The income secured for December 2009 & January 2010 is:<br />
t $15,075<br />
t $4,500<br />
new housing, health benefits, dental and<br />
long-term disability benefits.<br />
in ongoing monthly nutritional supplement<br />
benefit for children<br />
16 <strong>liv</strong>ing5 MayqJune 2010
treatment<br />
*nformation<br />
TREATMENT INFORMATION<br />
PROGRAM MANDATE &<br />
DISCLAIMER<br />
In accordance with our mandate<br />
to provide support activities and<br />
facilities for members for the<br />
purpose of self-help and self-care,<br />
the <strong>BC</strong>PWA Society operates a<br />
Treatment Information Program<br />
to make available to members<br />
up-to-date research and information<br />
on treatments, therapies,<br />
tests, clinical trials, and medical<br />
models associated with AIDS<br />
and HIV-related conditions. The<br />
intent of this project is to make<br />
available to members information<br />
they can access as they choose<br />
to become knowledgeable partners<br />
with their physicians and medical<br />
care team in making decisions to<br />
promote their health.<br />
The Treatment Information<br />
Program endeavours to provide<br />
all research and information to<br />
members without judgment or<br />
prejudice. The program does not<br />
recommend, advocate, or endorse<br />
the use of any particular treatment<br />
or therapy provided as information.<br />
The Board, staff, and volunteers<br />
of the <strong>BC</strong>PWA Society do not<br />
accept the risk of, or the responsibliity<br />
for, da<strong>mag</strong>es, costs, or<br />
consequences of any kind which<br />
may arise or result from the<br />
use of information disseminated<br />
through this program. Persons<br />
using the information provided<br />
do so by their own decisions<br />
and hold the Society’s Board,<br />
staff, and volunteers harmless.<br />
Accepting information from this<br />
program is deemed to be<br />
accepting the terms of<br />
this disclaimer.<br />
Report on an HIV/AIDS summit at the<br />
University of British Columbia by Lorne Berkovitz<br />
On<br />
February 26, there was a worldclass<br />
summit at the University of<br />
British Columbia (U<strong>BC</strong>) during the 2010<br />
Olympics. The title of the summit was<br />
“The Impact of Science and Innovation in<br />
the Evolving Global Health Paradigm: HIV<br />
and AIDS—A Global Challenge of Olympic<br />
Proportion.” The event was co-sponsored by<br />
MayqJune 2010 <strong>liv</strong>ing5 17<br />
LifeSciences British Columbia, The <strong>BC</strong><br />
Centre for Excellence in HIV/AIDS, the<br />
International AIDS Society, and U<strong>BC</strong>.<br />
Guest speakers came from a wide range<br />
of backgrounds, including pharmaceutical<br />
research, epidemiology, government,<br />
economics, sports, and mental health.<br />
continued on next page
Dr. Julio Montaner spoke briefly about his new Seek and<br />
Treat program. This new initiative to reach HIV-positive<br />
individuals not on highly active antiretroviral therapy (HAART),<br />
especially those <strong>liv</strong>ing in Vancouver’s Downtown Eastside and<br />
in Northern <strong>BC</strong>, will help to substantially bring down provincial<br />
HIV infection rates. The beauty of this new program is that<br />
the relatively small investment by the Government of <strong>BC</strong> and<br />
Merck will result in great long-term savings by avoiding the<br />
cost of individual lifetime HIV treatments.<br />
Selling HIV treatment and<br />
prevention as being<br />
fiscally prudent in the long<br />
term was one of the main<br />
themes of this summit.<br />
Selling HIV treatment and prevention as being fiscally<br />
prudent in the long term was one of the main themes of this<br />
summit. Ambassador Mark R. Dybul, co-director of the O’Neill<br />
Institute for National and Global Health Law at Georgetown<br />
University and the key architect of PEPFAR, insisted that<br />
business and government leaders need to be made aware that a<br />
humanitarian approach to the epidemic is also a wise financial<br />
approach. The wholesale decimation of adults in their prime is<br />
taking a terrible toll on local and global economies. Dr. Dybul<br />
cited Brazilian statistics indicating that since the introduction<br />
of HAART, Brazil has saved $1.86 billion in hospital stays.<br />
Stefano Bertozzi, HIV director of the HIV Global Health<br />
Program for the Bill and Melinda Gates Foundation, spoke<br />
about the world economic downturn and its repercussions on<br />
prevention and treatment of HIV. Because HAART is a lifelong<br />
investment, if the global funds remain only stable, it will be a<br />
backslide—it won’t be enough to keep up with the demand to<br />
put new PWAs on antiretrovirals. Dr. Bertozzi stressed the<br />
importance of spending money wisely. The problem with most<br />
HIV interventions, he said, is that after 30 years we’re still treating<br />
the epidemic as an emergency and making plans a year at a<br />
time. He said you can’t fight an epidemic without studying the<br />
cost effectiveness of prevention strategies for the long haul.<br />
Dr. Nora Volkow, director of the National Institute on Drug<br />
Abuse at the National Institutes of Health, gave a different<br />
perspective on HIV prevention. She addressed the connection<br />
between mental health and risk behaviours. Her studies have<br />
found that because the brain isn’t fully developed before<br />
adulthood, teenagers who use drugs have a greater likelihood of<br />
addiction and depression—both are factors in risky behaviours<br />
that can lead to HIV transmission.<br />
Another bright star of HIV/AIDS activism at the summit<br />
was Michel Sidibé, executive director of UNAIDS. He noted<br />
that every year, HIV kills two million people. Over 33 million<br />
people are still <strong>liv</strong>ing with the disease worldwide, and less than<br />
half the people who need HAART are able to access it. He<br />
said that HIV is still an issue of inequity, stigma, sexism, and<br />
homophobia. In Africa, 400,000 babies are still born with<br />
HIV every year, compared with zero babies anywhere else. Rich<br />
countries have a duty to help those in other parts of the world<br />
who aren’t so fortunate.<br />
The bottom line is that the HIV epidemic still remains an<br />
Olympic-sized challenge, even with the introduction of wonderful<br />
new treatments—which is why there’s a continued need for new<br />
and enduring global HIV initiatives. 5<br />
Lorne Berkovitz is the secretary<br />
of the <strong>BC</strong>PWA board.<br />
There are many different ways to get involved!<br />
Volunteer<br />
1) Volunteer weekly helping out with our<br />
many programs & services (Mon-Fri)<br />
@<br />
2) Volunteer at special events, AccolAIDS<br />
Gala, Pride Parade, AIDS Walk for Life<br />
3) Volunteer on projects, in meetings or with<br />
our <strong>liv</strong>ing5 <strong>mag</strong>azine<br />
<strong>BC</strong>PWA<br />
To find out about these & other volunteer opportunities, contact Marc > 604.893.2298 or marcs@bcpwa.org<br />
18 <strong>liv</strong>ing5 MayqJune 2010
Feature Story<br />
When old is new<br />
The intersection of HIV and aging is an emerging<br />
area of concern as people age with HIV<br />
by Glyn Townson (with notes from Sarah Burdeniuk)<br />
One<br />
of the most unforeseen consequences—and<br />
benefits—of improved treatment for HIV/AIDS<br />
is that most of us people <strong>liv</strong>ing with HIV will wind up in our<br />
golden years and consider retirement, something that wasn’t<br />
previously on our collective radar. It’s something most of us<br />
aren’t prepared for, and the time for effective decision-making<br />
is running out.<br />
The HIV/AIDS movement has focused the majority of its<br />
energies over the past 20 years on access to treatment, and<br />
while those battles have been fairly successful in the developed<br />
world, the battle is far from over. It’s no wonder, then, that our<br />
attention has been focused on the more immediate issue of <strong>liv</strong>ing<br />
another day. The concept of <strong>liv</strong>ing well with HIV into our<br />
retirement years hasn’t attracted too much attention.<br />
20 <strong>liv</strong>ing5 MayqJune 2010
Feature Story<br />
However, if we want to <strong>liv</strong>e out <strong>liv</strong>es that are self-determined,<br />
we must start to address a number of issues, ask<br />
the right questions, and do the research required to<br />
inf luence policy and services available in the not-sodistant<br />
future. Some of the questions about access to care<br />
that will directly affect us have been asked by many of the<br />
national seniors’ organizations, but not in the context of<br />
growing old with the complications of HIV.<br />
Aging demographics—for Canadians and<br />
for PWAs<br />
The overall percentage of seniors age 65 and older in<br />
Canada is projected to nearly double—from 13.2 percent<br />
in 2005 to 24.5 percent by 2036. In addition, a growing<br />
number of older adults are also being newly diagnosed<br />
with HIV. The Public Health Agency of Canada reported<br />
that by 2006, 14 percent of all reported positive HIV tests<br />
were in individuals 50 or older, up from eight percent<br />
between 1986 and 1998. The intersection of HIV and<br />
aging is an emerging area of concern as individuals age<br />
with HIV and experience more complex medical and<br />
psychosocial problems.<br />
Last month, the Parliamentary Budget Officer released<br />
a major report giving the first look into Canada’s demographics<br />
75 years into the future. With fewer people<br />
working and paying taxes, coupled with a declining birth<br />
rate, the report warned that the federal debt will continue<br />
to increase if the government fails to reduce spending or<br />
raise taxes.<br />
By 2015, the majority of PWAs in Canada will be over<br />
the age of 50, and this population has two distinct subgroups:<br />
those who have been <strong>liv</strong>ing with HIV/AIDS for<br />
many years, and those newly diagnosed with HIV in their<br />
later years. Each has its own set of unique issues.<br />
MayqJune 2010 <strong>liv</strong>ing5 21<br />
New emerging issues around being older<br />
with HIV<br />
For those who have been <strong>liv</strong>ing with HIV—and <strong>liv</strong>ing with<br />
the various generations of medications to treat the<br />
disease, side effects from those medications, and the<br />
effects of <strong>liv</strong>ing with HIV itself—there appears to be a<br />
trend of accelerated aging, even with successful viral<br />
suppression. PWAs are increasingly experiencing medical<br />
conditions more commonly associated with their parents<br />
or grandparents, rather than their uninfected peers:<br />
cardiovascular, renal, and <strong>liv</strong>er diseases; cancer; osteoporosis;<br />
arthritis; diabetes; hypertension; and various neurocognitiverelated<br />
symptoms, ranging from memory loss to HIVassociated<br />
dementia and cognitive motor disorders.<br />
As for the second group, those who are over 50 and<br />
are becoming newly infected with HIV—given that we<br />
<strong>liv</strong>e in a society that hasn’t come to grips with ageism,<br />
sex phobia, or death—it isn’t surprising that we haven’t<br />
focused on developing prevention programming for<br />
older adults. Although we may not like the idea that<br />
our parents and even our grandparents are still sexually<br />
active, the statistics show a different picture. Seniors<br />
are still sexually active. Many retirees are dealing with<br />
the loss of long-term partners and f ind themselves single<br />
in a new world, with very little appropriate sexual<br />
health information.<br />
“The HIV community does<br />
not care about aging and<br />
the aging community does<br />
not care about HIV.” –<br />
authors Jim Truax and<br />
Dr. Gordon Arbess<br />
A 2009 bulletin by the World Health Organization<br />
cautions: “HIV prevalence and incidence in the over-50-<br />
year-olds seem surprisingly high and the risk factors are<br />
totally unexplored.” Researchers point to a variety of<br />
risks that increase the vulnerability of this group: the<br />
advent of erectile dysfunction drugs in the late 1990s,<br />
which has extended sex <strong>liv</strong>es; the assumption on the part<br />
of some older adults and healthcare providers that this<br />
demographic isn’t at risk, which can lead to a lack of<br />
screening or failed diagnoses; the discomfort of some<br />
older adults and their healthcare providers to openly<br />
discuss safer sex; and a lack of, or ineffective, targeted<br />
prevention messaging.<br />
PWAs not on the national aging radar<br />
In an article entitled “The health of people <strong>liv</strong>ing with<br />
HIV” by Jim Truax and Dr. Gordon Arbess of St.<br />
Michael’s Hospital in Toronto, the authors make a rather<br />
alarming statement: “The HIV community does not care<br />
about aging, and the aging community does not care<br />
about HIV.” The article goes on to shed light on the lack<br />
of prevention messaging to older adults in our community<br />
continued on next page
Feature Story<br />
and notes that future messages must be culturally and age<br />
appropriate. The reality is that PWAs aren’t on the<br />
national aging radar, and the time to change that is now.<br />
By 2015, the majority of<br />
PWAs in Canada will be<br />
over the age of 50.<br />
Some preliminary work has been done. In October 2009,<br />
the Canadian Working Group on HIV and Rehabilitation<br />
(CWGHR) received funding to prepare a background paper<br />
on HIV and aging. The paper framed the dialogue at their<br />
2010 Partners in Aging National Forum, held in early March<br />
as a satellite meeting at the 6th Canadian HIV/AIDS Skills<br />
Building Symposium in Montreal. The symposium brought<br />
together Canada’s leaders in the HIV/AIDS and gerontology<br />
communities for the first time to discuss emerging trends<br />
and priorities, exchange information and experiences,<br />
consider best practices, and pave a strategic and collaborative<br />
way forward.<br />
The Partners in Aging forum included community<br />
representatives from geriatrics and HIV, doctors, service<br />
providers, and representatives from the research community.<br />
Senator Sharon Carstairs, chair of the Special Senate<br />
Committee on Aging and a member of the forum’s national<br />
advisory committee, gave a keynote address. Senator<br />
Carstairs has been a tireless champion for end-of-life<br />
palliative care and seniors issues. While the forum raised a<br />
lot more questions than answers, it did play an important<br />
role in getting this issue into the forefront and getting it<br />
into the overall national discussions.<br />
Taking charge of the issues<br />
One of the important issues raised by the forum was very<br />
clear: if we don’t start to address the issues faced by those<br />
aging with HIV now, the issues will be addressed for us,<br />
since we’re only a small subpopulation in a much larger<br />
pool of aging Canadians. Having to hide our HIV status<br />
in long-term care facilities, or receiving inadequate care<br />
without medications and income security is already a<br />
reality, and it will worsen if not addressed.<br />
The HIV/AIDS community can have a huge impact on<br />
the direction of our future care if we’re at the table. From<br />
our activist roots and track record of demanding patient<br />
and citizen voice in all aspects of our care for over two<br />
decades, we have a lot to offer to our partner groups.<br />
We must start now to build bridges with existing organizations<br />
that are dealing with seniors and aging issues and<br />
get HIV on the table. These will include prevention<br />
issues for the aged, as well as ensuring care facilities are<br />
stigma- and discrimination-free, if and when PWAs need<br />
to go into care facilities. Also, more research is needed to<br />
ensure we remain healthy as we <strong>liv</strong>e with HIV and other<br />
co-morbidities.<br />
CWGHR is well positioned with the Episodic Disabilities<br />
Network to build on its existing relationships among<br />
the various national partners and bring other groups of<br />
interest together at the table; this will be key to moving<br />
HIV issues on the larger aging platform. In addition to<br />
its involvement in various research projects on HIV and<br />
rehabilitation issues, CWGHR is also focusing on the<br />
issue of aging.<br />
All levels of government, private industry, the health<br />
community, community leaders, and special interest<br />
groups must work together effectively if we want to have<br />
the necessary services and supports in the future. Affecting<br />
change in public policy and service provisions takes years,<br />
and within the next 15 to 20 years many of our membership<br />
at <strong>BC</strong>PWA will be retired or very close to it. 5<br />
Future updates and videotapes of previous<br />
sessions are online<br />
CWGHR will be holding a second forum on aging and HIV in<br />
Toronto before its annual general meeting in June 2010.<br />
Information on the upcoming forum is available at the Canadian<br />
Working Group on HIV and Rehabilitation website at<br />
www.backtolife.ca. As well, links to the videos of the speaker<br />
panels and discussion of the Partners in Aging Forum held in<br />
March are available at the website.<br />
Glyn Townson is the chair of <strong>BC</strong>PWA.<br />
Sarah Burdeniuk is the communications<br />
coordinator at the Canadian Working Group<br />
on HIV and Rehabilitation.<br />
22 <strong>liv</strong>ing5 MayqJune 2010
Treatment Research<br />
GS<br />
Phase II results for the new GS 9350 booster hold promise<br />
for a four-in-one pill by Nicole Lewis<br />
9350 may look like just a bunch of letters<br />
and numbers, but it could be the next big drug<br />
released to help treat HIV. Gilead Sciences, a US-based<br />
pharmaceutical company, is currently working on an<br />
experimental drug known as GS 9350 (generic name<br />
cobicistat), which boosts the effectiveness of other<br />
HIV drugs. The drug just completed Phase II of<br />
clinical trials and it’s being tested with Gilead’s existing<br />
antiretrovirals with hopes that a four-in-one—or quad—<br />
pill can be developed.<br />
This new product would be used in place of the<br />
current drug, ritonavir (Norvir), manufactured by Abbott<br />
Laboratories. Ritonavir is a protease inhibitor—it<br />
prevents HIV-infected cells from producing new HIV,<br />
therefore limiting the number of doses a person needs to<br />
take of their existing medications. However, ritonavir<br />
can be quite pricey and has side effects such as weight<br />
gain and gastrointestinal problems; it may also cause<br />
drug-resistant HIV, as it always provides anti-HIV activity,<br />
even at a very low dose. These concerns about ritonavir<br />
have driven the development of replacement drugs from<br />
other companies such as Gilead.<br />
The primary function of GS 9350 is to boost the<br />
blood levels of other anti-HIV drugs. For example, the<br />
experimental integrase inhibitor elvitegravir, when taken<br />
with GS 9350, is more effective in blocking the enzymes<br />
that normally allow HIV to integrate into the DNA of an<br />
infected cell.<br />
In 2009, a Phase I study showed promising results<br />
when comparing ritonavir to GS 9350. GS 9350 acted in<br />
a similar way to ritonavir at both 100 mg and 200 mg<br />
doses. Study participants experienced few side effects<br />
from either the daily or twice a day doses.<br />
The Phase I trial also tested how well GS 9350 worked<br />
when combined with the three other medications that<br />
Gilead is hoping to combine into the quad pill: elvitegravir;<br />
emtricitabine (Emtriva), which helps to lower the overall<br />
viral load; and tenofovir (Truvada), which blocks<br />
enzymes that are crucial to viral production. The 150 mg<br />
tablet of GS 9350 boosted levels of elvitegravir in the<br />
MayqJune 2010 <strong>liv</strong>ing5 23<br />
blood and maintained regular levels of the other two<br />
drugs. Participants experienced few side effects from the<br />
f ixed-dose tablets, with only one case of moderate<br />
increases in <strong>liv</strong>er enzymes.<br />
In recently released data from the Phase II trials,<br />
efavirenz/emtricitabine/tenofovir (Atripla) was compared<br />
to GS 9350. GS 9350 was also studied on its own to get<br />
a better idea of how it will work compared to ritonavir.<br />
The main difference between efavirenz/emtricitabine/<br />
tenofovir and the proposed new quad pill is that the<br />
quad pill would include elvitegravir in the place of<br />
efavirenz (Sustiva). Efavirenz is known to cause central<br />
nervous system side effects such as dizziness. In the<br />
Phase II trial, only 35 percent of participants taking<br />
the GS 9350-boosted combination experienced adverse<br />
events compared to 57 percent of participants taking<br />
efavirenz/emtricitabine/tenofovir. Only 10 percent of<br />
participants taking the quad pill experienced CNS<br />
side effects.<br />
The Phase II results also demonstrated that GS 9350<br />
doesn’t impact the kidneys, which can be a problem with<br />
drugs like GS 9350. Any changes in serum creatinine<br />
levels—which would indicate kidney problems—aren’t<br />
related to the f iltration problems caused by the drug but<br />
to tubular secretion instead.<br />
These strong results hopefully mean that GS 9350 will<br />
progress quickly through Phase III clinical trials, where<br />
any lingering questions around its effect on kidney<br />
function can be answered.<br />
Fingers crossed that GS 9350 is eventually approved,<br />
which would pave the way for a new cost-saving and less<br />
labour-intensive quad pill. Pill burdens for PWAs could<br />
become a thing of the past. 5<br />
Nicole Lewis is a recent graduate of the<br />
University of Victoria Writing Department<br />
and a volunteer with <strong>BC</strong>PWA’s Treatment<br />
Information Program.
Antiretrovirals<br />
Whatever happened to<br />
what-was-that-avir?<br />
Not all AIDS drugs have stayed with us over the years.<br />
We take a look back at the ones that didn’t go the distance<br />
by Derek Thaczuk<br />
Since AZT (zidovudine, Retrovir) was first approved for<br />
treating HIV, over 20 other antiretrovirals have joined it<br />
in the marketplace. Some are widely used, others less so.<br />
Some have disappeared from use entirely, while some have only<br />
vanished from the formularies of wealthy nations to become<br />
mainstays for the world’s poorest countries. Here’s a concise<br />
retrospective of those “whatever happened to?” drugs.<br />
ddC<br />
The drug ddC or zalcitabine (Hivid) was the third antiretroviral<br />
to be released. This nucleoside reverse transcriptase inhibitor<br />
(NRTI), or nuke, received approval after AZT and ddI (Videx),<br />
hitting pharmacy shelves in 1992. In those early days, singledrug<br />
treatment, or monotherapy, was unfortunately the<br />
standard, so—like AZT and ddI before it—ddC accomplished<br />
little more than generating drug resistance.<br />
Failure as monotherapy, though, was not the reason ddC<br />
bit the dust. AZT and ddI were equally futile when used solo,<br />
but are still in regular use as part of highly active antiretroviral<br />
therapy (HAART) combinations. Rather, ddC was simply<br />
too toxic. Peripheral neuropathy, a painful and sometimes<br />
permanent form of nerve da<strong>mag</strong>e that can occur with any of<br />
the “d drugs” (ddC, ddI, and d4T), was most common with<br />
ddC. Mouth ulcers and a potentially fatal inflammation of the<br />
pancreas called pancreatitis were also common. All told, about<br />
one in three people who took ddC were likely to develop one<br />
of these conditions.<br />
Furthermore, ddC proved to be one of the less powerful<br />
nukes, even when used in combination with other drugs.<br />
While Hivid’s approval was never withdrawn, it was abandoned<br />
wholesale as other, more tolerable and more effective alternatives<br />
became available. Hivid was discontinued in Canada and the<br />
US in 2006.<br />
Saquinavir<br />
Saquinavir (Invirase) arrived in 1995—the first in the new<br />
drug class of protease inhibitors (PIs). Saquinavir-based<br />
combinations were the first real success stories for HIV<br />
therapy. Using three drugs from two different classes led to<br />
drastically better success rates than single- or dual-drug<br />
therapy—though still poor by today’s standards. Even though<br />
PIs as a class were more powerful than nukes, saquinavir<br />
turned out to be the weakest of the class. This was mainly<br />
because very little of the drug actually made it into the cells<br />
where it was needed.<br />
The drug’s manufacturer, Hoffmann-LaRoche, found that a<br />
slightly different form of the saquinavir molecule was absorbed<br />
much more easily. In 1997, this modified saquinavir was introduced<br />
as Fortovase, which de<strong>liv</strong>ered about eight times more<br />
active drug than Invirase. Fortovase was intended to simply<br />
replace Invirase, with the latter eventually being phased out.<br />
In actuality, the transition was much messier, and in the end<br />
didn’t happen at all. Having two versions of the same drug was<br />
confusing to many people, and the digestive side effects of<br />
Fortovase were actually worse than Invirase.<br />
The waters really became muddied, though, with the release<br />
of a second PI, ritonavir (Norvir). At its original full-strength<br />
dose, ritonavir proved to be unbearably toxic and was rapidly<br />
abandoned as alternatives became available. However, much<br />
lower doses of ritonavir proved useful in another way: they<br />
greatly boosted the bloodstream levels of many other drugs.<br />
Prescribing PIs with a small booster dose of ritonavir became<br />
standard practice.<br />
You might expect that ritonavir-boosted Fortovase would<br />
perform better than boosted Invirase. Unexpectedly, the opposite<br />
proved true: boosted Invirase provided better drug levels, with<br />
fewer gut side effects to boot. Boosted Fortovase never did<br />
become a recommended treatment option. Unboosted<br />
Fortovase remained on the books as a viable treatment option,<br />
but nobody seemed quite sure what to do with it. Most doctors<br />
and PWAs gravitated to boosted Invirase (or perhaps gave up<br />
trying to follow the plot altogether, and moved on to other<br />
PIs). Demand for Fortovase evaporated, and Hoffmann<br />
LaRoche discontinued it in 2006. The company continues to<br />
produce Invirase for use in combination with ritonavir.<br />
Adefovir<br />
Adefovir has the dubious distinction of being the first<br />
antiretroviral to be denied approval in the US. Gilead Sciences<br />
requested that the US Food and Drug Administration (FDA)<br />
24 <strong>liv</strong>ing5 MayqJune 2010
approve adefovir as an HIV treatment under the brand name<br />
Preveon. Clinical trials showed that adefovir had good antiviral<br />
activity at both of the two doses studied—60 and 120 mg per<br />
day. However, the trials also showed that kidney toxicity was a<br />
serious problem. At least one-third of people receiving the<br />
higher dose of adefovir had developed some degree of kidney<br />
dysfunction after a year. At the lower dose, which was just as<br />
effective against the virus, kidney problems were about half<br />
as common.<br />
Initially, the FDA had fast-tracked Gilead’s application, a<br />
reflection of the pressing need for more new antiretroviral<br />
drugs. However, due to concerns about the severity and<br />
frequency of kidney toxicity, the expert review panel recommended<br />
not approving adefovir. Subsequently, in 1999 the<br />
FDA refused to approve adefovir as a treatment for HIV.<br />
Adefovir went on to be resurrected under a different name,<br />
at a lower dose, for the treatment of hepatitis B, with much less<br />
kidney toxicity than the doses tested for HIV.<br />
There are antiretrovirals in<br />
the marketplace that are<br />
effective against HIV, but<br />
other shortcomings have<br />
all but made them history—<br />
at least in countries like<br />
ours that are affluent<br />
enough to pick<br />
and choose.<br />
Forgotten but not gone<br />
Several other drugs are still formally available for use, but have<br />
dropped into obscurity nonetheless. When indinavir (Crixivan)<br />
was approved in 1996, it was the most powerful antiretroviral<br />
released up to that point, and quickly became the standard of<br />
care in combination with dual nucleosides. But it had to be<br />
taken on an empty stomach, three times a day, on a strict<br />
every-eight-hour schedule—spawning a wave of programmable<br />
beepers. Also, due to a high risk of kidney stones, people were<br />
advised to drink vast amounts of water every day. Crixivan is<br />
still on the pharmacy shelves, but isn’t recommended as part of<br />
a first combination, and is rarely used even in more treatmentexperienced<br />
people.<br />
Delavirdine (Rescriptor) is a non-nucleoside reverse<br />
transcriptase inhibitor (NNRTI) that was approved in 1997.<br />
Like indinavir, delavirdine required a three-times-daily dosing<br />
schedule. Delavirdine also appeared to be less effective than<br />
the other, twice-daily NNRTIs nevirapine (Viramune) and<br />
efavirenz (Sustiva). It was never widely used as a treatment<br />
MayqJune 2010 <strong>liv</strong>ing5 25<br />
option, and is currently not recommended as a first-line<br />
treatment. (Since delavirdine inhibits the same <strong>liv</strong>er enzymes<br />
as ritonavir, it could potentially be used to boost levels of<br />
other antiretrovirals. However, the dosing would still be<br />
inconvenient, so it’s unlikely that delavirdine will find a<br />
practical use as a boosting agent.)<br />
Stavudine (d4T, Zerit) was one of the earlier NRTIs,<br />
approved in 1994. It was widely used as an alternative to<br />
AZT, especially in people who had already received AZT<br />
monotherapy or who couldn’t handle AZT-related toxicities<br />
like anemia. Like the other “d drugs,” d4T led to peripheral<br />
neuropathy in some users, which could range from noticeable<br />
to crippling. The real knockout blow to stavudine was<br />
lipoatrophy—the loss of fat in the limbs and, especially, in<br />
the face. It took researchers some time to pinpoint stavudine<br />
as a consistent cause of lipoatrophy. Once it became clear<br />
that it was a major culprit, PWAs and their doctors abandoned<br />
it wholesale for alternate nukes. Unfortunately, by this time<br />
huge numbers of PWAs were stuck with the gaunt, wasted<br />
look—difficult to reverse except through plastic surgery using<br />
injectable fillers.<br />
Not good enough—for whom?<br />
Clearly, there are antiretrovirals in the marketplace that are<br />
effective against HIV, but other shortcomings have all but<br />
made them history—at least in countries like ours that are<br />
affluent enough to pick and choose. Unfortunately, the bulk<br />
of the HIV-affected world doesn’t have that luxury of choice.<br />
Full-price, North-American style HAART costs upwards of<br />
$10,000 a year. Cheaply priced generic versions of the same<br />
drugs have brought the annual cost of HAART down to a<br />
few hundred dollars or less, making treatment available to<br />
millions of PWAs who would never have seen it otherwise.<br />
However, poor nations’ options are limited to drugs that<br />
are available as generics. The most widely used combination<br />
in developing countries is a single-pill co-formulation of<br />
stavudine, lamivudine (3TC, Epivir), and nevirapine.<br />
This low-cost HAART option has brought improvements<br />
that can only be described as miraculous to people who otherwise<br />
had little hope. At the same time, the PWAs of poor<br />
nations are now wearing the gaunt faces of lipoatrophy that we<br />
in developed countries can afford to avoid. Drug companies,<br />
patent holders, and treatment program funders need to decide,<br />
as a matter of policy, that what’s good enough for one is good<br />
enough for all. 5<br />
Derek Thaczuk has worked in information and<br />
support services within the HIV community<br />
for over a decade and is now a freelance writer.
Please phone 604.893.2239<br />
or email elginl@bcpwa.org<br />
to set up an appointment
Nutrition<br />
Comfort food<br />
Some tips to use food and<br />
nutrition to support you<br />
when quitting smoking<br />
by Cheryl Collier<br />
Quitting smoking is tough. Eating can be a source of<br />
support when you quit, but it can also be a source of<br />
stress if, for example, you gain weight. Many people do<br />
gain weight when they quit, usually five to six pounds, but not<br />
everyone does. Some studies indicate that quitting decreases<br />
your metabolism—your body’s ability to burn energy—back to<br />
normal levels. And many people do eat more. It’s not surprising<br />
though; food smells and tastes better when you quit.<br />
Some people believe that if smoking helps keep the weight<br />
off, then it’s like a health benefit. However, being lean isn’t<br />
necessarily equivalent to being healthy. In fact, there’s increasing<br />
evidence that smoking can affect fat build-up in your belly,<br />
right where you don’t want it.<br />
Quitting smoking is one of the best changes you can make<br />
for your health. The trick is to know how to use food and<br />
nutrition to your advantage when you quit.<br />
Switch up your routine<br />
Smoking may have been part of your regular routine, so shaking<br />
things up can help keep triggers in check. For example, if you<br />
usually had a morning cigarette with your coffee on the go, try<br />
having breakfast at home and choose a different beverage. Avoid<br />
the temptation of an after-dinner cigarette by planning a<br />
distraction—those dishes need to be washed anyway. Or<br />
perhaps an evening walk with a friend might do the trick.<br />
Ease off caffeine<br />
Caffeine may be a trigger for a cigarette. Even if it isn’t, it can<br />
make life more difficult when you’re trying to quit smoking.<br />
Too much caffeine can cause irritability and poor sleep, and if<br />
you’re quitting smoking you’re probably already dealing with<br />
these side effects. Consider slowly reducing the amount of coffee<br />
you drink. Drinking more water can also be a distraction, and<br />
it helps to flush out your system.<br />
Stay regular<br />
You may be tempted to eat more to work through nicotine cravings.<br />
When you give your body energy through the day with regular<br />
meals, you can be better aware of how much food your body<br />
really needs, and it’s easier to stop when you get to that point.<br />
Get to know your stomach again<br />
Your stomach sends out signals to the brain, and these<br />
messages are understood as feelings of hunger or fullness. We<br />
know that smoking can suppress appetite, so when you quit,<br />
Quitting smoking is one of the<br />
best changes you can make for<br />
your health. The trick is to know<br />
how to use food and nutrition to<br />
your advantage when you quit.<br />
you may need to retrain your body to hear hunger and fullness<br />
cues. Try slowing down when you eat. It’s hard to hear the signals<br />
your body sends when you eat quickly. Sipping on water between<br />
bites or putting your cutlery down while chewing can help.<br />
Take the time to enjoy all the flavours in your meal. When you<br />
finish your snack or meal, wait it out. If it seems like the portion<br />
you ate should be enough, wait 30 minutes and then see if<br />
you’re still hungry.<br />
Bring healthy snacks for reinforcement<br />
If you’re at work or out for the day, arm yourself with snacks<br />
that help ease the need to have something in your hand. Pack<br />
some fresh fruit, raw veggies, unbuttered popcorn, or a handful<br />
of trail-mix. Sugar-free gum or candies can help keep your<br />
mouth busy, too.<br />
Embrace activity<br />
Getting outside and moving burns calories, which will help to<br />
keep off the extra weight. Activity can also be calming or<br />
exhilarating. For many people, activity provides a lasting relief<br />
from stress, which can take the place of cigarettes, especially<br />
during the first few difficult weeks.<br />
Most importantly, don’t forget to take it one day at a time. 5<br />
Cheryl Collier is a registered dietitian at the Oak Tree Clinic at<br />
<strong>BC</strong> Women’s Hospital and Health Care Centre. She previously<br />
worked in the HIV program at St Paul’s Hospital in Vancouver.<br />
She is a member of Vancouver Dietitians in AIDS Care.<br />
MayqJune 2010 <strong>liv</strong>ing5 27
Nutrition<br />
Nutrition and HIV,<br />
revisited<br />
Looking back at the role of nutrition in HIV treatment over the years<br />
by Diana Johansen<br />
Deciding to retire after 17 years of work in the HIV<br />
field has made me think about how nutrition has<br />
evolved over the past 25 years. Not only has our<br />
overall understanding of nutrition and health grown dramatically,<br />
but the specific nutrition issues facing people<br />
<strong>liv</strong>ing with HIV have also morphed and changed as HIV<br />
has become more of a chronic illness.<br />
Nutrition has always been an HIV issue. Before scientists<br />
identified the human immunodeficiency virus, when infected<br />
individuals were dying of wasting and malnutrition, some<br />
researchers were looking for a nutritional disease. At that<br />
time, vitamin and mineral (or micronutrient) deficiencies<br />
were prevalent, especially zinc. People with HIV died of<br />
opportunistic infections, and it was the loss of body cell mass<br />
due to profound wasting that ultimately led to people’s death.<br />
Without antiretroviral treatment, the only way to stay<br />
healthy and prolong life was nutritional therapy. The<br />
main focus of nutrition at that time was to get in enough<br />
calories and protein to prevent wasting, and to supplement<br />
with micronutrients to prevent deficiencies.<br />
Key learnings pre-HAART<br />
The era before highly active antiretroviral therapy (HAART)<br />
was a period of vigorous nutrition research, and many<br />
important findings helped guide nutrition education and<br />
intervention at that time—and still guide it today. Every<br />
major HIV conference had significant nutrition-related<br />
content. In 1995 there was the first of four international<br />
HIV nutrition conferences.<br />
At the time, we learned that the timing of death is<br />
related to body cell mass and survival is contingent on<br />
maintaining a body cell mass greater than 54 percent of<br />
the body. Body cell mass is the metabolically active tissue<br />
that does most of the work of keeping us a<strong>liv</strong>e. It<br />
includes muscle, organs, and other active cells types.<br />
It was also discovered that the body composition of PWAs<br />
changed over time. Body cell mass progressively declined<br />
even in those people who maintained the same weight.<br />
When weight loss did occur, body cell mass was preferentially<br />
lost over fat. These findings led to greater understanding<br />
about how chronic inflammation with abnormal cytokine<br />
activity affects the wasting process. Bioelectrical impedance<br />
analysis (BIA) became a common clinical procedure used by<br />
HIV dietitians to monitor body composition. A lot of BIA<br />
research was published at the time.<br />
Another key learning was that gut infection by HIV was<br />
considered a factor in wasting because of malabsorption. Also,<br />
futile cycling of nutrients contributed to wasting because<br />
the body did not use calories, protein, and fats properly.<br />
During this period, there was a lot of research on<br />
calorie and protein requirements. Earlier in the epidemic<br />
it was thought that PWAs had extraordinarily high calorie<br />
requirements. The educational materials of the day suggested<br />
consuming 3,000 or more calories a day; many people<br />
were <strong>liv</strong>ing on whipped cream, ice cream, and other fatty<br />
foods to increase calories.<br />
Studies showed that there was a 10 percent increase in<br />
calorie requirements for people with asymptomatic HIV (that<br />
is, people with HIV but no symptoms) and 20 – 30 percent<br />
increase for people with AIDS and/or opportunistic infections.<br />
However, this didn’t necessarily translate into a real increase<br />
because PWAs tended to decrease physical activity, which<br />
also has a significant impact on calorie requirements. The<br />
conclusion from all this was that there is an increase in<br />
requirements; with the amount depending on the individual.<br />
The studies on protein requirements concurred that<br />
PWAs needed higher protein to preserve body cell mass and<br />
provide substrate for an overstimulated immune system.<br />
The educational material of the day recommended protein<br />
intakes of about one gram per pound of body weight, but<br />
this was probably too high as the body can really only<br />
efficiently use about 0.5 – 0.75 grams per pound. Whey protein<br />
became a popular supplement to boost protein intake.<br />
Micronutrient deficiencies were common even among<br />
people who ate well. Deficiencies were associated with<br />
faster disease progression and increased risk of mortality.<br />
Initially this phenomenon was felt to be from malabsorption,<br />
but in the late 1990s the concept of increased turnover<br />
due to chronic inflammation became more popular. During<br />
this period, we learned a lot about oxidative stress and<br />
28 <strong>liv</strong>ing5 MayqJune 2010
the role of antioxidants in preserving health and immune<br />
function. Depletion of glutathione was thought to be a<br />
driving force in increasing oxidative stress. Studies showed<br />
that high doses of N-acetyl cysteine increased intracellular<br />
glutathione, and thus it became a popular supplement.<br />
PWAs used numerous supplements.<br />
During this era, a big part of nutrition intervention<br />
was symptom and side effect management, including loss<br />
of appetite, thrush, esophageal candidiasis, diarrhea,<br />
nausea, and weight loss.<br />
PWAs were awarded Schedule C benefits. An expert<br />
work group led by <strong>BC</strong>PWA worked with government to<br />
create the Monthly Nutritional Supplement Benefit.<br />
The era before HAART<br />
was a period of vigorous<br />
nutrition research, and<br />
many important findings<br />
helped guide nutrition<br />
education and intervention<br />
at that time—and still<br />
guide it today.<br />
The advent of HAART<br />
The 1996 World AIDS conference in Vancouver was a<br />
turning point with the release of protease inhibitors and<br />
the initiation of triple therapy.<br />
Early experience with HAART saw huge pill burdens.<br />
People had to take many pills three times a day, which<br />
led to numerous nutrition issues. For example, with the<br />
early indinavir (Crixivan) regimens, people lost weight<br />
due to the complex medication regimens with three<br />
periods a day of restricted food intake, especially those<br />
on both didanosine (ddI, Videx), and indinavir. Dietitians<br />
developed food lists of low protein low-fat foods that<br />
could be eaten with indinavir. Severe nausea was common,<br />
as were kidney stones if people didn’t drink enough liquids.<br />
Ritonavir (Norvir) liquid tasted so bad that food lists<br />
were developed to mask the taste. Saquinavir (Fortovase)<br />
had a huge pill burden and needed fatty foods to<br />
enhance absorption. Nelfinavir (Viracept) caused diarrhea,<br />
which required dietary modifications. The nutrition<br />
interventions generally focused on managing side effects<br />
and appropriate food/medication routines.<br />
The HAART era<br />
Once people began HAART, they started to show signs<br />
of altered body fat distribution, which came to be known<br />
as lipodystrophy. “Crix belly”—from Crixivan—became<br />
the marker for visceral fat accumulation. People also<br />
developed buffalo humps behind the shoulders, and lipomas,<br />
which are benign tumours of fat cells. Women developed<br />
enlarged breasts and fat on the back. PWAs and<br />
clinicians also began to notice lipoatrophy (loss of fat<br />
tissue) especially in the face, arms, legs, and buttocks.<br />
These trends generated a lot of research on body<br />
composition, using more sophisticated technology such as<br />
DEXA, MRA, and CT scans, as well as studies of the<br />
mechanism of these changes. It turned out that lipoatrophy<br />
and lipoaccumulation (a type of lipodystrophy) were two<br />
distinct conditions caused by different drugs and different<br />
mechanisms. Symptoms varied between individuals but the<br />
devastating effects on quality of life and adherence were<br />
captured in numerous studies and testimonials.<br />
Also in the HAART era, metabolic abnormalities—<br />
notably insulin resistance, diabetes, and dyslipidemia—<br />
especially elevated triglycerides and low HDL<br />
cholesterol—became commonplace.<br />
Researchers found that PWAs have decreased bone<br />
density with an increased risk of osteopenia/osteoporosis<br />
and fracture. Bones appear to age prematurely and lose<br />
bone density at an accelerated rate. This is likely due to a<br />
combination of factors related to the virus, HAART,<br />
genetics, and nutrition.<br />
There was a greater prevalence of obesity among PWAs.<br />
Research at the Oak Tree Clinic found that 19 percent of<br />
patients were obese and 40 percent were overweight<br />
compared to 17 percent and 23 percent, respectively, in<br />
the overall <strong>BC</strong> population. Years ago dietitians wouldn’t<br />
have told people to reduce calories and lose weight, but<br />
now there can be more health risks from excess weight.<br />
Where are we now<br />
The most common nutritional issues today are related to<br />
managing HIV as a chronic illness. Many PWAs enjoy<br />
good quality of life, with great nutrition and active<br />
lifestyles. Dyslipidemia, insulin resistance and diabetes,<br />
osteopenia/osteoporosis, and obesity are prevalent. Many<br />
PWAs have low levels of vitamin D and/or B12. Some<br />
individuals still struggle with poor appetites, unwanted<br />
weight loss, chronic diarrhea and depression, all of which<br />
profoundly affect food intake. People <strong>liv</strong>ing with HIV<br />
are aging with all that entails. Poverty and food insecurity<br />
remain huge—and often insurmountable—barriers to<br />
good nutrition.<br />
In 25 years, nutrition issues have changed significantly<br />
but they haven’t necessarily gotten any easier. 5<br />
Diana Johansen was the dietitian<br />
at Oak Tree Clinic at <strong>BC</strong> Women’s<br />
Hospital and Health Centre.<br />
MayqJune 2010 <strong>liv</strong>ing5 29
Wednesdays • 5:30 PM • Training Room at <strong>BC</strong>PWA, 1107 Seymour St.<br />
Designed to accommodate working individuals, FitOne<br />
Yoga is a one-hour yoga class which supports the body and<br />
mind in forestalling the negative effect of HIV disease.<br />
FitOne Yoga promotes flexibility, range of movement,<br />
detoxification and improved muscle tone for all fitness levels.<br />
For more information 604.893. 2200 or<br />
email prevention@bcpwa.org<br />
What to bring:<br />
• Towel and water bottle<br />
• Comfortable clothes<br />
• Yoga mat (spare mats are available)
Opportunistic Infections<br />
PML is a rare disease of the central<br />
nervous system that affects<br />
immunocompromised people<br />
by Leslie Leung<br />
was 1971, and John Cunningham felt progressively weak on<br />
Itone side of his body. His eyes had become blurry over the<br />
previous month. He frequently lost balance. He couldn’t think<br />
straight. After a series of investigations, doctors determined he<br />
had a condition called progressive multifocal leukoencephalopathy<br />
(PML). The term sounds fancy, but doctors at that time<br />
actually knew very little about the disease. All they knew was<br />
that people with PML had a weak immune system and that a<br />
virus could be potentially causing the disease. It was from John<br />
Cunningham’s brain that Billie L. Padgett, a researcher from<br />
University of Wisconsin, first isolated the PML-causing virus,<br />
which he thus named the JC virus.<br />
Today, most cases of PML are among people with HIV;<br />
fortunately, it’s very rare.<br />
Ninety percent of the population harbours the JC virus. It<br />
enters our system through inhaling or ingesting contaminated<br />
water during childhood or early adulthood. It then sleeps in<br />
our kidneys, tonsils, and bone marrow. Most of us don’t get<br />
PML because our immune system keeps the JC virus in check.<br />
However, the virus can infect the brain, causing PML in cases<br />
where our immune system is disrupted—for example, certain<br />
types of lymphoma, use of immunosuppressant drugs, and<br />
HIV infection.<br />
In fact, 85 percent of all PML cases are from HIV infection.<br />
However, less than one percent of HIV-infected people actually<br />
acquire the disease. In most cases, PML occurs in a person with<br />
AIDS where immunosuppression is severe from low CD4<br />
counts under 100. Unlike other opportunistic infections, PML<br />
can occur in people with CD4 counts greater than 200.<br />
Since the JC virus infects areas of the brain disrupting the<br />
transfer of nervous signals, PML can lead to sensory and motor<br />
problems. The most common symptom is limb weakness,<br />
which occurs in 52 percent of cases. Thirty to 40 percent of all<br />
cases involve decline in cognitive function, visual field loss, and<br />
difficulty speaking. Headaches, seizures, loss of movement control,<br />
and memory loss can occur, though they’re more rare.<br />
Without proper diagnosis or intervention, people with PML<br />
rapidly deteriorate and die within six months.<br />
Because PML shares symptoms similar to other AIDSdefining<br />
infections of the central nervous system, doctors<br />
need to perform special procedures to diagnose the disease.<br />
There are generally three things doctors might do if you<br />
have any of the symptoms of PML. First, doctors might<br />
take snapshots of your brain using a CT scan or an MRI to<br />
check for any abnormal lesions. Second, doctors might<br />
collect cerebrospinal fluid from your spine to see whether<br />
the JC virus is active in your central nervous system.<br />
Finally, doctors might obtain a sample of your brain tissue<br />
and look under the microscope for the JC virus.<br />
Unfortunately, there’s no known cure or a specific<br />
treatment for PML. Several drugs have been tested, but haven’t<br />
been proven to work. To date, the only therapy that has been<br />
shown to be indirectly beneficial for PML management is<br />
highly active antiretroviral therapy (HAART). HAART should<br />
be initiated or continued in people diagnosed with PML<br />
regardless of their CD4 count; the rationale is that a boost in<br />
the immune system can keep the JC virus in check. In fact,<br />
studies have shown that HAART increases the mean survival<br />
time of PML. 5<br />
Leslie Leung is a University of British Columbia<br />
medical student and a community pharmacist.<br />
He volunteers with <strong>BC</strong>PWA’s<br />
Treatment Information Program.<br />
MayqJune 2010 <strong>liv</strong>ing5 31
Let’s<br />
clinical! get<br />
Clinical trials: beyond virology<br />
by Suzanne MacCarthy<br />
Immune-based therapies are on the cutting edge of HIV<br />
clinical research and are advancing treatment strategies to<br />
a new level. Unlike current treatments that try to kill or<br />
suppress the virus while breaking down the immune system,<br />
immunology therapies are designed to boost the immune<br />
response to combat the virus on its own.<br />
Drs. Jean-Pierre Routy and Bertrand Lebouché from the<br />
Royal Victoria Hospital in Montreal, joined by José Sousa,<br />
community representative and CIHR Canadian HIV Trials<br />
Network (CTN) Community Advisory Committee chair, led an<br />
open dialogue at the 6th Canadian HIV/AIDS Skills Building<br />
Symposium in Montreal from March 4 – 7, to discuss this new<br />
direction in HIV research.<br />
PWAs and community representatives heard about developments<br />
in immune-based trials and the corresponding ethical issues in<br />
informed consent. Facilitated by the CTN, this gathering of<br />
science and community was the first of its kind in Canada.<br />
Dr. Routy’s research in immune-based therapies aspires<br />
to give PWAs a break from the complications and costly toll<br />
of highly active antiretroviral therapy (HAART). Dr. Routy<br />
acknowledges the lifesaving benefits of HAART but also<br />
believes that 14 years after its advent, we need to investigate<br />
alternative therapies.<br />
Advancing research in immune-based therapies wouldn’t be<br />
possible without the commitment and support of community<br />
members, says Sousa. For immune-based trials, there are certain ethical<br />
issues surrounding informed consent that must be considered.<br />
“Participation in immunology trials generally excludes<br />
individuals from joining any other clinical trials,” said CTN/Merck<br />
Studies enrolling in <strong>BC</strong><br />
CTN 247—<br />
CTN 244—<br />
CTN 240—<br />
Canadian cohort of HIV-positive slow progressors<br />
<strong>BC</strong> sites: St. Paul’s Hospital, Vancouver; Spectrum<br />
Health Care, Vancouver; Downtown Infectious Diseases<br />
Clinic (DIDC), Vancouver; Cool Aid Community Health<br />
Centre, Victoria<br />
Seek and Treat for Optimal outcomes and prevention<br />
in HIV & AIDS in IDU (STOP HIV & AIDS in IDU)<br />
<strong>BC</strong> sites: St. Paul’s Hospital, Vancouver<br />
Valacyclovir In Delaying Antiretroviral Treatment Entry<br />
(VALIDATE) trial<br />
<strong>BC</strong> site: DIDC, Vancouver<br />
CTN 238—<br />
CTN 236—<br />
CTN 194—<br />
32 <strong>liv</strong>ing5 MayqJune 2010<br />
postdoctoral fellow Dr. Bertrand Lebouché. “Immune-based<br />
therapies may have persistent effects on an individual’s immune<br />
system and would therefore impact how he/she responds to<br />
other treatment studies.”<br />
In order to successfully recruit participants, researchers<br />
must find ethically justifiable ways to help ensure individuals<br />
remain eligible for other clinical trials after participating in an<br />
immune-based study.<br />
CTN 239, which investigated AGS-004, an immunotherapeutic<br />
agent composed of an individual’s white blood cells<br />
and a sample of their pre-HAART HIV, did succeed in<br />
recruiting participants who had been involved in immunebased<br />
trials no more than six months before the beginning<br />
of the study. Results from this study will be presented at<br />
AIDS 2010 in Vienna in July.<br />
At present, the CTN doesn’t have an immune-based<br />
study enrolling participants in <strong>BC</strong>. However, Dr. Routy is<br />
currently leading an immune-based cohort in Montreal to<br />
analyze the impact of HIV on memory CD4 T-cells during<br />
HIV disease progression and after initiating antiretrovirals.<br />
The study will be extended to <strong>BC</strong>; researchers hope to<br />
begin enrolment this summer. 5<br />
Suzanne MacCarthy is the communications<br />
and information coordinator at the CIHR<br />
Canadian HIV Trials Network in Vancouver.<br />
The MAINTAIN study<br />
<strong>BC</strong> sites: DIDC, Vancouver<br />
St. Paul’s Hospital, Vancouver<br />
HPV vaccine in HIV-positive girls and women<br />
<strong>BC</strong> site: Oak Tree Clinic, Vancouver<br />
Peg-Interferon and citalopram in co-infection (PICCO)<br />
<strong>BC</strong> sites: St. Paul’s Hospital, Vancouver;<br />
DIDC, Vancouver<br />
To find out more about these and other CTN studies, visit the CIHR Canadian HIV Trials Network database at<br />
www.hivnet.ubc.ca or call 1.800.661.4664.
what’s new in research<br />
Report from CROI 2010<br />
By Dr. Marianne Harris<br />
The<br />
17th Conference on Retrovirus and Opportunistic<br />
Infections was held in February 2010 in San Francisco.<br />
Researchers from the <strong>BC</strong> Centre for Excellence in HIV/AIDS<br />
presented two important studies.<br />
Dr. Mark Hull and colleagues performed an analysis of<br />
the Canadian Observational Cohort Collaboration (CANOC)<br />
cohort, a cross-Canada collaboration. They analyzed 1,674 HIVpositive<br />
adults who received highly active antiretroviral therapy<br />
(HAART) between January 2000 and December 2008. Study<br />
participants had all achieved two viral loads below 400 copies/mL<br />
in a row, and had six or more viral load results available over<br />
the following two years.<br />
Participants were classified into four groups: full suppressors—<br />
all viral loads during follow-up were below 50 copies/mL;<br />
transient viremia (detectable virus in the blood)—viral loads<br />
below 50 copies/mL for at least 75 percent of the time, and<br />
the remaining viral loads were between 50 and 1000 copies/mL;<br />
short-term persisting viremia—viral loads below 50<br />
copies/mL 25 to 75 percent of the time; and long-term<br />
persisting viremia—viral loads below 50 copies/mL less<br />
than 25 percent of the time.<br />
Viral rebound was defined as having two viral loads in a<br />
row—from two different tests—above 1,000 copies/mL—this is<br />
usually accepted as a sign of treatment failure and indicates the<br />
need to change antiretroviral therapy. The risk of viral rebound<br />
was about the same for people with transient viremia as for the<br />
full suppressors, suggesting that occasional low-level viral load<br />
“blips” don’t predict ultimate treatment failure. On the other<br />
hand, people with short-term persisting viremia were about six<br />
times as likely to experience viral rebound as full suppressors.<br />
Long-term persisting viremia was even worse—people with longterm<br />
persisting viremia were about 20 times more likely to have<br />
viral rebound than the full suppressors.<br />
These results confirm that sustained suppression of the viral<br />
load to below 50 copies/mL, at least 75 percent of the time<br />
remains the ideal goal of successful HAART.<br />
The second presentation showed that PWAs with undetectable<br />
levels of HIV in their blood are less likely to transmit the virus to<br />
others. Dr. Julio Montaner presented data showing an association<br />
between the number of people receiving HAART in <strong>BC</strong> and the<br />
number of new HIV infections diagnosed in the province.<br />
HAART first became available in <strong>BC</strong> in 1996, and over the<br />
next three years the number of people in the province newly<br />
diagnosed with HIV decreased by nearly half—from about 700<br />
in 1996 to about 400 in 1999. Over the next several years, the<br />
number of British Columbians receiving HAART remained stable<br />
at about 2,500. Then, between 2004 and 2009, there was<br />
roughly a doubling of the number of people receiving HAART<br />
to about 5,000. A significant drop in the number of new HIV<br />
diagnoses in <strong>BC</strong> again followed this expansion of HAART coverage,<br />
despite that fact that more people were being tested.<br />
Of note, starting in 2007 there was a targeted effort to encourage<br />
HAART use particularly among injection drug users (IDU) in<br />
Vancouver’s Downtown Eastside. Over the next two years, the<br />
number of new HIV infections in this population fell by about half.<br />
Dr. Montaner acknowledged that there may be many factors<br />
contributing to the decline in new HIV diagnoses in this population<br />
and in <strong>BC</strong> in general, and that a significant proportion (estimated<br />
to be about 20 – 25 percent) of people who are HIV-positive aren’t<br />
aware of their diagnosis. However, these <strong>BC</strong> data provide the first<br />
evidence of an association between the number of people receiving<br />
HAART and the rate of new HIV infections within a large population,<br />
even amongst the most vulnerable IDU group.<br />
Details on these and other conference presentations can be<br />
found at the CROI website at www.retroconference.org/2010. 5<br />
Dr. Marianne Harris is a family doctor with the<br />
AIDS Research Program at<br />
St. Paul’s Hospital in Vancouver.<br />
MayqJune 2010 <strong>liv</strong>ing5 33
New <strong>BC</strong>PWA AGM<br />
voting procedure<br />
Now all <strong>BC</strong>PWA members can vote by mail<br />
<strong>BC</strong>PWA’s Board of Directors will no longer be elected<br />
solely by <strong>BC</strong>PWA members who can make it to the<br />
Annual General Meeting (AGM) or who get an attending<br />
member to use their proxy vote for them.<br />
Instead, as of this year, you can vote by using a mail-in ballot<br />
form that will be mailed to you in late July—or you can pick up<br />
your ballot up at our office. An independent returning officer<br />
will count the votes and announce the results at the AGM.<br />
These fundamental changes are part of a package of<br />
amendments to <strong>BC</strong>PWA’s bylaws that were approved at last<br />
year’s AGM. From now on, all special resolutions—including<br />
amendments to the bylaws, motions authorizing <strong>BC</strong>PWA<br />
to borrow money, and similar major decisions—will be<br />
resolved by <strong>BC</strong>PWA’s membership using mail-in ballots.<br />
Regular and ordinary motions will still be dealt with at<br />
the AGM.<br />
Because of this change in voting procedures, <strong>BC</strong>PWA will<br />
no longer use proxy forms for voting.<br />
This year’s AGM will be held on the evening of Thursday,<br />
August 19, 2010.<br />
How the new system will work<br />
All <strong>BC</strong>PWA members who receive mail from us will receive two mailings this year, one in June and one in July.<br />
The first mailing will include:<br />
3 Information about the AGM, including the date, time,<br />
and place<br />
3 An invitation to submit special resolutions for consideration<br />
by the membership<br />
3 If you want to run for the Board of Directors, there will<br />
be an invitation to submit your personal information and<br />
a statement about why you want to run for the Board.<br />
This information will need to be submitted in a specified<br />
format and be endorsed with the original signature of the<br />
nominee and the signatures of two people who second the<br />
nomination—all of whom must be full members of <strong>BC</strong>PWA<br />
in good standing<br />
3 A notice stating that the nominee information and the text<br />
of any special resolutions must be received by the returning<br />
officer by July 20, 2010<br />
The second mailing will include:<br />
3 The ballot to vote for the Board of Directors, including the<br />
names of all duly nominated candidates received by the returning<br />
officer<br />
3 Statements and biographical information for all candidates<br />
running for the available Board positions<br />
3 If applicable, the ballot to vote for any special resolutions<br />
submitted (the text and an explanation of the special resolutions<br />
will also be included)<br />
3 A notice stating that all mail-in ballots must be completed<br />
and received by the returning officer no later than August<br />
13, 2010 at 4:00 pm<br />
3 A post-paid return envelope for you to send your completed<br />
ballots<br />
If you don’t currently receive mail from <strong>BC</strong>PWA, you<br />
can apply in person at the <strong>BC</strong>PWA office to have your ballots<br />
issued to you at the beginning of August. Remember,<br />
there will be no more voting by proxy.<br />
The minutes of the 2009 AGM and the 2010 annual report<br />
and financial statements will be available by request by mail or<br />
pickup at <strong>BC</strong>PWA two weeks before the AGM.<br />
The deadline for the returning officer to receive a<br />
request from a Board nominee for a ballot recount is no<br />
later than August 26, 2010—seven days following the<br />
AGM. Ballots can be destroyed by September 2, 2010—14<br />
days after the AGM. 5<br />
MayqJune 2010 <strong>liv</strong>ing5 35
This year’s conference focused<br />
on our shared commitment to<br />
healthy self-preservation<br />
by Willie Blackmore<br />
Sitting at the registration desk during the first night<br />
of this year’s <strong>Positive</strong> Gathering, I experienced a few<br />
moments of panic when I wondered: “Did we use<br />
the wrong posters to promote this thing?”<br />
This year’s <strong>Positive</strong> Gathering, a conference developed<br />
for and by HIV-positive British Columbians, was held on<br />
March 26 – 28, at the Plaza Hotel in Vancouver. It’s an<br />
opportunity for people <strong>liv</strong>ing with HIV/AIDS from<br />
around the province to share experiences, participate in<br />
workshops, and have fun.<br />
The planning committee had designated the theme of<br />
this year’s event as “<strong>Living</strong> Longer, <strong>Living</strong> Well.” However,<br />
on the surface, the crowd before me seemed a much<br />
better embodiment of our 2009 theme, “Strength in<br />
Diversity.” Never before has the Gathering served such a<br />
broad representation of ethnicities, genders, ages, and<br />
sexualities within our province’s HIV-positive community.<br />
My worry was short-<strong>liv</strong>ed and, of course, unfounded.<br />
As the weekend progressed, and as attentive, motivated,<br />
and actively engaged audiences consistently filled the<br />
health-centric workshops, our diverse community’s<br />
shared commitment to healthy self-preservation became<br />
abundantly clear to me. Now that the Gathering is closed<br />
and we look forward to next year’s event, I’m left with<br />
an ongoing sense of inspiration from having witnessed<br />
the new networks of support and friendship built<br />
among participants.<br />
Before I pass on the planning committee chair<br />
position to the next elected peer among our dedicated<br />
group, I want to give thanks to all the organizations and<br />
individuals who gave so generously to make <strong>Positive</strong><br />
Gathering 2010 such a success. <strong>Positive</strong> Gathering 2010<br />
was presented by ANKORS, <strong>BC</strong>PWA, Downtown Eastside<br />
Consumers Board, <strong>Living</strong> <strong>Positive</strong> Resource Centre<br />
Okanagan, Pacific AIDS Network, <strong>Positive</strong> <strong>Living</strong><br />
Fraser Valley, <strong>Positive</strong> <strong>Living</strong> North, South Fraser AIDS<br />
Services Society, Vancouver Friends for Life Society,<br />
Vancouver Island Persons With AIDS Society, and<br />
YouthCO AIDS Society.<br />
Funding was generously provided by the Public Health<br />
Agency of Canada’s AIDS Community Action Program,<br />
Pacific Region. 5<br />
Willie Blackmore was the chair of the<br />
<strong>Positive</strong> Gathering 2010 planning committee.<br />
36 <strong>liv</strong>ing5 MayqJune 2010
Volunteering at <strong>BC</strong>PWA<br />
Profile of a volunteer:<br />
“Don is technically<br />
gifted and I regularly<br />
call upon him to give<br />
me assistance with<br />
computers, software,<br />
and more. He’s a patient<br />
teacher. We keep discovering<br />
more of his skill<br />
set as he seems to be<br />
able to do anything. He’s<br />
a joy to have around.”<br />
Richard Harrison<br />
Member services coordinator<br />
Don TenDen<br />
Volunteer history<br />
I started volunteering in IT with Marie, then assisted<br />
Suzan setting up a housing kiosk. Now I’m with the<br />
Retreat Team in the Support Department, doing general<br />
administration work.<br />
Started at <strong>BC</strong>PWA<br />
Just over a year ago.<br />
Why pick <strong>BC</strong>PWA?<br />
I had become a member a few months prior, and it<br />
seemed like a good fit for me as a way to get familiarized<br />
with the organization.<br />
Rating <strong>BC</strong>PWA<br />
Excellent, of course.<br />
<strong>BC</strong>PWA’s strongest point<br />
The support, in all its forms for the membership. There really is<br />
something there for every member of this diverse community.<br />
Favourite memory<br />
Being selected to be part of the Retreat Team.<br />
Future vision at <strong>BC</strong>PWA<br />
Continuing to expand programs for members to find a place to<br />
socialize and build supportive ties with one another.<br />
Polli & Esther’s Closet<br />
Your peer-run, second time around store!<br />
Bring your membership card<br />
and pay us a visit at<br />
1107 Seymour Street, 2nd Floor<br />
Great selection!<br />
Open Tuesdays, Wednesdays & Thursdays,<br />
11AM to 2PM for your shopping convenience<br />
MayqJune 2010 <strong>liv</strong>ing5 37
where to find help<br />
If you’re looking for help or information on HIV/AIDS, the following list is a starting point.<br />
A Loving Spoonful<br />
Suite 100 – 1300 Richards St,<br />
Vancouver, <strong>BC</strong> V6B 3G6<br />
604.682.6325<br />
e clients@alovingspoonful.org<br />
www.alovingspoonful.org<br />
AIDS Society of Kamloops<br />
P.O. Box 1064, 437 Lansdowne St,<br />
Kamloops, <strong>BC</strong> V2C 6H2<br />
t 250.372.7585 or 1.800.661.7541<br />
e ask@telus.net<br />
AIDS Vancouver<br />
1107 Seymour St, Vancouver <strong>BC</strong> V6B 5S8<br />
t 604.893.2201 e av@aidsvancouver.org<br />
www.aidsvancouver.bc.ca<br />
AIDS Vancouver Island (Victoria)<br />
1601 Blanshard St, Victoria, <strong>BC</strong> V8W 2J5<br />
t 250.384.2366 or 1.800.665.2437<br />
e info@avi.org www.avi.org<br />
AIDS Vancouver Island<br />
(Cowichan Valley Mobile Needle Exchange)<br />
t 250.701.3667<br />
AIDS Vancouver Island (Campbell River)<br />
t 250.830.0787 or 1.877.650.8787<br />
AIDS Vancouver Island (Port Hardy)<br />
t 250.949.0432<br />
AIDS Vancouver Island (Nanaimo)<br />
t 250.753.2437<br />
AIDS Vancouver Island (Courtenay)<br />
t 250.338.7400 or 1.877.311.7400<br />
ANKORS (Nelson)<br />
101 Baker St, Nelson, <strong>BC</strong> V1L 4H1<br />
t 250.505.5506 or 1.800.421.AIDS<br />
f 250.505.5507 e info@ankors.bc.ca<br />
http://kics.bc.ca/~ankors/<br />
ANKORS (Cranbrook)<br />
205 – 14th Ave N Cranbrook,<br />
<strong>BC</strong> V1C 3W3<br />
250.426.3383 or 1.800.421.AIDS<br />
f 250.426.3221 e gary@ankors.bc.ca<br />
http://kics.bc.ca/~ankors/<br />
Asian Society for the Intervention of AIDS (ASIA)<br />
210 – 119 West Pender St,<br />
Vancouver, <strong>BC</strong> V6B 1S5<br />
t 604.669.5567 f 604.669.7756<br />
e asia@asia.bc.ca www.asia.bc.ca<br />
<strong>BC</strong> Persons With AIDS Society<br />
1107 Seymour St, Vancouver <strong>BC</strong> V6B 5S8<br />
604.893.2200 or 1.800.994.2437<br />
e info@bcpwa.org www.bcpwa.org<br />
Dr Peter Centre<br />
1100 Comox St,<br />
Vancouver, <strong>BC</strong> V6E 1K5<br />
t 604.608.1874 f 604.608.4259<br />
e info@drpetercentre.ca<br />
www.drpetercentre.ca<br />
Friends For Life Society<br />
1459 Barclay St, Vancouver, <strong>BC</strong> V6G 1J6<br />
t 604.682.5992 f 604.682.3592<br />
e info@friendsforlife.ca<br />
www.friendsforlife.ca<br />
Healing Our Spirit<br />
3144 Dollarton Highway,<br />
North Vancouver, <strong>BC</strong> V7H 1B3<br />
t 604.879.8884 or 1 866.745.8884<br />
e info@healingourspirit.org<br />
www.healingourspirit.org<br />
<strong>Living</strong> <strong>Positive</strong> Resource Centre<br />
Okanagan<br />
101–266 Lawrence Ave.,<br />
Kelowna, <strong>BC</strong> V1Y 6L3<br />
t 250.862.2437 or 1.800.616.2437<br />
e info@lprc.ca<br />
www.<strong>liv</strong>ingpositive.ca<br />
McLaren Housing Society<br />
200 – 649 Helmcken St,<br />
Vancouver, <strong>BC</strong> V6B 5R1<br />
t 604.669.4090 f 604.669.4092<br />
e mclarenhousing@telus.net<br />
www.mclarenhousing.com<br />
Okanagan Aboriginal AIDS Society<br />
101 – 266 Lawrence Ave.,<br />
Kelowna, <strong>BC</strong> V1Y 6L3<br />
t 250.862.2481 or 1.800.616.2437<br />
e info@oaas.ca www.oaas.ca<br />
Pacific AIDS Network<br />
P.O. Box 3102<br />
Vancouver, <strong>BC</strong> V6B 3X6<br />
t 250.537.4082<br />
e evin@pacificaidsnetwork.org<br />
www.pacificaidsnetwork.org<br />
<strong>Positive</strong> <strong>Living</strong> Fraser Valley Society<br />
Unit 1 – 2712 Clearbrook Rd.,<br />
Abbotsford, <strong>BC</strong> V2T 2Z1<br />
t 604.854.1101 or 604.556.6228<br />
f 604.8541105<br />
e info@positive<strong>liv</strong>ingfraservalley.org<br />
www.positive<strong>liv</strong>ingfraservalley.org<br />
<strong>Positive</strong> <strong>Living</strong> North<br />
1–1563 2nd Ave,<br />
Prince George, <strong>BC</strong> V2L 3B8<br />
t 250.562.1172 f 250.562.3317<br />
e info@positive<strong>liv</strong>ingnorth.ca<br />
www.positive<strong>liv</strong>ingnorth.ca<br />
<strong>Positive</strong> <strong>Living</strong> North West<br />
Box 4368 Smithers, <strong>BC</strong> V0J 2N0<br />
3862 F Broadway, Smithers <strong>BC</strong><br />
t 250.877.0042 or 1.886.877.0042<br />
e plnw@bulkley.net<br />
<strong>Positive</strong> Women’s Network<br />
614 – 1033 Davie St, Vancouver, <strong>BC</strong> V6E 1M7<br />
t 604.692.3000 or 1.866.692.3001<br />
e pwn@pwn.bc.ca www.pwn.bc.ca<br />
Purpose Society HIV/AIDS program<br />
40 Begbie Street<br />
New Westminster, <strong>BC</strong> V3M 3L9<br />
t 604.526.2522 f 604.526.6546<br />
Red Road HIV/AIDS Network Society<br />
804 – 100 Park Royal South,<br />
W. Vancouver, <strong>BC</strong> V7T 1A2<br />
t 604.913.3332 or 1.800.336.9726<br />
e info@red-road.org www.red-road.org<br />
Vancouver Native Health Society<br />
441 East Hastings St, Vancouver, <strong>BC</strong> V6G 1B4<br />
t 604.254.9949<br />
e vnhs@shaw.ca<br />
Victoria AIDS Resource & Community<br />
Service Society<br />
1284 F Gladstone Ave, Victoria, <strong>BC</strong> V8T 1G6<br />
t 250.388.6620 f 250.388.7011<br />
e varcs@islandnet.com<br />
www.varcs.org/varcs./varcs.nsf<br />
Victoria Persons With AIDS Society<br />
1139 Yates St., Victoria <strong>BC</strong> V8V 3N2<br />
t 250.382.7927 f 250.382.3232<br />
e support@vpwas.com www.vpwas.com<br />
Wings Housing Society<br />
12 – 1041 Comox St, Vancouver, <strong>BC</strong> V6E 1K1<br />
t 604.899.5405 f 604.899.5410<br />
e info@wingshousing.bc.ca<br />
www.wingshousing.bc.ca<br />
YouthCO AIDS Society<br />
205 – 1104 Hornby St. ,<br />
Vancouver <strong>BC</strong> V6Z 1V8<br />
t 604.688.1441 1.877.968.8426<br />
e information@youthco.org<br />
www.youthco.org<br />
For more comprehensive listings<br />
of HIV/AIDS organizations and<br />
services please visit <strong>BC</strong>PWA’s<br />
website at www.bcpwa.org and<br />
click on “Links and Services”<br />
under the “Empower Yourself”<br />
drop-down menu.<br />
38 <strong>liv</strong>ing5 MayqJune 2010
If you are a member of the <strong>BC</strong> Persons<br />
With AIDS Society, you can get involved<br />
and help make crucial decisions by joining<br />
a committee. To become a voting member<br />
on a committee, please attend three<br />
consecutive meetings. For more information<br />
on meeting dates and times, please<br />
see the contact information on the right<br />
column for the respective committee that<br />
you are interested in.<br />
Board & Volunteer Development<br />
Contact: Marc Seguin<br />
t 604.893.2298 e marcs@bcpwa.org<br />
Community Representation &<br />
Engagement<br />
Contact: Paul Kerston<br />
t 604.646.5309 e paulk@bcpwa.org<br />
Education & Communications<br />
Contact: Adam Reibin<br />
t 604.893.2209 e adamr@bcpwa.org<br />
IT Committee<br />
Contact: Ruth Marzetti<br />
t 604.646.5328 e ruthm@bcpwa.org<br />
<strong>Living</strong> <strong>Positive</strong> Magazine<br />
Contact: Jeff Rotin<br />
t 604.893.2206 e jeffr@bcpwa.org<br />
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Name_________________________________________________________<br />
Address ____________________________ City _____________________<br />
Province/State _____ Country________________ Postal/Zip Code________<br />
Phone ___________________ E-mail _______________________________<br />
Upcoming <strong>BC</strong>PWA Society Board Meetings:<br />
Date Time Location Reports to be presented<br />
June 2, 2010 1:00 Board Room Standing Committees/Director of APT<br />
June 16, 2010 1:00 Board Room Written Executive Director Report / Director of HR<br />
Complete Board Evaluation Chart<br />
June 30, 2010 1:00 Board Room Executive Committee<br />
Financial Statements—April / Audited Financials<br />
July 14, 2010 1:00 Board Room Written Executive Director Report / Standing Committees<br />
Director of Communications<br />
July 28, 2010 1:00 Board Room Financial Statements—May/Quarterly Department Reports / 1st Quarter<br />
Director of IT<br />
<strong>BC</strong>PWA Society is located at 1107 Seymour St., 2nd Floor, Vancouver.<br />
For more information, contact: Alexandra Regier, director of operations Direct: 604.893.2292 Email: alexr@bcpwa.org<br />
<strong>BC</strong>PWA Standing Committees and Subcommittees<br />
<strong>Positive</strong> Gathering Committee<br />
Contact: Stephen Macdonald<br />
t 604.893.2290 e stephenm@bcpwa.org<br />
Health Promotion<br />
Contact: Elgin Lim<br />
t 604.893.2225 e elginl@bcpwa.org<br />
Support Services<br />
Contact: Jackie Haywood<br />
t 604.893.2259 e jackieh@bcpwa.org<br />
Advocacy & Prison Outreach<br />
Contact: Adriaan de Vries<br />
t 604.893.2284 e adriaand@bcpwa.org<br />
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o r g<br />
1107 Seymour Street<br />
2nd Floor<br />
Vancouver <strong>BC</strong><br />
Canada V6B 5S8<br />
For more information visit<br />
www.bcpwa.org<br />
e-mail to <strong>liv</strong>ing@bcpwa.org<br />
or call 604.893.2206<br />
MayqJune 2010 <strong>liv</strong>ing5 39
Last Blast<br />
The plane truth<br />
Air travel can be either death-defying or life-confirming—<br />
it just depends on your perspective<br />
by Denise Becker<br />
My father was a geography<br />
teacher and during our<br />
summer vacations in the<br />
1960s he would take groups of<br />
students to Italy. He knew if he<br />
got enough students to go, our<br />
family could all fly free of<br />
charge. So I was lucky<br />
enough to travel to<br />
Italy ten times.<br />
The journey could be pretty hairy.<br />
The planes were propeller driven. Crossing<br />
the Alps was a jolting experience, often<br />
with terrible turbulence. While most of<br />
the passengers were white knuckled, my<br />
brother and I loved every minute—it was<br />
better than any fairground ride. We<br />
would giggle and pretend we were on<br />
a roller coaster.<br />
As I’ve grown older, the rush of air<br />
travel has worn off. I get more and more<br />
nervous each time I fly. And flying between<br />
Kelowna and Vancouver for regular<br />
board meetings, I’m now travelling much<br />
more. I’ve also attended various national<br />
conferences and workshops. And I seem<br />
to be getting into more hair-raising<br />
situations. The statistics of going down<br />
in a plane don’t help. Yes, I know you<br />
have more chance of getting killed crossing<br />
a road and that very few planes have<br />
crashed on Canadian soil, but then I<br />
always wonder if I’ll be on the plane that<br />
finally evens up Canada’s score relative<br />
to the rest of the world.<br />
Once I was flying to an HIV conference<br />
in Toronto, and the pilot told us<br />
we were heading into bad weather. Sometimes<br />
I wonder if pilots say that, turn off<br />
the microphone, and then have a good<br />
laugh at all the passengers rushing back<br />
from the bathroom and hurriedly buckling<br />
up. I started to use my<br />
deep breathing exercises<br />
that I learned to cope with<br />
panic attacks and stress. On this<br />
occasion, it seemed we circled the<br />
airport forever and the snowstorm<br />
outside wasn’t getting any better. Finally,<br />
we descended and landed very close to<br />
the cloud line. I had no idea the cloud<br />
was so low but was very glad to finally<br />
get off the plane.<br />
Then there was the time I was in row<br />
13 and the plane started up and then<br />
stopped. The pilot announced that he<br />
didn’t have enough fuel! On my next<br />
flight, I was heading back to Kelowna<br />
from Vancouver when the turbulence<br />
felt like we were riding up and down on<br />
a big wave. I was petrified. The pilot<br />
announced that there was fog at the<br />
Kelowna airport. He attempted to land<br />
the plane three times and on the third<br />
attempt the pilot said he was headed for<br />
Calgary. I had a fleeting thought of the<br />
previous flight and wondered how much<br />
fuel the plane had left in the tank.<br />
Recently, a number of us were flying<br />
back to Kelowna from <strong>BC</strong>PWA’s <strong>Positive</strong><br />
Gathering. Before we boarded the plane,<br />
I joked with my friends that if our plane<br />
crashed, most of the Okanagan volunteers<br />
would be wiped out. It wasn’t so funny<br />
30 minutes later, when we<br />
were in the midst<br />
of some of the<br />
worst turbulence I’ve<br />
ever experienced. The girl<br />
next to me looked<br />
very nervous, and<br />
we held hands. The<br />
man across the aisle also<br />
looked frightened and I<br />
reached over to him,<br />
though I wasn’t sure if it was<br />
for his comfort or mine. Then<br />
the plane fell a distance and everyone<br />
cried a nervous “ugh!” When we finally<br />
landed, we were all thankful to the pilot<br />
for getting us home safely.<br />
It wasn’t until I was driving from the<br />
airport that I started to laugh. What an<br />
ironic situation had just occurred: we<br />
were all fearing for our <strong>liv</strong>es, and yet we<br />
were people who had been diagnosed as<br />
terminally ill. It was obvious we still<br />
believed we could <strong>liv</strong>e and weren’t going<br />
to die from HIV/AIDS. I recalled my<br />
initial diagnosis in 1994 and how at the<br />
time I wondered if I’d make it another<br />
five years. Suicide was an option—I<br />
stopped wearing my car seatbelt and<br />
hoped for a quick end.<br />
But now? Well, now things are different.<br />
And it made me happy as I drove<br />
home to think I was experiencing hope<br />
and a belief in a longer life. It felt good<br />
to be scared again. 5<br />
Denise Becker is a board<br />
member with <strong>BC</strong>PWA.<br />
She <strong>liv</strong>es in Kelowna.<br />
40 <strong>liv</strong>ing5 MayqJune 2010