liv poz mag.qxd - Positive Living BC

inside
333
features
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treatment
information
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05 3FIGHTING WORDS
The BC government has made a string of funding cuts. The Coalition to Build a Better BC
is taking action.
06 3ACCOLAIDS
Awards gala honours heroes in BC’s AIDS movement.
08 3EPIDEMIOLOGY
Is rectal mucus a source of HIV transmission?
12 3CRIMINALIZATION OF HIV
Current Canadian cases related to HIV non-disclosure
14 3GIRL TALK
kPreparing for a successful pregnancy.
kOne HIV-positive woman’s story of her pregnancy.
16 3PREVENTION
Important services from BCPWA for people who are newly diagnosed with HIV.
40 3LAST BLAST
Air travel can be death-defying or life-confirming—it just depends on your perspective.
q09
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REVITALIZATION AT BCPWA
BCPWA is changing with the times, with several initiatives aimed at ensuring we’re
serving all individuals in our diverse community equally.
HIV AND AGING
The intersection of HIV and aging is an emerging area of concern.
17 3CONFERENCES
Report on an HIV/AIDS summit at the University of British Columbia.
23 3TREATMENT RESEARCH
Phase II results for the new GS 9350 booster hold promise for a four-in-one pill.
24 3ANTIRETROVIRALS
Not all AIDS drugs have stayed with us over the years. Some didn’t go the distance.
27 3NUTRITION
kSome tips to use food and nutrition to support you when quitting smoking.
kLooking back at the role of nutrition in HIV treatment over the years.
31 3OPPORTUNISTIC INFECTIONS
PML is a rare disease of the central nervous system that affects
immunocompromised people.
32 3LET’S GET CLINICAL
Clinical trials: beyond virology.
33 3STRAIGHT FROM THE SOURCE
Report from the 2010 Conference on Retroviruses and Opportunistic Infections.
36 3POSITIVE GATHERING 2010
This year’s conference focused on our shared commitment to healthy self-preservation.
Living Positive is published by the British Columbia Persons With AIDS Society. This publication may report on
experimental and alternative therapies, but the Society does not recommend any particular therapy.
Opinions expressed are those of the individual authors and not necessarily those of the Society.
MayqJune 2010 living5 1

think5
opinion&editorial
The British Columbia Persons With AIDS Society
seeks to empower persons living with HIV
disease and AIDS through mutual support
and collective action. The Society has over
4800 HIV+ members.
Living Positive editorial board
Denise Becker, Lorne Berkovitz – chair,
Wayne Campbell, William Christiansen,
Doug Mitchell, Derek Thaczuk,
Neil Self, Tova Diva, Glyn Townson
Managing editor Jeff Rotin
Design / production Britt Permien
Copyediting Christina Thiele
Proofing Rob Gair, Carl Bognar
Contributing writers
Willie Blackmore, Cheryl Collier,
Dr. Marianne Harris, Diana Johansen,
Cécile Kazatchkine, Shannon Lee,
Leslie Leung, Nicole Lewis,
Suzanne MacCarthy, Chuck Osborne,
Ron Rosenes, Laura Vicol
Photography Britt Permien
Director of communications & education
Adam Reibin
Director of advocacy and prison outreach
Adriaan de Vries
Director of health promotion
Elgin Lim
Subscriptions / distribution
John Kozachenko, Joe LeBlanc
Funding for Living Positive is provided by the
BC Gaming Policy & Enforcement Branch
and by subscription and donations.
Living Positive magazine
1107 Seymour St., 2nd Floor
Vancouver BC V6B 5S8
TEL 604.893.2206 FAX 604.893.2251
EMAIL living@bcpwa.org
BCPWA ONLINE www.bcpwa.org
© 2010 living5
Permission to reproduce:
All Living Positive articles are copyrighted.
Non-commercial reproduction is welcomed.
For permission to reprint articles, either in
part or in whole, please email living@bcpwa.org
Get your vote on
at our AGM
by Glyn Townson
last year’s Annual General
AtMeeting (AGM), BCPWA
members voted in favour of a new
system of mail-in balloting that has
revolutionized our standard voting
procedure for BCPWA business.
Whereas we once saved all special
resolutions until the AGM and
relied on the handful of members
who were present to cast deciding
votes, mail-in balloting allows us to
motion special resolutions at any
time of the year and trust their
approval or refusal to a broader,
more representative range of BCPWA
voting members.
I personally put this special
resolution forward on behalf of
the board of directors because we
strongly believe this system will
produce long-term and meaningful
benef its for our community. Our
Society is now comprised of more
than 4,800 members; last year, less
than 100 members showed up to
our AGM. That they should decide
the direction of our business simply
isn’t fair.
While your attendance at our
AGM this August is still vital
(see the inside front cover of this
issue for details), I urge you all to
familiarize yourselves with the new
mail-in balloting procedures outlined
in this issue of Living Positive and
to respond, thoughtfully, when you
receive your voting packages later
this spring. Remember, BCPWA is
your Society—you’re obliged to guide
its success.
Of course, your input to BCPWA
isn’t limited to voting on special
resolutions. We’re always open
to member feedback about our
programs, services, and resources. In
particular, we’re extremely interested
to hear your thoughts and suggestions
on the image-building work we’ve
been doing over the past year. What
do you think of our redesigned
website at www.bcpwa.org? Can you
f ind all the information you need
there? And how do you feel about
our new front desk management? If
you’ve visited our Vancouver off ice
recently, have you noticed greater
eff iciency when you check in at the
reception desk? We’d love to know.
Please email us at info@bcpwa.org.
I’ll be reading! 5
Glyn Townson is the
chair of BCPWA.
2 living5 MayqJune 2010

Canada cuts funding
to international AIDS
vaccine project
Canada has pulled the plug on funding
to one of the largest AIDS vaccine
development agencies in the world.
Between 2001 and 2008, the Canadian
International Development Agency
contributed nearly $80 million to the
International AIDS Vaccine Initiative
(IAVI), one of the biggest backers of HIV
vaccine trials in the developing world.
In 2009, Canada contributed nothing
to the organization and said funding
was under review. There was no money
again in this year’s federal budget and
no decision on whether IAVI will ever
receive Canadian funding again.
In 2007, when Canada announced its
own Canadian HIV Vaccine Initiative
(CHVI), Canada committed that the
CHVI “would not compromise Canada’s
international support of AIDS vaccines.”
The CHVI is a $139-million, five-year
joint venture between Canada and the
Bill and Melinda Gates Foundation. It
was announced to great fanfare in February
2007. But three years later, less than $9
million has been spent on CHVI,
including almost $700,000 on a proposed
$88-million vaccine production facility
that was scrapped last month.
Source: Canwest News Service
HIV and hepatitis C crisis in
federal prisons
A report released by the Correctional
Service of Canada (CSC) in early April
reveals an HIV prevalence rate in
federal prisons that rivals those of many
countries in sub-Saharan Africa and is
greater than the HIV prevalence rates in
all other regions of the world.
At 4.6 percent, the rate of HIV infection
in federal prisons is 15 times greater than
that in the community as a whole. As for
hepatitis C in federal prisons, the 31 percent
rate of infection is 39 times greater than
the population as a whole. In both cases,
incarcerated women and especially Aboriginal
women—of whom 11.7 percent are infected
with HIV—are disproportionately infected
with HIV and hepatitis C.
“About half the prisoners surveyed
reported sharing used needles or syringes
to inject drugs, and about one-third
reported sharing a needle with someone
who has HIV, hepatitis C or unknown
infection status,” said Sandra Ka Hon Chu,
senior policy analyst at the Canadian
HIV/AIDS Legal Network. “This clearly poses
a risk of HIV or hepatitis C transmission, a
risk that could be remedied with prisonbased
needle and syringe programs.”
China repeals ban on
HIV-positive visitors
China has scrapped a 20-year-old travel
ban that barred people with HIV and
AIDS from entering the country just days
ahead of the opening of the Shanghai
Expo, which hopes to welcome millions
of overseas visitors.
China’s cabinet, the State Council,
said in a statement posted to its website
that the government passed amendments
on April 19 revising the Border Quarantine
Law as well as China’s Law on Control of
the Entry and Exit of Aliens. The changes
were effective immediately.
The decision follows similar moves by
the US and South Korea to eliminate
travel restrictions for people with HIV.
Both lifted their bans on visitors with
HIV on January 1, 2010.
Source: The Associated Press
MayqJune 2010 living5 3
Victoria still waiting for needle
exchange site
After two years without a f ixed
needle-exchange site, Victoria can’t
sit back and wait for health officials
to develop an Island-wide distribution
model, says Victoria Councillor
Philippe Lucas.
“There’s absolutely no reason and
no excuse for us to wait for an Islandwide
model to be put in place before
this municipality takes action in trying
to reduce the spread of disease and
improve the public health of our region,”
Lucas said.
The Vancouver Island Health Authority
(VIHA) is looking at a number of
potential sites to establish an Island-wide
distributed needle exchange program.
At Lucas’s urging, council has asked
city staff to compile past reports on
harm reduction initiatives and consult
with stakeholders such as drug user
advocacy groups, VIHA, AIDS Vancouver
Island, and police to produce a
report on potential courses of action
and costs.
Source: The Victoria Times Colonist
photo Mike Verbergt
Pharma firm sees quick
FDA approval
Montreal’s Theratechnologies Inc.,
developer of tesamorelin to treat excess
abdominal fat in HIV/AIDS patients, is
confident US regulators will approve the
drug’s US launch for late this year.
CEO Yves Rosconi said a US Food
and Drug Administration panel of experts
will review the new drug application
(NDA) for tesamorelin without further
modifications on May 27 in a public
process. The panel’s recommendation
will go immediately to the FDA. “We
continued on next page

think it will be favourable so the
regulators can give the green light on
July 27, the final action date, for the US
launch,” Rosconi said.
Theratechnologies’ partner for the US
market is EMD Serono, a unit of Germany’s
Merck KGaA pharmaceutical giant.
Source: The Montreal Gazette
Drug users must be helped to
halt AIDS spread: UN
Countries in eastern Europe and central
Asia face spiraling AIDS epidemics if they
fail to help people who inject drugs and
stop the spread of infection, according to
the head of the United Nations agency
for HIV/AIDS.
Michel Sidibé told Reuters that countries
such as Russia, Ukraine, and others
could halt or buck the global downward
trend in new HIV infections if they ignored
the threat posed by drug users and failed to
introduce effective harm reduction steps.
“HIV infection has slowed down
globally, but it is expanding in this region
of eastern Europe and central Asia,” he
said. “We’re not seeing anything like this
in any other region of the world.”
Sidibé said of the 3.7 million people in
the region who inject drugs, a quarter
have HIV.
Sidibé warned that newly emerging
and growing pockets of HIV spread
among drug users could propel a wave of
infections and undermine gains in curbing
sexual transmission of the disease.
A report published last month showed
that more than 90 percent of the world’s 16
million injection drug users are offered no
help to avoid contracting HIV.
Source: Reuters India
Bananas enlisted to help stop
spread of HIV: Study
A simple fruit that many of us eat every
day could soon prove to be a powerful
new inhibitor of HIV, and lead to new
treatments to prevent sexual transmission
of the virus.
Bananas, according to new research of
the University of Michigan Medical
School, might be good for you in an
exciting new way.
Lectins, naturally occurring chemicals
in plants, are drawing the interest of scientists
because they can stop the chain
reactions that lead to a variety of infections.
In laboratory tests, BanLec, the
lectin found in bananas, was as effective
as two current anti-HIV drugs, according
to a news release from the school.
Based on the findings published in
the Journal of Biological Chemistry, BanLec
may become a less expensive new component
of applied vaginal microbicides,
researchers say.
Source: Canwest News Service
HIV rise in Saskatoon
The number of newly diagnosed HIV
cases in Saskatoon jumped again in 2009,
prompting warnings from the health
region’s top physician that action is
needed so the outbreak doesn’t become
unmanageable.
There were 94 new cases of HIV in
the Saskatoon Health Region in 2009, up
22 per cent from 77 a year earlier. The
number is also up 141 per cent from five
years earlier, in 2005, when there were 39
new cases.
The increase is partly attributable to
more aggressive screening for HIV in the
4 living5 MayqJune 2010
city after the region increased its followup
with newly diagnosed cases in 2005-06
to find out who they may have
interacted with.
But there has also been an increase
in transmissions. The increase in HIV
cases has been associated most closely
with intravenous drug use, and that
trend is continuing.
Source: The Star Phoenix 5
photo: Glenn Anderson
Volunteers at “Yellow Mellow,” BCPWA’s annual
volunteer recognition event which took place on
April 29, 2010 at the Hotel Chateau Granville
in Vancouver.

The
FIGHTING WORDS
Fighting back
The BC government has made a string of funding cuts.
The Coalition to Build a Better BC is taking action by Glyn Townson
BC government is on a cutting spree. And those
funding cuts are going to hurt PWAs, among many
other groups in the province. It’s time to take action—and
that’s exactly what the Coalition to Build a Better BC intends
to do.
Last spring, the BC government made serious funding cuts
to non-profit arts programs throughout the province. How
does this travesty affect our HIV-positive community? Most
directly, BCPWA benefits from a long-standing affiliation with
the Vancouver Queer Film Festival, through which we receive
free promotional and networking opportunities at the festival’s
wide-reaching annual events.
Then last summer, British Columbians were shocked to
learn of our newly re-elected Liberal government’s plans to
implement the harmonized service tax (HST) and the emptiness
of associated campaign trail assurances that BC’s finance structure
was steadfast and true.
How will the HST impact our HIV-positive community
more than others in our province? Our good health and
longevity relies on sustained access to a range of products and
services not covered by the Medical Service Plan—or any other
insurance provider, for that matter. Whether we are employed,
retired, or making ends meet with a socially assisted income;
HIV-positive British Columbians can’t afford to sacrifice our
complementary healthcare necessities for increased taxes.
Last fall, BC’s Ministry of Health announced devastating
cuts to the administration budgets of community-based health
organizations (CBHOs) funded through the Vancouver Coastal
Health and Fraser Health Authorities. Though BCPWA operates
outside of this government funding strategy, these cuts still impact
us. BCPWA does its best to meet the ever-changing needs of our
diverse community, but we don’t have the resources to be all things
to all HIV-positive people. Instead, we serve our community best
as part of a network of CBHOs whose collective efforts provide
our province with a full continuum of HIV/AIDS care. Our success—
and the livelihood of HIV-positive British Columbians—is
interdependent with the success of our CBHO partners.
The last straw came this past March, when the BC government
announced severe amendments to the terms that govern
MayqJune 2010 living5 5
disability income eligibility and payments. Truly, the demographics
of our community are changing and an increasing number of
us are now consistently employed. But none of us can ignore
the significant percentage of our HIV-positive peers who rely on
disability income for such basic needs as clean, bottled water.
How can our already
cash-strapped HIV-positive
community affect
meaningful and immediate
change in an environment
where our own government
compromises our every
effort to survive?
So the big, overarching question is: how can our already
cash-strapped HIV-positive community affect meaningful and
immediate change in an environment where our own government
compromises our every effort to survive?
We can’t do it alone.
Early this year, BCPWA was invited to join the Coalition
to Build a Better BC. This grassroots initiative combines the
strengths of a diverse range of community organizations
impacted by the BC government’s unwieldy, irresponsible
system of funding cuts and policy amendments. By the time
this issue of Living Positive is published, we’ll have already
facilitated a “teach-in” at the Vancouver Public Library and a
large-scale rally at the Vancouver Art Gallery.
If you missed either event, don’t worry; the Coalition is
committed to its long-term campaign for public awareness
and active opposition to the BC government’s strategy for
community funding. I encourage you to check www.bcpwa.org
and BCPWA’s eNews for updates about the Coalition’s events
over the coming months. 5
Glyn Townson is the chair of BCPWA.

On
Shining stars
Awards gala honours heroes in BC’s AIDS movement
April 18, the 9th annual AccolAIDS awards gala
took place at the Vancouver Convention Centre.
The event recognized the outstanding contributions of individuals
and organizations in BC’s HIV/AIDS movement.
INNOVATIVE PROGRAMS AND SERVICES
Chee Mamuk Aboriginal Program
The Chee Mamuk Aboriginal Program of the BC Centre for
Disease Control was created in response to the disproportionate
numbers of new HIV infections among BC’s Aboriginal
population. Three exceptional women—Melanie Rivers, Jada-
Gabrielle Pape, and Felicia Tebb—are behind Chee Mamuk,
working with tireless devotion to create and implement innovative
programming that effectively reduces HIV transmission in the
most vulnerable communities. Every program is grounded in
culture and tradition, creating a supportive environment that
engages every participant.
Chee Mamuk’s initiatives extend beyond awareness workshops
and aim to create the capacity for change within the
communities themselves. Chee Mamuk has ensured that
Aboriginal individuals and communities are prepared to win
the fight against HIV/AIDS.
PHILANTHROPHY
The Printing House
The Printing House (TPH) actively supports HIV/AIDS
organizations throughout BC. For nearly a decade it has chosen
Vancouver’s AIDS WALK for LIFE as one of its signature
charities, donating an average of $10,000 a year. In addition
to funds, TPH donates printing services and encourages
employee participation in AIDS WALKS all over Canada.
One of the many projects organized by TPH is its annual
seasonal greeting card campaign, which donates 100 percent
of the proceeds to registered Canadian charities. In 2009, the
funds went to programs that “feed Canada,” including the Dr.
Peter AIDS Foundation Health Program. Over the years, a
number of AIDS related charities throughout Canada have
benefited from TPH’s fundraising efforts and community
philanthropy activities.
KEVIN BROWN PWA HERO AWARD
Monique Desroches
Monique Desroches is a familiar face in the HIV/AIDS community,
lending her story to the media in order to challenge stereotypes,
break down stigma, and promote women’s issues across Canada.
She has served as a pacific regional representative to the Canadian
AIDS Society Board, as well as the Positive Women’s Network
(PWN) representative at the Pacific AIDS Network. Desroches
is currently co-chair of the PWN Board of Directors, leading the
organization’s provincial initiatives.
On a personal level, Monique has made it her mission to
provide support and guidance to women with HIV. Her
indomitable spirit, affable sense of humour, and eternally
positive attitude in the face of multiple adversities have
helped others cope with their own personal struggles.
SOCIAL/POLITICAL/COMMUNITY ACTION (tie)
Micheal Vonn
Staunchly committed to defending the rights of people living
with HIV/AIDS, Vonn has been tireless in her advocacy and
public awareness endeavors. As policy director of the BC
Civil Liberties Association, she works to protect the personal
health information of HIV-positive individuals through initiatives
such as the Right to Privacy Campaign. Vonn has joined with
several HIV/AIDS organizations to form BC’s Big Opt Out,
an active awareness campaign against centralized electronic
health data, or eHealth. She’s been instrumental in educating
people on their rights in regards to disclosing their HIV status.
Since joining the HIV/AIDS community as a volunteer at
AIDS Vancouver, Vonn has used her legal savvy and personal
determination to call for change and empower the vulnerable.
She’s an influential advocate, speaker, writer, and educator
who has done much to publicize issues relevant to HIV/AIDS.
6 living5 MayqJune 2010

Jennifer Evin Jones
For the past 15 years, Jones has lent her legal expertise and
innovative spirit to the HIV/AIDS movement, demonstrating
a sophisticated knowledge and sensitivity to the complex
issues of discrimination and stigma. As head of the advocacy
department at BCPWA, she challenged provincial disability
policy, which led to an increase in supplemental income for
many people living with HIV/AIDS. As executive director of
YouthCo AIDS Society and the Vancouver Friends for Life
Society, she designed and implemented innovative programming
aimed at addressing critical gaps in community services.
Currently, as executive director of the Pacific AIDS Network,
Jones has been integral in shaping its vision and building
formal relationships with key players in the HIV/AIDS
community. She has demonstrated the vision, leadership,
and iron will needed to influence change and promote
cooperation in the fight against HIV/AIDS.
HEALTH PROMOTION AND HARM REDUCTION
Dr. Silvia Guillemi
Dr. Guillemi is a physician at the John Ruedy Immunodeficiency
Clinic (IDC) at St Paul’s Hospital and a consulting physician
at the Dr. Peter Centre. As clinical coordinator of the IDC,
she’s actively involved in enhancing primary HIV care
programs and improving patient access to both medical and
support services. In 2000, Dr. Guillemi initiated a tireless
crusade to overhaul the IDC and is largely responsible for
the exceptional and comprehensive treatment the clinic now
provides for PWAs.
Dr. Guillemi organizes regular educational sessions for staff
at St Paul’s Hospital and arranges preceptorships for visiting
healthcare professionals. She also directs the skills enhancement
program in HIV/AIDS at the University of British Columbia
(UBC) and co-coordinates the BC Centre for Excellence in
HIV/AIDS’ (BC-CfE) biannual Antiretroviral Updates. Her
unrelenting mission towards improved care for PWAs reveals
itself through the effective management of the disease in medical
facilities throughout BC.
SCIENCE/RESEARCH/TECHNOLOGY
Dr. Richard Harrigan
Dr. Harrigan is the director of the research laboratory at the
BC-CfE and is among the world’s leading experts in
HIV/AIDS. Under his direction, the lab performs the vast
majority of Canada’s HIV drug resistance testing and is
regarded as the most outstanding HIV/AIDS research centre
in Canada. Dr. Harrigan’s research focuses on drug efficacy,
drug resistance, and the human and viral parameters that
influence HIV disease progression. His innovative HIV drug
resistance testing program is modeled throughout the world.
Recently Dr. Harrigan conducted a study that indicates a
dramatic decline in drug resistance within BC’s HIV population.
These findings result from the development and application
of innovative treatment and drug management strategies based
on his lab’s findings. His primary goal of helping doctors
make better decisions for their patients continues to inspire
his research and lead to new discoveries.
LIFETIME ACHIEVEMENT AWARD (tie)
Irene Goldstone
Goldstone has accomplished much over the course of her
long and impressive career, first as a nurse and later as an
educator and program director. In 1982, she was appointed
director of medical nursing at St. Paul’s Hospital where she
was involved in developing the HIV/AIDS program. In 1992,
she joined the BC-CfE as director of professional education.
Goldstone later joined the UBC faculty where she teaches an
HIV/AIDS elective in nursing and assists in the delivery of an
interprofessional HIV/AIDS course.
Goldstone’s commitment to improving the lives of those
living with HIV/AIDS is well respected throughout the
community. The passion she brings to the classroom has
inspired many, while her compassionate and understanding
manner with her patients has impacted countless others. Her
strong leadership and insistence on excellence has helped to
ensure that top quality care is available to people with HIV/AIDS—
today and well into the future.
Diana Johansen
As a dietitian at the Oak Tree Clinic at BC Women’s Hospital
and Health Centre, Johansen has dedicated the last 16 years of
her life to promoting the health of women and children with
HIV/AIDS through improved nutrition and by advocating for
their enhanced care. She played a key role in implementing
the monthly nutrition supplement benefit and the free formula
benefit for infants born to HIV infected mothers. She developed
the BC nutrition guidelines for HIV and has contributed to
various national and international manuals.
Johansen has also been a leader in education, helping to
teach the interprofessional HIV/AIDS course at UBC and
conducting workshops for healthcare professionals in the
Caribbean. She founded the Vancouver Dietitians in AIDS
Care practice group to create opportunities for professional
development. Her active presence within the HIV/AIDS
community and long list of contributions towards health
promotion will ensure her continued relevance. 5
Shannon Lee is the communications
assistant for AccolAIDS 2010.
MayqJune 2010 living5 7

The bottom line
Is rectal mucus a source of HIV transmission?
by Chuck Osborne
rectal mucus a source of HIV transmission? There have
Isbeen few studies conducted on rectal secretions and HIV
plasma load, but the limited data does point to the probability
that rectal mucus has a higher concentration of HIV than
other bodily fluids such as blood or semen.
Rectal mucus is a natural-forming substance that occurs when
the bowels contract to allow smooth passage of stool. In most people,
this only happens in small amounts. Most rectal mucus discharges
are benign, but there are many conditions that can cause abnormal
or excessive discharge. Amongst these could be hemorrhoids, anal
fissures, prolapses, and warts. Crohn’s disease, colitis, rectal ulcers,
anal tuberculosis, or any number of sexually transmitted infections
(STIs), as well as some AIDS-defining illnesses, could also be responsible.
It’s also normal that rectal mucus can consist of a litany of
fluids, the most evident being blood.
The US Centers for Disease Control and Prevention do not
specifically list rectal mucus as a source of HIV transmission,
and very few other agencies mention this fluid by name; however,
the general reference to vaginal or anal fluids presumably
includes anal mucus.
The US Centers for Disease
Control and Prevention do not
specifically list rectal
mucus as a source of HIV
transmission, and very few
other agencies mention this
fluid by name.
Nevertheless, scientists have been aware that rectal fluids
can be a source of infection since Dennis Osmond’s report
from the University of California, San Francisco, in 1998.
There appear to be only two studies of note that have
attempted to measure levels of viral load in rectal mucus.
The first, conducted in 2000 by investigators at the Center for
AIDS & STD at the University of Washington in Seattle, found
only one man out of 54 participants with blood plasma viral
loads below 50 copies/mL who had detectable HIV virus in
rectal secretions. The other study, conducted in 2004 by
Zuckerman et al, again at the University of Washington,
compared viral loads in the blood, semen, and mucosal lining
of the rectum in 64 gay men in the US and Peru. Viral loads
tended to be higher in rectal mucus.
Bodily fluids and their risk factor
in HIV transmission
HIV is not present in:
• Urine
• Feces
• Vomit
• Sweat
HIV is present in negligible (non-infectious) quantities in:
• Saliva (only detected in a very small number of people)
• Tears
• Blister fluid
HIV is present in sufficient (infectious) quantities in:
• Rectal lubricating secretions (in very high concentrations)
• Blood and blood products
• Semen and pre-ejaculate (pre-cum)
• Vaginal/cervical secretions or juices
• Breast milk
Zuckerman’s study fails to note that of 63 patients, only 27
were on antiretroviral therapy and only 18 had undetectable
viral loads. The study also doesn’t address how long the viral load
was non-detectable before biopsy, or the type of antiretrovirals
participants were taking.
We know from many other studies that some people can have
undetectable viral load in their blood but detectable viral loads in
either genital secretions or sperm. Scientists believe that this may
be more likely to happen in people who have STIs or even
asymptomatic herpes (that is, herpes with no visible symptoms).
The bottom line is that when engaging in anal sex, it’s
always wise to use precautions. 5
Chuck Osborne is a volunteer with BCPWA’s
Prevention and Treatment Information Programs.
8 living5 MayqJune 2010

Cover Story
BCPWA is changing with the times
by Adam Reibin
Changes are afoot here at BCPWA. If you’re a
regular participant in our programs, services,
and events, you’ve no doubt noticed several
changes in our methods of operation over the past two
years. If you connect to us only through our external
communications resources, recent enhancements to
our published content and graphic style should make
the new trends in our Society’s direction just as obvious
to you. If this issue of Living Positive is your first
introduction to BCPWA, welcome; you couldn’t have
chosen a more exciting time to get involved.
New audiences are at the core of BCPWA’s efforts
to transform. Why? Because we’re committed, by our
mission, to “enable persons living with AIDS and HIV
to empower themselves through mutual support and
collective action.” This statement is no less relevant to
our community today than when BCPWA members
crafted it in 1990.
continued on next page
MayqJune 2010 living5 9

Cover Story
So, when the BCPWA staff and board of directors realized that
the culture of our own membership didn’t reflect rising HIV
infection rates among almost every demographic region and
population in our province, we had to reevaluate our approach.
In so doing, we reconfirmed our commitment to HIV-positive
British Columbians at large—not just those individuals living
with HIV/AIDS who are our longest standing members, or the
few members who show up at our Annual General Meetings
(AGMs), and clearly not the founding members who have long
since passed.
HIV/AIDS culture in our province is constantly evolving,
and BCPWA has a responsibility to serve all individuals in our
diverse community equally.
The status quo won’t work anymore
Be sure, by attracting new populations to our organization, we don’t
intend to displace, disrespect, or deny service to anyone who is
already connected to BCPWA. But for us to offer future generations
of HIV-positive individuals the same opportunities we’ve always
promised by our mission, we can’t continue with our status quo.
Anecdotal evidence of BCPWA’s failings is disheartening,
particularly when we hear it from our volunteers, staff, and
board members. Raised eyebrows and rolled eyes are common
images in stories from those whose public affiliation with
BCPWA has often been rebuked by peers—especially in the gay
community, where a substantial number of middle-class,
professional males have claimed that our Vancouver facility’s
predominant street culture is dangerous and unwelcoming.
Several staff members have admitted that they rarely identify
their employer to outsiders, because they’re tired of defending
the organization. Most alarming are tales of HIV care providers
and newly diagnosed individuals who have told BCPWA staff—
in no uncertain terms—that they deliberately avoid BCPWA
because they feel our focus is only relevant to HIV-positive
injection drug users and older gay males.
Identifying areas for improvement
Results from a more formalized analysis of BCPWA’s cultural
relevance have been no more encouraging. In the fall of 2008,
we partnered with a student intern from the University of
British Columbia’s Community Based Research program
(School of Social Work) to assess awareness and opinions of
BCPWA among HIV care providers and populations most
at-risk for HIV transmission.
Targeted surveys delivered online and on-the-street, as well
as in-person interviews with key healthcare professionals, all
confirmed our worst suspicions: at-risk populations were
mostly unfamiliar with BCPWA, or misinformed about our
services; healthcare providers generally felt that our methodology
lacked innovation; and portions of both groups indicated that,
if presented with the option, BCPWA wouldn’t be their first
choice for HIV/AIDS service and support.
The sum of our research—anecdotal and formal—was that
the following operational components were the biggest deterrents
to new people connecting with BCPWA:
q Our name
q Our focus on socially marginalized HIV-positive populations
q Our public representation, including our brochures, posters,
logo, and website
q Our front-of-house service
Accordingly, our staff and board have worked diligently to
address these areas of concern over the past two years. While
our course of action is constantly challenged by our limited
resources, the results of our efforts are mounting. And we’re
proud to share our progress.
Changing our name
Highly active antiretroviral therapy (HAART) has reduced the
prevalence of AIDS in BC. Indeed, most HIV/AIDS specialists
in our province advise their patients—especially those who are
newly diagnosed—that combining HAART with a healthy lifestyle
can delay this late stage disease for decades, if not altogether.
Considering that most individuals in our community don’t
identify as persons living with AIDS, but rather as persons
living with HIV, there’s little wonder why many choose not to
connect with us.
The solution to this problem seemed simple—initially. At last
year’s AGM, our vice chair, Ken Buchanan, presented a motion
to change our Society’s registered name to the “HIV Society of
BC.” The motion didn’t pass a majority vote, but it was close.
So close, in fact, that the board will follow-up with a revised
name change motion later this year. Our intention is to present
members with several new name options crafted in accordance
with the feedback we received from them at last year’s AGM.
Whether or not this new motion passes, make no mistake:
we’re determined that a majority of voting members will soon
accept this important step in increasing accessibility to our
services. As Buchanan stated in his motion last year, “BCPWA
changed the disease. It’s time we changed with it.”
Developing more socially relevant programming
When BCPWA was founded, most of our members were subsisting
on disability pensions, many had retreated from active social
involvement, and they were suffering from debilitating treatment
side effects. Basically, they were living life in preparation for an
early death. To enable and empower them—as our mission
dictates—meant that BCPWA’s efforts focused on advocating for
fair social benefits, housing and care, researching and relaying
complex treatment information, and providing access to daily
basics such as food and clothing.
BCPWA still offers all of those services because a portion of
our members relies on them. But the majority of our members
now require an entirely new system of support to maintain the
healthy, active, social lifestyle promised by HAART. Here are
10 living5 MayqJune 2010

Cover Story
just some of the programs we’ve developed over
the past two years to meet the needs of everdiversifying
populations in our community:
Am-BIG-You-Us: A monthly trans community
mix ‘n’ mingle for transgendered HIV-positive
individuals, open to all cross dressers, transsexuals
(both MTF and FTM), and other gender
variant individuals.
Suits: This monthly dinner for HIV-positive gay
working men takes place at various Vancouverarea
restaurants on the last Monday of each
month. The event offers HIV-positive gay working
men a chance to foster a sense of community,
meet other professionals, network, and provide a
positive, active influence on our culture.
Ou+doorsmen: This monthly social group
is designed for gay HIV-positive men who
enjoy being active in the outdoors. Activities
planned for this year include Grouse zipline,
ice skating, hiking at Mount Gardiner and
Killarney Lake Loop on Bowen Island,
curling, kayaking, and more. The program is
intended to promote a healthy, active HIVpositive
lifestyle in our community.
Opposites Attract: Both a workshop and
retreat, this program engages serodiscordant
couples—gay, straight, or other—in facilitated
discussions, presentations, and group work, as
well as outdoor fun, indoor games, and relaxation.
The weekend is designed to strengthen, affirm,
and enhance their relationships.
HIV Complementary Care Clinic: At this
in-house program, provided in partnership
with the Boucher Institute of Naturopathic
Medicine, HIV-positive individuals can receive
a free consultation on their health and treatments
from naturopathic students under the
supervision of a licensed naturopath.
Revitalizing our public representation
Living Positive readers will no doubt agree that
BCPWA has always maintained a high standard of
design. We’re confident that the look of all our
communications tools is consistently eye-catching,
engaging, and modern. But the consistency of
our public identity ends there. Each part of our
organization seems to have defined its own brand
rather than a collective one for BCPWA.
However, we can only revitalize BCPWA’s
reputation if audiences connect it to the highquality
programs that our staff provides. To tie
our public identity together, a common graphic
theme is developing within all our promotional
and educational materials. So far we’ve
introduced this graphic subtly, but as we release
more materials over the next few months—including
a new letterhead, envelopes, business cards—our
distinct new style will become more apparent.
Our new graphic template is most evident in
the new version of our website, www.bcpwa.org.
The colours, fonts, and graphics found there
form the basis of how BCPWA’s brand will look
in the future. The reorganization of information
on our website is a further sign of our intent to
make BCPWA more accessible to outside audiences.
Take a look at the website and let us know if
we’re meeting that goal.
Enhancing our front-of-house service
Of course, increased accessibility through our
programs, services, and design is only part of
the equation. Our primary access point is our
front office; this is where outsiders learn to
navigate the complexities of our organization.
Until recently, this essential part of our business
suffered from a lack of staff resources. As a
result, our ability to connect to our community
suffered as well. However, we now have a fulltime
member services coordinator, and we’re
confident that the increased level of consistently
well-informed and professional service at the
front desk is in line with what audiences will
expect by our new graphic identity and
improved programming.
As BCPWA moves even further toward a
stronger identity and better service delivery for
our community, we invite Living Positive readers
to be an active part of this change. What do you
think of our new look? Are we meeting your
needs with our new suite of programs and services?
Do you have any suggestions of what we might
do better? Let us know by email at
info@bcpwa.org. 5
More information about our programs
Visit www.bcpwa.org for more information
about our programs and how to get involved.
Adam Reibin is BCPWA’s director
of communications and education.
MayqJune 2010 living5 11

In the courts
Current Canadian cases related
to HIV non-disclosure
by Cécile Kazatchkine
Since the Supreme Court of Canada’s 1998 decision in
R. v. Cuerrier, not disclosing your HIV-positive status
can amount to “fraud” that renders a partner’s consent
to sex legally invalid, thus transforming consensual sex
into an aggravated sexual assault under the Criminal Code.
However, your legal duty under criminal law to disclose
your HIV-positive status only arises before engaging in an
activity that represents a “significant risk of serious bodily
harm” (the courts have accepted that HIV infection is a
serious harm).
It’s the act of exposing a sexual partner to a significant risk
of infection, without disclosing your HIV-positive status that is
the crime. People can be, and have been, convicted even when
their sexual partner wasn’t infected.
It remains difficult to identify which specific situations
require disclosure under criminal law. In the Cuerrier case,
the Supreme Court didn’t define the notion of “significant
risk” of HIV transmission. It clearly stated that vaginal or
anal unprotected sex represents a significant risk, but left
room for interpretation of other sexual activities, such as
safer sex (for example, vaginal or anal sex with a condom)
or oral sex (with or without a condom).
In Cuerrier, the majority of the Supreme Court indicated
that condom use might reduce the risk of HIV transmission so
that it’s no longer significant, but they didn’t make an explicit
ruling on this issue. Also, science has evolved since 1998. It’s
become increasingly clear that an undetectable viral load
dramatically reduces the risk of HIV transmission, but what
this means for the legal duty of people living with HIV to
disclose still isn’t clear.
Several cases raising these issues are currently before
Canadian courts and may provide additional guidance to
identify what sexual activities do or don’t require disclosure.
R. v. Wright
Wright was convicted by a jury in a BC trial court on two
counts of aggravated sexual assault for failing to disclose his
status to two complainants before having unprotected sex.
Neither of them was infected with HIV.
In November 2009, the BC Court of Appeal dismissed his
appeal. The Court said that, in the absence of specific evidence
regarding Wright’s viral load, a 0.5 percent average risk of transmission
for unprotected vaginal sex was sufficient evidence for a trial jury to
conclude that there was a significant risk of HIV transmission to
therefore convict him. However, the Court also recognized that if
viral load at the relevant time was known, it would be “very relevant”
to the determination of criminal liability. This decision may allow a
“viral load defence” when the accused’s viral load is undetectable
and thus dramatically reduces the risk of the transmission.
In terms of condom use, the Court refused to accept that
it would automatically remove the requirement to disclose.
Instead, the Court ruled that it’s a question of fact in each case
to determine whether the use of condoms has reduced the risk
of HIV transmission below the “significant risk” threshold.
An application for leave to appeal to the Supreme Court
is pending.
R. v. Mabior
In July 2008, a Manitoba trial court convicted the accused on
six counts of aggravated sexual assault for failing to disclose his
12 living5 MayqJune 2010

HIV-positive status to his partners. Mabior had vaginal intercourse
with multiple women—one of whom was underage—without
disclosing his HIV status. Condoms were used on some
occasions, but not on others. During the relevant times,
Mabior’s viral load varied from low to undetectable. None of
the complainants in this case became infected with HIV.
This judgment is the first case since Cuerrier to analyze in
detail the meaning of “significant risk.” In this case, the trial judge
relied heavily on the evidence of the Crown’s medical expert and
ruled that condom use alone wouldn’t be enough to remove the
duty to disclose—there must also be an undetectable viral load.
The trial judge’s decision suggests that there would need to be
“complete elimination” of any risk of HIV transmission, or close
to it otherwise, disclosing HIV-positive status is required.
This is at odds with judgments in several other cases, where
courts either explicitly stated, or seem to have implicitly accepted,
that using a condom would mean there’s no duty to disclose. The
trial judge’s decision has been appealed. The Canadian HIV/AIDS
Legal Network intervened, arguing that people who use condoms
for vaginal or anal sex shouldn’t be criminally prosecuted for not
disclosing their HIV-positive status. Where the risk is similarly low
or lower because of a person’s undetectable viral load, there also
should be no prosecution. The decision is pending.
R. v. DC
In February 2008, the Court of Quebec found DC, an HIV-positive
woman, guilty of sexual assault and aggravated assault for not
informing her sexual partner JLP that she was HIV-positive
before they had sex.
DC and her ex-partner had a four-year relationship before she
successfully brought assault charges for domestic violence, for which
JLP received an unconditional discharge after being convicted. He
later brought charges against her, alleging that they had unprotected
sexual intercourse several times before she disclosed her HIV status.
According to DC, they had only one sexual encounter before she
disclosed and a condom was used. At the relevant time, DC had an
undetectable viral load. JLP was not infected with HIV.
The trial judge declared that neither JLP nor DC were reliable.
He found that DC had unprotected sex with JLP once before
she disclosed her HIV status. He relied on evidence from DC’s
physician, whose notes indicated that DC had consulted her
about the risk of HIV transmission if a condom broke.
The trial judge’s decision is confusing. The judge states that
there’s a duty to disclose HIV status prior to sex, whatever the
risk of HIV transmission (contrary to the “significant risk” test
from Cuerrier) but also acknowledges that there should be no
conviction when a condom is used. Also, despite the fact that
DC’s viral load was undetectable at the relevant time and that
the Crown’s expert described the risk of transmission as close
to zero, he nonetheless convicted her.
The decision is currently under appeal. The Legal Network
and COCQ-Sida, Quebec’s provincial AIDS network, have
joined forces to intervene.
MayqJune 2010 living5 13
In Canada, charges for
HIV non-disclosure before
having otherwise consensual
sex have escalated from
common nuisance to
aggravated sexual assault
and now to murder.
R. v. Aziga
In April 2009, an Ontario jury convicted Aziga of two counts
of first-degree murder, ten counts of aggravated sexual assault,
and one count of attempted aggravated sexual assault in relation
to sexual encounters he had with 11 women without disclosing
his status. Of the seven women who tested HIV-positive, two
subsequently died of cancer said to be related to their HIV
infection. At this writing, Aziga’s sentencing is still pending,
following a psychiatric assessment. An appeal may follow.
The case and its outcome are disturbing for several reasons. In
terms of the aggravated sexual assault charges, Aziga was convicted
of at least one count for not disclosing his HIV status before
engaging in unprotected oral sex, and of at least one count in
relation to unprotected oral and vaginal sex while wearing a
condom. There is an implication that oral sex alone constitutes a
“significant risk” of HIV transmission under criminal law. This
doesn’t reflect scientific evidence on oral sex and it means that
people can be convicted when there is, at best, a marginal risk of
harm. It’s also at odds with a number of other court decisions.
Aziga appears to be the first person convicted of murder for not
disclosing his HIV status. Murder charges require specific intent.
The prosecution argued that Aziga’s failure to tell the women
“about his HIV status before, during, and after he had unprotected
sexual activity with them so they could obtain medical treatment,
is evidence of the intent to kill [them].” This appears to have
been the extent of the evidence regarding Aziga’s intent.
Since Cuerrier, charges in Canada for HIV non-disclosure
before having otherwise consensual sex have escalated from
common nuisance to aggravated sexual assault, and now to
murder. There is a risk that the Aziga case may be used as a
precedent to pursue murder and attempted murder charges,
but that remains to be seen. 5
Cécile Kazatchkine is a policy analyst at the
Canadian HIV/AIDS Legal Network.

Girl Talk
Healthy bundles of joy
What HIV-positive women can do to prepare for a successful pregnancy
by Laura Vicol
-positive women have to grapple with many decisions
HIVand life challenges when embarking on the wonderful
journey of childbearing. Obtaining specialized HIV care and
support during pregnancy is very important for the health of the
mother and can ensure the birth of a healthy, uninfected baby.
Women starting their care early, receiving intensive
pregnancy-related health counselling and HIV therapy, have
enjoyed safe pregnancies and healthy, uninfected babies.
If you’re HIV-positive and considering childbearing, prepare
for the pregnancy well in advance of becoming pregnant. For
example, before getting pregnant, start taking prenatal vitamins.
Review your antiretroviral regimen with your healthcare providers
to ensure your medications are safe during pregnancy.
Get a nutritional assessment. Address your ongoing primary
healthcare issues.
Once you’re pregnant, take a prenatal multivitamin
containing at least 0.6 mg of folic acid. Most prenatal
vitamins have an average of 0.6 – 1 mg of folic acid along
with other important vitamins and minerals. Eat a balanced
diet, rich in a variety of nutrients—this is good for your own
health and for the development of a healthy baby. Eat a
variety of fresh, wholesome foods that are high in iron,
folate, proteins, and vitamins.
Healthy eating doesn’t mean you need expensive or special
foods. The most important aspect during your pregnancy is to
make healthy choices in the foods you buy and prepare. For
some women, this may only mean integrating more fruits and
vegetables into your diet or getting used to eating breakfast
regularly. Work closely with a registered dietitian who is experienced
in HIV care and pregnancy.
Research data indicates that the risk of HIV transmission
from mother to child increases with injection drug use (such as
heroin), use of other substances like cocaine, cigarette smoking,
and unprotected sexual intercourse with multiple partners.
There are also unique considerations related to the use of
antiretroviral medication before and during pregnancy. The
choice of HIV medication is always made based on the unique
needs of each HIV-positive woman. Avoid certain medications,
such as efavirenz (Sustiva) during the first trimester of your
pregnancy and when you’re trying to get pregnant; clinical data
indicates an increased risk for birth defects related to these
medications. Also avoid other medications such as nevirapine
(Viramune), didanosine (Videx) and stavudine (Zerit), or take
them with great care, because these medications can have potential
unwanted side effects and toxicities in pregnant women.
Pregnancy represents a major change in your self-image,
priorities, behaviour patterns, relationships with others, problem
solving, and coping skills. Compounded with the multiple
challenges you face as a person with HIV underscores the need
for support, housing, adequate nutrition, and stable general
health in order to achieve the best possible outcomes. 5
Laura Vicol is a family nurse practitioner at the
Oak Tree Clinic at BC Women’s Hospital and
Health Centre.
Oak Tree Clinic
Oak Tree Clinic, located at BC Women’s Hospital and Health
Center in Vancouver, provides HIV-related medical care to
women and children, as well as pre-pregnancy planning and
pregnancy care to HIV-positive women. In BC, all pregnant HIVpositive
women are referred to Oak Tree, which serves as a
provincial referral centre for obstetrical care in HIV. Over 400
pregnant HIV-positive women have received care and have delivered
uninfected infants at the clinic since 1996.
Staff also provides medical advice to primary care providers,
specialists, and midwives in communities throughout the
province. Oak Tree’s multidisciplinary team provides ongoing
support in specialized HIV care, obstetrical, gynecological,
dental, pharmaceutical, and primary care. The clinic also has a
registered dietitian, social worker, and addiction counsellor.
14 living5 MayqJune 2010

Pain and anguish—and bliss
One HIV-positive woman’s story of her pregnancy by Lynn
My name is Lynn and I’m HIV-positive. I never would
have imagined giving birth at the age of 39. Not to
mention my health status. I don’t exercise regularly
like I should. However, I eat healthy, meditate, do holistic
therapies, and am very spiritual. From what I experienced, it is
possible nowadays for an HIV-positive woman to give birth and
not transfer the disease to the baby. But not without great pain
and anguish. I was astonished.
The Oak Tree Clinic played a very important role during
my pregnancy. All their hard work and recommendations were
amazing. Upon deciding to have a baby, I spoke with three
obstetricians, a paediatrician, a gynaecologist, a dietitian, two
pharmacists—even the receptionists. One of the doctors
explained that the rate of mother-to-child transmission was
down to one percent, and the fact that only one patient at Oak
Tree had given birth to an HIV-positive baby in the last 15 years.
I was still skeptical and my mind was racing to seek further
knowledge. There must be other risk factors, I thought. Yes,
there were, but there were ways to reduce them, such as totally
complying with my medicine regime to lower my viral load and
raise CD4 count. And having a caesarean section.
Everything was going good until the third month of my
pregnancy. I developed cholestasis, which is an overproduction of
bile that flows into the skin and causes severe itchiness. It’s the
most annoying, aggravating condition I ever experienced. I couldn’t
sleep in any one position for long and suffered from chronic
insomnia, anxiety, and depression. Then I got hypertension—
my blood pressure was so high, I was bedridden at home with
nurses coming in to do checkups. The cholestasis and hypertension
became critical to the life of the fetus and my own life.
I stuck to a strict regime of HIV medications at the proper
time each day. I had to take vitamins K, C, E, calcium, plus I
had meds for cholestasis to reduce the itching. Taking meds
and vitamins took up a lot of my day. It was quite rigorous. I
took HIV meds with breakfast, vitamins with lunch, cholestasis
and anxiety meds at dinner, then HIV meds again at bedtime.
Plus two daily baths to ease the itchiness. That was the only
time I got out of bed, due to my high blood pressure.
Eventually I was hospitalized. I had chronic insomnia, so I
walked around the hospital halls a lot. The straps wrapped
around my tummy to monitor the fetus’s heartbeat were so
aggravating to my skin that the nurses and I developed a
strategy where I would hold the instruments myself. But I
could only stand the straps for 15 minutes whether they got
their measurements or not, otherwise I’d have a panic attack.
My blood pressure would rise, which was also detrimental to
the fetus. So the nurses would have to stop and try again later.
It was a very distressing and aggravating pregnancy. Not the
usual happy, shiny hair, glowing cheeks, shining and bright
pregnancy. No way.
Taking meds and vitamins took
up a lot of my day. I took HIV
meds with breakfast, vitamins
with lunch, cholestasis and
anxiety meds at dinner, then
HIV meds again at bedtime.
I was hospitalized for eight weeks in total. The emotional
fear was excruciating; I was scared for my fetus. By 36 weeks I
couldn’t take the itchiness. I broke down and cried to the
nurses. I prayed to Great Spirit to help me, and one hour later
my water broke.
After my baby girl was born, my pure blessing, she had to
take AZT for six weeks as a precaution, and then get a blood
test again. Waiting is nerve-wracking. I brought my baby girl to
Oak Tree to show everyone, I am such a proud mother.
Oak Tree took very good care of us, physically, mentally,
and emotionally, and I’m very grateful to them. No matter how
much I suffered it was all worth it for I have a beautiful baby
girl who is healthy and vibrant. We’re very happy and owe it to
Oak Tree and BC Women’s Hospital and Health Centre. God
bless them. 5
Lynn is a member of BCPWA.
MayqJune 2010 living5 15

Prevention
The first steps
Important services from BCPWA for people
who are newly diagnosed with HIV
by Chuck Osborne
If
you’ve recently been
diagnosed with HIV,
you’re probably wondering
what to do next. Coming
to terms with your diagnosis
often starts with taking
control and learning as
much as you can. You can
overcome anxieties and
fears and actively participate
in your own recovery by
asking questions.
BCPWA’s Health
Promotion Department can help you with real answers to
these questions by offering a number of important services
that are part of its continuum of care for newly diagnosed.
If you want to tell someone how you feel or express
your emotions and don’t know who will listen, our Peer
Counselling Hotline is available from 10:00 am – 8:00 pm
daily at 604.908.7710; if you live outside the Lower Mainland,
you can call toll-free at 1.800.908.7710. Trained counsellors
will lend a supportive ear in a confidential manner—they can
also follow-up with resources if needed.
When you’re ready to increase your HIV knowledge base,
you can attend our workshop series entitled HIV Fundamentals.
This peer-facilitated series will help you better understand
the new realities of having HIV, disease progression, treatment
information, disclosure, and self-care. You can also get
support from newly diagnosed peers.
If you need to access primary health care, our HIV Care
Registry can help you locate a doctor or clinic. We can put
you in touch with appropriate HIV/AIDS resources or other
agencies to meet your individual needs. We can also assist in
your doctor-patient relationship by helping you ask the right
questions to get meaningful answers.
Becoming a member of BCPWA has many benefits such
as the Complementary Health Fund, where you can receive
up to $55 per month for your non-prescription HIV-related
healthcare needs, which can include such things as water,
vitamins, nutritional supplements, and gym passes. For stress
relief and general relaxation, every Wednesday we offer gentle
yoga. Also on Wednesdays, students from the Boucher
Institute of Naturopathic Medicine are on-site to attend to
your physical needs.
We also offer many other support services, including
weekend retreats, complimentary tickets to various events,
and other social networking opportunities. We can refer you
to other BCPWA departments if you need help with housing
or addictions issues. Don’t be afraid to drop by for a haircut
or take home something nice from our “gently used”
clothing store.
The goal of our continuum of care model is to take HIVspecific
services and together create a plan that is best suited
to you and your needs, thereby providing you with
optimism, answers to questions, and a better quality of life.
For more information, or if you have any questions about
any BCPWA services, call 604.893.2200. 5
Chuck Osborne is a volunteer with
BCPWA’s Health Promotion Program.
BCPWA
Advocacy
gets
results!
The BCPWA Society’s Advocacy Program continues to work
hard to secure funds and benefits for our members.
The income secured for December 2009 & January 2010 is:
t $15,075
t $4,500
new housing, health benefits, dental and
long-term disability benefits.
in ongoing monthly nutritional supplement
benefit for children
16 living5 MayqJune 2010

treatment
*nformation
TREATMENT INFORMATION
PROGRAM MANDATE &
DISCLAIMER
In accordance with our mandate
to provide support activities and
facilities for members for the
purpose of self-help and self-care,
the BCPWA Society operates a
Treatment Information Program
to make available to members
up-to-date research and information
on treatments, therapies,
tests, clinical trials, and medical
models associated with AIDS
and HIV-related conditions. The
intent of this project is to make
available to members information
they can access as they choose
to become knowledgeable partners
with their physicians and medical
care team in making decisions to
promote their health.
The Treatment Information
Program endeavours to provide
all research and information to
members without judgment or
prejudice. The program does not
recommend, advocate, or endorse
the use of any particular treatment
or therapy provided as information.
The Board, staff, and volunteers
of the BCPWA Society do not
accept the risk of, or the responsibliity
for, damages, costs, or
consequences of any kind which
may arise or result from the
use of information disseminated
through this program. Persons
using the information provided
do so by their own decisions
and hold the Society’s Board,
staff, and volunteers harmless.
Accepting information from this
program is deemed to be
accepting the terms of
this disclaimer.
Report on an HIV/AIDS summit at the
University of British Columbia by Lorne Berkovitz
On
February 26, there was a worldclass
summit at the University of
British Columbia (UBC) during the 2010
Olympics. The title of the summit was
“The Impact of Science and Innovation in
the Evolving Global Health Paradigm: HIV
and AIDS—A Global Challenge of Olympic
Proportion.” The event was co-sponsored by
MayqJune 2010 living5 17
LifeSciences British Columbia, The BC
Centre for Excellence in HIV/AIDS, the
International AIDS Society, and UBC.
Guest speakers came from a wide range
of backgrounds, including pharmaceutical
research, epidemiology, government,
economics, sports, and mental health.
continued on next page

Dr. Julio Montaner spoke briefly about his new Seek and
Treat program. This new initiative to reach HIV-positive
individuals not on highly active antiretroviral therapy (HAART),
especially those living in Vancouver’s Downtown Eastside and
in Northern BC, will help to substantially bring down provincial
HIV infection rates. The beauty of this new program is that
the relatively small investment by the Government of BC and
Merck will result in great long-term savings by avoiding the
cost of individual lifetime HIV treatments.
Selling HIV treatment and
prevention as being
fiscally prudent in the long
term was one of the main
themes of this summit.
Selling HIV treatment and prevention as being fiscally
prudent in the long term was one of the main themes of this
summit. Ambassador Mark R. Dybul, co-director of the O’Neill
Institute for National and Global Health Law at Georgetown
University and the key architect of PEPFAR, insisted that
business and government leaders need to be made aware that a
humanitarian approach to the epidemic is also a wise financial
approach. The wholesale decimation of adults in their prime is
taking a terrible toll on local and global economies. Dr. Dybul
cited Brazilian statistics indicating that since the introduction
of HAART, Brazil has saved $1.86 billion in hospital stays.
Stefano Bertozzi, HIV director of the HIV Global Health
Program for the Bill and Melinda Gates Foundation, spoke
about the world economic downturn and its repercussions on
prevention and treatment of HIV. Because HAART is a lifelong
investment, if the global funds remain only stable, it will be a
backslide—it won’t be enough to keep up with the demand to
put new PWAs on antiretrovirals. Dr. Bertozzi stressed the
importance of spending money wisely. The problem with most
HIV interventions, he said, is that after 30 years we’re still treating
the epidemic as an emergency and making plans a year at a
time. He said you can’t fight an epidemic without studying the
cost effectiveness of prevention strategies for the long haul.
Dr. Nora Volkow, director of the National Institute on Drug
Abuse at the National Institutes of Health, gave a different
perspective on HIV prevention. She addressed the connection
between mental health and risk behaviours. Her studies have
found that because the brain isn’t fully developed before
adulthood, teenagers who use drugs have a greater likelihood of
addiction and depression—both are factors in risky behaviours
that can lead to HIV transmission.
Another bright star of HIV/AIDS activism at the summit
was Michel Sidibé, executive director of UNAIDS. He noted
that every year, HIV kills two million people. Over 33 million
people are still living with the disease worldwide, and less than
half the people who need HAART are able to access it. He
said that HIV is still an issue of inequity, stigma, sexism, and
homophobia. In Africa, 400,000 babies are still born with
HIV every year, compared with zero babies anywhere else. Rich
countries have a duty to help those in other parts of the world
who aren’t so fortunate.
The bottom line is that the HIV epidemic still remains an
Olympic-sized challenge, even with the introduction of wonderful
new treatments—which is why there’s a continued need for new
and enduring global HIV initiatives. 5
Lorne Berkovitz is the secretary
of the BCPWA board.
There are many different ways to get involved!
Volunteer
1) Volunteer weekly helping out with our
many programs & services (Mon-Fri)
@
2) Volunteer at special events, AccolAIDS
Gala, Pride Parade, AIDS Walk for Life
3) Volunteer on projects, in meetings or with
our living5 magazine
BCPWA
To find out about these & other volunteer opportunities, contact Marc > 604.893.2298 or marcs@bcpwa.org
18 living5 MayqJune 2010

Feature Story
When old is new
The intersection of HIV and aging is an emerging
area of concern as people age with HIV
by Glyn Townson (with notes from Sarah Burdeniuk)
One
of the most unforeseen consequences—and
benefits—of improved treatment for HIV/AIDS
is that most of us people living with HIV will wind up in our
golden years and consider retirement, something that wasn’t
previously on our collective radar. It’s something most of us
aren’t prepared for, and the time for effective decision-making
is running out.
The HIV/AIDS movement has focused the majority of its
energies over the past 20 years on access to treatment, and
while those battles have been fairly successful in the developed
world, the battle is far from over. It’s no wonder, then, that our
attention has been focused on the more immediate issue of living
another day. The concept of living well with HIV into our
retirement years hasn’t attracted too much attention.
20 living5 MayqJune 2010

Feature Story
However, if we want to live out lives that are self-determined,
we must start to address a number of issues, ask
the right questions, and do the research required to
inf luence policy and services available in the not-sodistant
future. Some of the questions about access to care
that will directly affect us have been asked by many of the
national seniors’ organizations, but not in the context of
growing old with the complications of HIV.
Aging demographics—for Canadians and
for PWAs
The overall percentage of seniors age 65 and older in
Canada is projected to nearly double—from 13.2 percent
in 2005 to 24.5 percent by 2036. In addition, a growing
number of older adults are also being newly diagnosed
with HIV. The Public Health Agency of Canada reported
that by 2006, 14 percent of all reported positive HIV tests
were in individuals 50 or older, up from eight percent
between 1986 and 1998. The intersection of HIV and
aging is an emerging area of concern as individuals age
with HIV and experience more complex medical and
psychosocial problems.
Last month, the Parliamentary Budget Officer released
a major report giving the first look into Canada’s demographics
75 years into the future. With fewer people
working and paying taxes, coupled with a declining birth
rate, the report warned that the federal debt will continue
to increase if the government fails to reduce spending or
raise taxes.
By 2015, the majority of PWAs in Canada will be over
the age of 50, and this population has two distinct subgroups:
those who have been living with HIV/AIDS for
many years, and those newly diagnosed with HIV in their
later years. Each has its own set of unique issues.
MayqJune 2010 living5 21
New emerging issues around being older
with HIV
For those who have been living with HIV—and living with
the various generations of medications to treat the
disease, side effects from those medications, and the
effects of living with HIV itself—there appears to be a
trend of accelerated aging, even with successful viral
suppression. PWAs are increasingly experiencing medical
conditions more commonly associated with their parents
or grandparents, rather than their uninfected peers:
cardiovascular, renal, and liver diseases; cancer; osteoporosis;
arthritis; diabetes; hypertension; and various neurocognitiverelated
symptoms, ranging from memory loss to HIVassociated
dementia and cognitive motor disorders.
As for the second group, those who are over 50 and
are becoming newly infected with HIV—given that we
live in a society that hasn’t come to grips with ageism,
sex phobia, or death—it isn’t surprising that we haven’t
focused on developing prevention programming for
older adults. Although we may not like the idea that
our parents and even our grandparents are still sexually
active, the statistics show a different picture. Seniors
are still sexually active. Many retirees are dealing with
the loss of long-term partners and f ind themselves single
in a new world, with very little appropriate sexual
health information.
“The HIV community does
not care about aging and
the aging community does
not care about HIV.” –
authors Jim Truax and
Dr. Gordon Arbess
A 2009 bulletin by the World Health Organization
cautions: “HIV prevalence and incidence in the over-50-
year-olds seem surprisingly high and the risk factors are
totally unexplored.” Researchers point to a variety of
risks that increase the vulnerability of this group: the
advent of erectile dysfunction drugs in the late 1990s,
which has extended sex lives; the assumption on the part
of some older adults and healthcare providers that this
demographic isn’t at risk, which can lead to a lack of
screening or failed diagnoses; the discomfort of some
older adults and their healthcare providers to openly
discuss safer sex; and a lack of, or ineffective, targeted
prevention messaging.
PWAs not on the national aging radar
In an article entitled “The health of people living with
HIV” by Jim Truax and Dr. Gordon Arbess of St.
Michael’s Hospital in Toronto, the authors make a rather
alarming statement: “The HIV community does not care
about aging, and the aging community does not care
about HIV.” The article goes on to shed light on the lack
of prevention messaging to older adults in our community
continued on next page

Feature Story
and notes that future messages must be culturally and age
appropriate. The reality is that PWAs aren’t on the
national aging radar, and the time to change that is now.
By 2015, the majority of
PWAs in Canada will be
over the age of 50.
Some preliminary work has been done. In October 2009,
the Canadian Working Group on HIV and Rehabilitation
(CWGHR) received funding to prepare a background paper
on HIV and aging. The paper framed the dialogue at their
2010 Partners in Aging National Forum, held in early March
as a satellite meeting at the 6th Canadian HIV/AIDS Skills
Building Symposium in Montreal. The symposium brought
together Canada’s leaders in the HIV/AIDS and gerontology
communities for the first time to discuss emerging trends
and priorities, exchange information and experiences,
consider best practices, and pave a strategic and collaborative
way forward.
The Partners in Aging forum included community
representatives from geriatrics and HIV, doctors, service
providers, and representatives from the research community.
Senator Sharon Carstairs, chair of the Special Senate
Committee on Aging and a member of the forum’s national
advisory committee, gave a keynote address. Senator
Carstairs has been a tireless champion for end-of-life
palliative care and seniors issues. While the forum raised a
lot more questions than answers, it did play an important
role in getting this issue into the forefront and getting it
into the overall national discussions.
Taking charge of the issues
One of the important issues raised by the forum was very
clear: if we don’t start to address the issues faced by those
aging with HIV now, the issues will be addressed for us,
since we’re only a small subpopulation in a much larger
pool of aging Canadians. Having to hide our HIV status
in long-term care facilities, or receiving inadequate care
without medications and income security is already a
reality, and it will worsen if not addressed.
The HIV/AIDS community can have a huge impact on
the direction of our future care if we’re at the table. From
our activist roots and track record of demanding patient
and citizen voice in all aspects of our care for over two
decades, we have a lot to offer to our partner groups.
We must start now to build bridges with existing organizations
that are dealing with seniors and aging issues and
get HIV on the table. These will include prevention
issues for the aged, as well as ensuring care facilities are
stigma- and discrimination-free, if and when PWAs need
to go into care facilities. Also, more research is needed to
ensure we remain healthy as we live with HIV and other
co-morbidities.
CWGHR is well positioned with the Episodic Disabilities
Network to build on its existing relationships among
the various national partners and bring other groups of
interest together at the table; this will be key to moving
HIV issues on the larger aging platform. In addition to
its involvement in various research projects on HIV and
rehabilitation issues, CWGHR is also focusing on the
issue of aging.
All levels of government, private industry, the health
community, community leaders, and special interest
groups must work together effectively if we want to have
the necessary services and supports in the future. Affecting
change in public policy and service provisions takes years,
and within the next 15 to 20 years many of our membership
at BCPWA will be retired or very close to it. 5
Future updates and videotapes of previous
sessions are online
CWGHR will be holding a second forum on aging and HIV in
Toronto before its annual general meeting in June 2010.
Information on the upcoming forum is available at the Canadian
Working Group on HIV and Rehabilitation website at
www.backtolife.ca. As well, links to the videos of the speaker
panels and discussion of the Partners in Aging Forum held in
March are available at the website.
Glyn Townson is the chair of BCPWA.
Sarah Burdeniuk is the communications
coordinator at the Canadian Working Group
on HIV and Rehabilitation.
22 living5 MayqJune 2010

Treatment Research
GS
Phase II results for the new GS 9350 booster hold promise
for a four-in-one pill by Nicole Lewis
9350 may look like just a bunch of letters
and numbers, but it could be the next big drug
released to help treat HIV. Gilead Sciences, a US-based
pharmaceutical company, is currently working on an
experimental drug known as GS 9350 (generic name
cobicistat), which boosts the effectiveness of other
HIV drugs. The drug just completed Phase II of
clinical trials and it’s being tested with Gilead’s existing
antiretrovirals with hopes that a four-in-one—or quad—
pill can be developed.
This new product would be used in place of the
current drug, ritonavir (Norvir), manufactured by Abbott
Laboratories. Ritonavir is a protease inhibitor—it
prevents HIV-infected cells from producing new HIV,
therefore limiting the number of doses a person needs to
take of their existing medications. However, ritonavir
can be quite pricey and has side effects such as weight
gain and gastrointestinal problems; it may also cause
drug-resistant HIV, as it always provides anti-HIV activity,
even at a very low dose. These concerns about ritonavir
have driven the development of replacement drugs from
other companies such as Gilead.
The primary function of GS 9350 is to boost the
blood levels of other anti-HIV drugs. For example, the
experimental integrase inhibitor elvitegravir, when taken
with GS 9350, is more effective in blocking the enzymes
that normally allow HIV to integrate into the DNA of an
infected cell.
In 2009, a Phase I study showed promising results
when comparing ritonavir to GS 9350. GS 9350 acted in
a similar way to ritonavir at both 100 mg and 200 mg
doses. Study participants experienced few side effects
from either the daily or twice a day doses.
The Phase I trial also tested how well GS 9350 worked
when combined with the three other medications that
Gilead is hoping to combine into the quad pill: elvitegravir;
emtricitabine (Emtriva), which helps to lower the overall
viral load; and tenofovir (Truvada), which blocks
enzymes that are crucial to viral production. The 150 mg
tablet of GS 9350 boosted levels of elvitegravir in the
MayqJune 2010 living5 23
blood and maintained regular levels of the other two
drugs. Participants experienced few side effects from the
f ixed-dose tablets, with only one case of moderate
increases in liver enzymes.
In recently released data from the Phase II trials,
efavirenz/emtricitabine/tenofovir (Atripla) was compared
to GS 9350. GS 9350 was also studied on its own to get
a better idea of how it will work compared to ritonavir.
The main difference between efavirenz/emtricitabine/
tenofovir and the proposed new quad pill is that the
quad pill would include elvitegravir in the place of
efavirenz (Sustiva). Efavirenz is known to cause central
nervous system side effects such as dizziness. In the
Phase II trial, only 35 percent of participants taking
the GS 9350-boosted combination experienced adverse
events compared to 57 percent of participants taking
efavirenz/emtricitabine/tenofovir. Only 10 percent of
participants taking the quad pill experienced CNS
side effects.
The Phase II results also demonstrated that GS 9350
doesn’t impact the kidneys, which can be a problem with
drugs like GS 9350. Any changes in serum creatinine
levels—which would indicate kidney problems—aren’t
related to the f iltration problems caused by the drug but
to tubular secretion instead.
These strong results hopefully mean that GS 9350 will
progress quickly through Phase III clinical trials, where
any lingering questions around its effect on kidney
function can be answered.
Fingers crossed that GS 9350 is eventually approved,
which would pave the way for a new cost-saving and less
labour-intensive quad pill. Pill burdens for PWAs could
become a thing of the past. 5
Nicole Lewis is a recent graduate of the
University of Victoria Writing Department
and a volunteer with BCPWA’s Treatment
Information Program.

Antiretrovirals
Whatever happened to
what-was-that-avir?
Not all AIDS drugs have stayed with us over the years.
We take a look back at the ones that didn’t go the distance
by Derek Thaczuk
Since AZT (zidovudine, Retrovir) was first approved for
treating HIV, over 20 other antiretrovirals have joined it
in the marketplace. Some are widely used, others less so.
Some have disappeared from use entirely, while some have only
vanished from the formularies of wealthy nations to become
mainstays for the world’s poorest countries. Here’s a concise
retrospective of those “whatever happened to?” drugs.
ddC
The drug ddC or zalcitabine (Hivid) was the third antiretroviral
to be released. This nucleoside reverse transcriptase inhibitor
(NRTI), or nuke, received approval after AZT and ddI (Videx),
hitting pharmacy shelves in 1992. In those early days, singledrug
treatment, or monotherapy, was unfortunately the
standard, so—like AZT and ddI before it—ddC accomplished
little more than generating drug resistance.
Failure as monotherapy, though, was not the reason ddC
bit the dust. AZT and ddI were equally futile when used solo,
but are still in regular use as part of highly active antiretroviral
therapy (HAART) combinations. Rather, ddC was simply
too toxic. Peripheral neuropathy, a painful and sometimes
permanent form of nerve damage that can occur with any of
the “d drugs” (ddC, ddI, and d4T), was most common with
ddC. Mouth ulcers and a potentially fatal inflammation of the
pancreas called pancreatitis were also common. All told, about
one in three people who took ddC were likely to develop one
of these conditions.
Furthermore, ddC proved to be one of the less powerful
nukes, even when used in combination with other drugs.
While Hivid’s approval was never withdrawn, it was abandoned
wholesale as other, more tolerable and more effective alternatives
became available. Hivid was discontinued in Canada and the
US in 2006.
Saquinavir
Saquinavir (Invirase) arrived in 1995—the first in the new
drug class of protease inhibitors (PIs). Saquinavir-based
combinations were the first real success stories for HIV
therapy. Using three drugs from two different classes led to
drastically better success rates than single- or dual-drug
therapy—though still poor by today’s standards. Even though
PIs as a class were more powerful than nukes, saquinavir
turned out to be the weakest of the class. This was mainly
because very little of the drug actually made it into the cells
where it was needed.
The drug’s manufacturer, Hoffmann-LaRoche, found that a
slightly different form of the saquinavir molecule was absorbed
much more easily. In 1997, this modified saquinavir was introduced
as Fortovase, which delivered about eight times more
active drug than Invirase. Fortovase was intended to simply
replace Invirase, with the latter eventually being phased out.
In actuality, the transition was much messier, and in the end
didn’t happen at all. Having two versions of the same drug was
confusing to many people, and the digestive side effects of
Fortovase were actually worse than Invirase.
The waters really became muddied, though, with the release
of a second PI, ritonavir (Norvir). At its original full-strength
dose, ritonavir proved to be unbearably toxic and was rapidly
abandoned as alternatives became available. However, much
lower doses of ritonavir proved useful in another way: they
greatly boosted the bloodstream levels of many other drugs.
Prescribing PIs with a small booster dose of ritonavir became
standard practice.
You might expect that ritonavir-boosted Fortovase would
perform better than boosted Invirase. Unexpectedly, the opposite
proved true: boosted Invirase provided better drug levels, with
fewer gut side effects to boot. Boosted Fortovase never did
become a recommended treatment option. Unboosted
Fortovase remained on the books as a viable treatment option,
but nobody seemed quite sure what to do with it. Most doctors
and PWAs gravitated to boosted Invirase (or perhaps gave up
trying to follow the plot altogether, and moved on to other
PIs). Demand for Fortovase evaporated, and Hoffmann
LaRoche discontinued it in 2006. The company continues to
produce Invirase for use in combination with ritonavir.
Adefovir
Adefovir has the dubious distinction of being the first
antiretroviral to be denied approval in the US. Gilead Sciences
requested that the US Food and Drug Administration (FDA)
24 living5 MayqJune 2010

approve adefovir as an HIV treatment under the brand name
Preveon. Clinical trials showed that adefovir had good antiviral
activity at both of the two doses studied—60 and 120 mg per
day. However, the trials also showed that kidney toxicity was a
serious problem. At least one-third of people receiving the
higher dose of adefovir had developed some degree of kidney
dysfunction after a year. At the lower dose, which was just as
effective against the virus, kidney problems were about half
as common.
Initially, the FDA had fast-tracked Gilead’s application, a
reflection of the pressing need for more new antiretroviral
drugs. However, due to concerns about the severity and
frequency of kidney toxicity, the expert review panel recommended
not approving adefovir. Subsequently, in 1999 the
FDA refused to approve adefovir as a treatment for HIV.
Adefovir went on to be resurrected under a different name,
at a lower dose, for the treatment of hepatitis B, with much less
kidney toxicity than the doses tested for HIV.
There are antiretrovirals in
the marketplace that are
effective against HIV, but
other shortcomings have
all but made them history—
at least in countries like
ours that are affluent
enough to pick
and choose.
Forgotten but not gone
Several other drugs are still formally available for use, but have
dropped into obscurity nonetheless. When indinavir (Crixivan)
was approved in 1996, it was the most powerful antiretroviral
released up to that point, and quickly became the standard of
care in combination with dual nucleosides. But it had to be
taken on an empty stomach, three times a day, on a strict
every-eight-hour schedule—spawning a wave of programmable
beepers. Also, due to a high risk of kidney stones, people were
advised to drink vast amounts of water every day. Crixivan is
still on the pharmacy shelves, but isn’t recommended as part of
a first combination, and is rarely used even in more treatmentexperienced
people.
Delavirdine (Rescriptor) is a non-nucleoside reverse
transcriptase inhibitor (NNRTI) that was approved in 1997.
Like indinavir, delavirdine required a three-times-daily dosing
schedule. Delavirdine also appeared to be less effective than
the other, twice-daily NNRTIs nevirapine (Viramune) and
efavirenz (Sustiva). It was never widely used as a treatment
MayqJune 2010 living5 25
option, and is currently not recommended as a first-line
treatment. (Since delavirdine inhibits the same liver enzymes
as ritonavir, it could potentially be used to boost levels of
other antiretrovirals. However, the dosing would still be
inconvenient, so it’s unlikely that delavirdine will find a
practical use as a boosting agent.)
Stavudine (d4T, Zerit) was one of the earlier NRTIs,
approved in 1994. It was widely used as an alternative to
AZT, especially in people who had already received AZT
monotherapy or who couldn’t handle AZT-related toxicities
like anemia. Like the other “d drugs,” d4T led to peripheral
neuropathy in some users, which could range from noticeable
to crippling. The real knockout blow to stavudine was
lipoatrophy—the loss of fat in the limbs and, especially, in
the face. It took researchers some time to pinpoint stavudine
as a consistent cause of lipoatrophy. Once it became clear
that it was a major culprit, PWAs and their doctors abandoned
it wholesale for alternate nukes. Unfortunately, by this time
huge numbers of PWAs were stuck with the gaunt, wasted
look—difficult to reverse except through plastic surgery using
injectable fillers.
Not good enough—for whom?
Clearly, there are antiretrovirals in the marketplace that are
effective against HIV, but other shortcomings have all but
made them history—at least in countries like ours that are
affluent enough to pick and choose. Unfortunately, the bulk
of the HIV-affected world doesn’t have that luxury of choice.
Full-price, North-American style HAART costs upwards of
$10,000 a year. Cheaply priced generic versions of the same
drugs have brought the annual cost of HAART down to a
few hundred dollars or less, making treatment available to
millions of PWAs who would never have seen it otherwise.
However, poor nations’ options are limited to drugs that
are available as generics. The most widely used combination
in developing countries is a single-pill co-formulation of
stavudine, lamivudine (3TC, Epivir), and nevirapine.
This low-cost HAART option has brought improvements
that can only be described as miraculous to people who otherwise
had little hope. At the same time, the PWAs of poor
nations are now wearing the gaunt faces of lipoatrophy that we
in developed countries can afford to avoid. Drug companies,
patent holders, and treatment program funders need to decide,
as a matter of policy, that what’s good enough for one is good
enough for all. 5
Derek Thaczuk has worked in information and
support services within the HIV community
for over a decade and is now a freelance writer.

Please phone 604.893.2239
or email elginl@bcpwa.org
to set up an appointment

Nutrition
Comfort food
Some tips to use food and
nutrition to support you
when quitting smoking
by Cheryl Collier
Quitting smoking is tough. Eating can be a source of
support when you quit, but it can also be a source of
stress if, for example, you gain weight. Many people do
gain weight when they quit, usually five to six pounds, but not
everyone does. Some studies indicate that quitting decreases
your metabolism—your body’s ability to burn energy—back to
normal levels. And many people do eat more. It’s not surprising
though; food smells and tastes better when you quit.
Some people believe that if smoking helps keep the weight
off, then it’s like a health benefit. However, being lean isn’t
necessarily equivalent to being healthy. In fact, there’s increasing
evidence that smoking can affect fat build-up in your belly,
right where you don’t want it.
Quitting smoking is one of the best changes you can make
for your health. The trick is to know how to use food and
nutrition to your advantage when you quit.
Switch up your routine
Smoking may have been part of your regular routine, so shaking
things up can help keep triggers in check. For example, if you
usually had a morning cigarette with your coffee on the go, try
having breakfast at home and choose a different beverage. Avoid
the temptation of an after-dinner cigarette by planning a
distraction—those dishes need to be washed anyway. Or
perhaps an evening walk with a friend might do the trick.
Ease off caffeine
Caffeine may be a trigger for a cigarette. Even if it isn’t, it can
make life more difficult when you’re trying to quit smoking.
Too much caffeine can cause irritability and poor sleep, and if
you’re quitting smoking you’re probably already dealing with
these side effects. Consider slowly reducing the amount of coffee
you drink. Drinking more water can also be a distraction, and
it helps to flush out your system.
Stay regular
You may be tempted to eat more to work through nicotine cravings.
When you give your body energy through the day with regular
meals, you can be better aware of how much food your body
really needs, and it’s easier to stop when you get to that point.
Get to know your stomach again
Your stomach sends out signals to the brain, and these
messages are understood as feelings of hunger or fullness. We
know that smoking can suppress appetite, so when you quit,
Quitting smoking is one of the
best changes you can make for
your health. The trick is to know
how to use food and nutrition to
your advantage when you quit.
you may need to retrain your body to hear hunger and fullness
cues. Try slowing down when you eat. It’s hard to hear the signals
your body sends when you eat quickly. Sipping on water between
bites or putting your cutlery down while chewing can help.
Take the time to enjoy all the flavours in your meal. When you
finish your snack or meal, wait it out. If it seems like the portion
you ate should be enough, wait 30 minutes and then see if
you’re still hungry.
Bring healthy snacks for reinforcement
If you’re at work or out for the day, arm yourself with snacks
that help ease the need to have something in your hand. Pack
some fresh fruit, raw veggies, unbuttered popcorn, or a handful
of trail-mix. Sugar-free gum or candies can help keep your
mouth busy, too.
Embrace activity
Getting outside and moving burns calories, which will help to
keep off the extra weight. Activity can also be calming or
exhilarating. For many people, activity provides a lasting relief
from stress, which can take the place of cigarettes, especially
during the first few difficult weeks.
Most importantly, don’t forget to take it one day at a time. 5
Cheryl Collier is a registered dietitian at the Oak Tree Clinic at
BC Women’s Hospital and Health Care Centre. She previously
worked in the HIV program at St Paul’s Hospital in Vancouver.
She is a member of Vancouver Dietitians in AIDS Care.
MayqJune 2010 living5 27

Nutrition
Nutrition and HIV,
revisited
Looking back at the role of nutrition in HIV treatment over the years
by Diana Johansen
Deciding to retire after 17 years of work in the HIV
field has made me think about how nutrition has
evolved over the past 25 years. Not only has our
overall understanding of nutrition and health grown dramatically,
but the specific nutrition issues facing people
living with HIV have also morphed and changed as HIV
has become more of a chronic illness.
Nutrition has always been an HIV issue. Before scientists
identified the human immunodeficiency virus, when infected
individuals were dying of wasting and malnutrition, some
researchers were looking for a nutritional disease. At that
time, vitamin and mineral (or micronutrient) deficiencies
were prevalent, especially zinc. People with HIV died of
opportunistic infections, and it was the loss of body cell mass
due to profound wasting that ultimately led to people’s death.
Without antiretroviral treatment, the only way to stay
healthy and prolong life was nutritional therapy. The
main focus of nutrition at that time was to get in enough
calories and protein to prevent wasting, and to supplement
with micronutrients to prevent deficiencies.
Key learnings pre-HAART
The era before highly active antiretroviral therapy (HAART)
was a period of vigorous nutrition research, and many
important findings helped guide nutrition education and
intervention at that time—and still guide it today. Every
major HIV conference had significant nutrition-related
content. In 1995 there was the first of four international
HIV nutrition conferences.
At the time, we learned that the timing of death is
related to body cell mass and survival is contingent on
maintaining a body cell mass greater than 54 percent of
the body. Body cell mass is the metabolically active tissue
that does most of the work of keeping us alive. It
includes muscle, organs, and other active cells types.
It was also discovered that the body composition of PWAs
changed over time. Body cell mass progressively declined
even in those people who maintained the same weight.
When weight loss did occur, body cell mass was preferentially
lost over fat. These findings led to greater understanding
about how chronic inflammation with abnormal cytokine
activity affects the wasting process. Bioelectrical impedance
analysis (BIA) became a common clinical procedure used by
HIV dietitians to monitor body composition. A lot of BIA
research was published at the time.
Another key learning was that gut infection by HIV was
considered a factor in wasting because of malabsorption. Also,
futile cycling of nutrients contributed to wasting because
the body did not use calories, protein, and fats properly.
During this period, there was a lot of research on
calorie and protein requirements. Earlier in the epidemic
it was thought that PWAs had extraordinarily high calorie
requirements. The educational materials of the day suggested
consuming 3,000 or more calories a day; many people
were living on whipped cream, ice cream, and other fatty
foods to increase calories.
Studies showed that there was a 10 percent increase in
calorie requirements for people with asymptomatic HIV (that
is, people with HIV but no symptoms) and 20 – 30 percent
increase for people with AIDS and/or opportunistic infections.
However, this didn’t necessarily translate into a real increase
because PWAs tended to decrease physical activity, which
also has a significant impact on calorie requirements. The
conclusion from all this was that there is an increase in
requirements; with the amount depending on the individual.
The studies on protein requirements concurred that
PWAs needed higher protein to preserve body cell mass and
provide substrate for an overstimulated immune system.
The educational material of the day recommended protein
intakes of about one gram per pound of body weight, but
this was probably too high as the body can really only
efficiently use about 0.5 – 0.75 grams per pound. Whey protein
became a popular supplement to boost protein intake.
Micronutrient deficiencies were common even among
people who ate well. Deficiencies were associated with
faster disease progression and increased risk of mortality.
Initially this phenomenon was felt to be from malabsorption,
but in the late 1990s the concept of increased turnover
due to chronic inflammation became more popular. During
this period, we learned a lot about oxidative stress and
28 living5 MayqJune 2010

the role of antioxidants in preserving health and immune
function. Depletion of glutathione was thought to be a
driving force in increasing oxidative stress. Studies showed
that high doses of N-acetyl cysteine increased intracellular
glutathione, and thus it became a popular supplement.
PWAs used numerous supplements.
During this era, a big part of nutrition intervention
was symptom and side effect management, including loss
of appetite, thrush, esophageal candidiasis, diarrhea,
nausea, and weight loss.
PWAs were awarded Schedule C benefits. An expert
work group led by BCPWA worked with government to
create the Monthly Nutritional Supplement Benefit.
The era before HAART
was a period of vigorous
nutrition research, and
many important findings
helped guide nutrition
education and intervention
at that time—and still
guide it today.
The advent of HAART
The 1996 World AIDS conference in Vancouver was a
turning point with the release of protease inhibitors and
the initiation of triple therapy.
Early experience with HAART saw huge pill burdens.
People had to take many pills three times a day, which
led to numerous nutrition issues. For example, with the
early indinavir (Crixivan) regimens, people lost weight
due to the complex medication regimens with three
periods a day of restricted food intake, especially those
on both didanosine (ddI, Videx), and indinavir. Dietitians
developed food lists of low protein low-fat foods that
could be eaten with indinavir. Severe nausea was common,
as were kidney stones if people didn’t drink enough liquids.
Ritonavir (Norvir) liquid tasted so bad that food lists
were developed to mask the taste. Saquinavir (Fortovase)
had a huge pill burden and needed fatty foods to
enhance absorption. Nelfinavir (Viracept) caused diarrhea,
which required dietary modifications. The nutrition
interventions generally focused on managing side effects
and appropriate food/medication routines.
The HAART era
Once people began HAART, they started to show signs
of altered body fat distribution, which came to be known
as lipodystrophy. “Crix belly”—from Crixivan—became
the marker for visceral fat accumulation. People also
developed buffalo humps behind the shoulders, and lipomas,
which are benign tumours of fat cells. Women developed
enlarged breasts and fat on the back. PWAs and
clinicians also began to notice lipoatrophy (loss of fat
tissue) especially in the face, arms, legs, and buttocks.
These trends generated a lot of research on body
composition, using more sophisticated technology such as
DEXA, MRA, and CT scans, as well as studies of the
mechanism of these changes. It turned out that lipoatrophy
and lipoaccumulation (a type of lipodystrophy) were two
distinct conditions caused by different drugs and different
mechanisms. Symptoms varied between individuals but the
devastating effects on quality of life and adherence were
captured in numerous studies and testimonials.
Also in the HAART era, metabolic abnormalities—
notably insulin resistance, diabetes, and dyslipidemia—
especially elevated triglycerides and low HDL
cholesterol—became commonplace.
Researchers found that PWAs have decreased bone
density with an increased risk of osteopenia/osteoporosis
and fracture. Bones appear to age prematurely and lose
bone density at an accelerated rate. This is likely due to a
combination of factors related to the virus, HAART,
genetics, and nutrition.
There was a greater prevalence of obesity among PWAs.
Research at the Oak Tree Clinic found that 19 percent of
patients were obese and 40 percent were overweight
compared to 17 percent and 23 percent, respectively, in
the overall BC population. Years ago dietitians wouldn’t
have told people to reduce calories and lose weight, but
now there can be more health risks from excess weight.
Where are we now
The most common nutritional issues today are related to
managing HIV as a chronic illness. Many PWAs enjoy
good quality of life, with great nutrition and active
lifestyles. Dyslipidemia, insulin resistance and diabetes,
osteopenia/osteoporosis, and obesity are prevalent. Many
PWAs have low levels of vitamin D and/or B12. Some
individuals still struggle with poor appetites, unwanted
weight loss, chronic diarrhea and depression, all of which
profoundly affect food intake. People living with HIV
are aging with all that entails. Poverty and food insecurity
remain huge—and often insurmountable—barriers to
good nutrition.
In 25 years, nutrition issues have changed significantly
but they haven’t necessarily gotten any easier. 5
Diana Johansen was the dietitian
at Oak Tree Clinic at BC Women’s
Hospital and Health Centre.
MayqJune 2010 living5 29

Wednesdays • 5:30 PM • Training Room at BCPWA, 1107 Seymour St.
Designed to accommodate working individuals, FitOne
Yoga is a one-hour yoga class which supports the body and
mind in forestalling the negative effect of HIV disease.
FitOne Yoga promotes flexibility, range of movement,
detoxification and improved muscle tone for all fitness levels.
For more information 604.893. 2200 or
email prevention@bcpwa.org
What to bring:
• Towel and water bottle
• Comfortable clothes
• Yoga mat (spare mats are available)

Opportunistic Infections
PML is a rare disease of the central
nervous system that affects
immunocompromised people
by Leslie Leung
was 1971, and John Cunningham felt progressively weak on
Itone side of his body. His eyes had become blurry over the
previous month. He frequently lost balance. He couldn’t think
straight. After a series of investigations, doctors determined he
had a condition called progressive multifocal leukoencephalopathy
(PML). The term sounds fancy, but doctors at that time
actually knew very little about the disease. All they knew was
that people with PML had a weak immune system and that a
virus could be potentially causing the disease. It was from John
Cunningham’s brain that Billie L. Padgett, a researcher from
University of Wisconsin, first isolated the PML-causing virus,
which he thus named the JC virus.
Today, most cases of PML are among people with HIV;
fortunately, it’s very rare.
Ninety percent of the population harbours the JC virus. It
enters our system through inhaling or ingesting contaminated
water during childhood or early adulthood. It then sleeps in
our kidneys, tonsils, and bone marrow. Most of us don’t get
PML because our immune system keeps the JC virus in check.
However, the virus can infect the brain, causing PML in cases
where our immune system is disrupted—for example, certain
types of lymphoma, use of immunosuppressant drugs, and
HIV infection.
In fact, 85 percent of all PML cases are from HIV infection.
However, less than one percent of HIV-infected people actually
acquire the disease. In most cases, PML occurs in a person with
AIDS where immunosuppression is severe from low CD4
counts under 100. Unlike other opportunistic infections, PML
can occur in people with CD4 counts greater than 200.
Since the JC virus infects areas of the brain disrupting the
transfer of nervous signals, PML can lead to sensory and motor
problems. The most common symptom is limb weakness,
which occurs in 52 percent of cases. Thirty to 40 percent of all
cases involve decline in cognitive function, visual field loss, and
difficulty speaking. Headaches, seizures, loss of movement control,
and memory loss can occur, though they’re more rare.
Without proper diagnosis or intervention, people with PML
rapidly deteriorate and die within six months.
Because PML shares symptoms similar to other AIDSdefining
infections of the central nervous system, doctors
need to perform special procedures to diagnose the disease.
There are generally three things doctors might do if you
have any of the symptoms of PML. First, doctors might
take snapshots of your brain using a CT scan or an MRI to
check for any abnormal lesions. Second, doctors might
collect cerebrospinal fluid from your spine to see whether
the JC virus is active in your central nervous system.
Finally, doctors might obtain a sample of your brain tissue
and look under the microscope for the JC virus.
Unfortunately, there’s no known cure or a specific
treatment for PML. Several drugs have been tested, but haven’t
been proven to work. To date, the only therapy that has been
shown to be indirectly beneficial for PML management is
highly active antiretroviral therapy (HAART). HAART should
be initiated or continued in people diagnosed with PML
regardless of their CD4 count; the rationale is that a boost in
the immune system can keep the JC virus in check. In fact,
studies have shown that HAART increases the mean survival
time of PML. 5
Leslie Leung is a University of British Columbia
medical student and a community pharmacist.
He volunteers with BCPWA’s
Treatment Information Program.
MayqJune 2010 living5 31

Let’s
clinical! get
Clinical trials: beyond virology
by Suzanne MacCarthy
Immune-based therapies are on the cutting edge of HIV
clinical research and are advancing treatment strategies to
a new level. Unlike current treatments that try to kill or
suppress the virus while breaking down the immune system,
immunology therapies are designed to boost the immune
response to combat the virus on its own.
Drs. Jean-Pierre Routy and Bertrand Lebouché from the
Royal Victoria Hospital in Montreal, joined by José Sousa,
community representative and CIHR Canadian HIV Trials
Network (CTN) Community Advisory Committee chair, led an
open dialogue at the 6th Canadian HIV/AIDS Skills Building
Symposium in Montreal from March 4 – 7, to discuss this new
direction in HIV research.
PWAs and community representatives heard about developments
in immune-based trials and the corresponding ethical issues in
informed consent. Facilitated by the CTN, this gathering of
science and community was the first of its kind in Canada.
Dr. Routy’s research in immune-based therapies aspires
to give PWAs a break from the complications and costly toll
of highly active antiretroviral therapy (HAART). Dr. Routy
acknowledges the lifesaving benefits of HAART but also
believes that 14 years after its advent, we need to investigate
alternative therapies.
Advancing research in immune-based therapies wouldn’t be
possible without the commitment and support of community
members, says Sousa. For immune-based trials, there are certain ethical
issues surrounding informed consent that must be considered.
“Participation in immunology trials generally excludes
individuals from joining any other clinical trials,” said CTN/Merck
Studies enrolling in BC
CTN 247—
CTN 244—
CTN 240—
Canadian cohort of HIV-positive slow progressors
BC sites: St. Paul’s Hospital, Vancouver; Spectrum
Health Care, Vancouver; Downtown Infectious Diseases
Clinic (DIDC), Vancouver; Cool Aid Community Health
Centre, Victoria
Seek and Treat for Optimal outcomes and prevention
in HIV & AIDS in IDU (STOP HIV & AIDS in IDU)
BC sites: St. Paul’s Hospital, Vancouver
Valacyclovir In Delaying Antiretroviral Treatment Entry
(VALIDATE) trial
BC site: DIDC, Vancouver
CTN 238—
CTN 236—
CTN 194—
32 living5 MayqJune 2010
postdoctoral fellow Dr. Bertrand Lebouché. “Immune-based
therapies may have persistent effects on an individual’s immune
system and would therefore impact how he/she responds to
other treatment studies.”
In order to successfully recruit participants, researchers
must find ethically justifiable ways to help ensure individuals
remain eligible for other clinical trials after participating in an
immune-based study.
CTN 239, which investigated AGS-004, an immunotherapeutic
agent composed of an individual’s white blood cells
and a sample of their pre-HAART HIV, did succeed in
recruiting participants who had been involved in immunebased
trials no more than six months before the beginning
of the study. Results from this study will be presented at
AIDS 2010 in Vienna in July.
At present, the CTN doesn’t have an immune-based
study enrolling participants in BC. However, Dr. Routy is
currently leading an immune-based cohort in Montreal to
analyze the impact of HIV on memory CD4 T-cells during
HIV disease progression and after initiating antiretrovirals.
The study will be extended to BC; researchers hope to
begin enrolment this summer. 5
Suzanne MacCarthy is the communications
and information coordinator at the CIHR
Canadian HIV Trials Network in Vancouver.
The MAINTAIN study
BC sites: DIDC, Vancouver
St. Paul’s Hospital, Vancouver
HPV vaccine in HIV-positive girls and women
BC site: Oak Tree Clinic, Vancouver
Peg-Interferon and citalopram in co-infection (PICCO)
BC sites: St. Paul’s Hospital, Vancouver;
DIDC, Vancouver
To find out more about these and other CTN studies, visit the CIHR Canadian HIV Trials Network database at
www.hivnet.ubc.ca or call 1.800.661.4664.

what’s new in research
Report from CROI 2010
By Dr. Marianne Harris
The
17th Conference on Retrovirus and Opportunistic
Infections was held in February 2010 in San Francisco.
Researchers from the BC Centre for Excellence in HIV/AIDS
presented two important studies.
Dr. Mark Hull and colleagues performed an analysis of
the Canadian Observational Cohort Collaboration (CANOC)
cohort, a cross-Canada collaboration. They analyzed 1,674 HIVpositive
adults who received highly active antiretroviral therapy
(HAART) between January 2000 and December 2008. Study
participants had all achieved two viral loads below 400 copies/mL
in a row, and had six or more viral load results available over
the following two years.
Participants were classified into four groups: full suppressors—
all viral loads during follow-up were below 50 copies/mL;
transient viremia (detectable virus in the blood)—viral loads
below 50 copies/mL for at least 75 percent of the time, and
the remaining viral loads were between 50 and 1000 copies/mL;
short-term persisting viremia—viral loads below 50
copies/mL 25 to 75 percent of the time; and long-term
persisting viremia—viral loads below 50 copies/mL less
than 25 percent of the time.
Viral rebound was defined as having two viral loads in a
row—from two different tests—above 1,000 copies/mL—this is
usually accepted as a sign of treatment failure and indicates the
need to change antiretroviral therapy. The risk of viral rebound
was about the same for people with transient viremia as for the
full suppressors, suggesting that occasional low-level viral load
“blips” don’t predict ultimate treatment failure. On the other
hand, people with short-term persisting viremia were about six
times as likely to experience viral rebound as full suppressors.
Long-term persisting viremia was even worse—people with longterm
persisting viremia were about 20 times more likely to have
viral rebound than the full suppressors.
These results confirm that sustained suppression of the viral
load to below 50 copies/mL, at least 75 percent of the time
remains the ideal goal of successful HAART.
The second presentation showed that PWAs with undetectable
levels of HIV in their blood are less likely to transmit the virus to
others. Dr. Julio Montaner presented data showing an association
between the number of people receiving HAART in BC and the
number of new HIV infections diagnosed in the province.
HAART first became available in BC in 1996, and over the
next three years the number of people in the province newly
diagnosed with HIV decreased by nearly half—from about 700
in 1996 to about 400 in 1999. Over the next several years, the
number of British Columbians receiving HAART remained stable
at about 2,500. Then, between 2004 and 2009, there was
roughly a doubling of the number of people receiving HAART
to about 5,000. A significant drop in the number of new HIV
diagnoses in BC again followed this expansion of HAART coverage,
despite that fact that more people were being tested.
Of note, starting in 2007 there was a targeted effort to encourage
HAART use particularly among injection drug users (IDU) in
Vancouver’s Downtown Eastside. Over the next two years, the
number of new HIV infections in this population fell by about half.
Dr. Montaner acknowledged that there may be many factors
contributing to the decline in new HIV diagnoses in this population
and in BC in general, and that a significant proportion (estimated
to be about 20 – 25 percent) of people who are HIV-positive aren’t
aware of their diagnosis. However, these BC data provide the first
evidence of an association between the number of people receiving
HAART and the rate of new HIV infections within a large population,
even amongst the most vulnerable IDU group.
Details on these and other conference presentations can be
found at the CROI website at www.retroconference.org/2010. 5
Dr. Marianne Harris is a family doctor with the
AIDS Research Program at
St. Paul’s Hospital in Vancouver.
MayqJune 2010 living5 33

New BCPWA AGM
voting procedure
Now all BCPWA members can vote by mail
BCPWA’s Board of Directors will no longer be elected
solely by BCPWA members who can make it to the
Annual General Meeting (AGM) or who get an attending
member to use their proxy vote for them.
Instead, as of this year, you can vote by using a mail-in ballot
form that will be mailed to you in late July—or you can pick up
your ballot up at our office. An independent returning officer
will count the votes and announce the results at the AGM.
These fundamental changes are part of a package of
amendments to BCPWA’s bylaws that were approved at last
year’s AGM. From now on, all special resolutions—including
amendments to the bylaws, motions authorizing BCPWA
to borrow money, and similar major decisions—will be
resolved by BCPWA’s membership using mail-in ballots.
Regular and ordinary motions will still be dealt with at
the AGM.
Because of this change in voting procedures, BCPWA will
no longer use proxy forms for voting.
This year’s AGM will be held on the evening of Thursday,
August 19, 2010.
How the new system will work
All BCPWA members who receive mail from us will receive two mailings this year, one in June and one in July.
The first mailing will include:
3 Information about the AGM, including the date, time,
and place
3 An invitation to submit special resolutions for consideration
by the membership
3 If you want to run for the Board of Directors, there will
be an invitation to submit your personal information and
a statement about why you want to run for the Board.
This information will need to be submitted in a specified
format and be endorsed with the original signature of the
nominee and the signatures of two people who second the
nomination—all of whom must be full members of BCPWA
in good standing
3 A notice stating that the nominee information and the text
of any special resolutions must be received by the returning
officer by July 20, 2010
The second mailing will include:
3 The ballot to vote for the Board of Directors, including the
names of all duly nominated candidates received by the returning
officer
3 Statements and biographical information for all candidates
running for the available Board positions
3 If applicable, the ballot to vote for any special resolutions
submitted (the text and an explanation of the special resolutions
will also be included)
3 A notice stating that all mail-in ballots must be completed
and received by the returning officer no later than August
13, 2010 at 4:00 pm
3 A post-paid return envelope for you to send your completed
ballots
If you don’t currently receive mail from BCPWA, you
can apply in person at the BCPWA office to have your ballots
issued to you at the beginning of August. Remember,
there will be no more voting by proxy.
The minutes of the 2009 AGM and the 2010 annual report
and financial statements will be available by request by mail or
pickup at BCPWA two weeks before the AGM.
The deadline for the returning officer to receive a
request from a Board nominee for a ballot recount is no
later than August 26, 2010—seven days following the
AGM. Ballots can be destroyed by September 2, 2010—14
days after the AGM. 5
MayqJune 2010 living5 35

This year’s conference focused
on our shared commitment to
healthy self-preservation
by Willie Blackmore
Sitting at the registration desk during the first night
of this year’s Positive Gathering, I experienced a few
moments of panic when I wondered: “Did we use
the wrong posters to promote this thing?”
This year’s Positive Gathering, a conference developed
for and by HIV-positive British Columbians, was held on
March 26 – 28, at the Plaza Hotel in Vancouver. It’s an
opportunity for people living with HIV/AIDS from
around the province to share experiences, participate in
workshops, and have fun.
The planning committee had designated the theme of
this year’s event as “Living Longer, Living Well.” However,
on the surface, the crowd before me seemed a much
better embodiment of our 2009 theme, “Strength in
Diversity.” Never before has the Gathering served such a
broad representation of ethnicities, genders, ages, and
sexualities within our province’s HIV-positive community.
My worry was short-lived and, of course, unfounded.
As the weekend progressed, and as attentive, motivated,
and actively engaged audiences consistently filled the
health-centric workshops, our diverse community’s
shared commitment to healthy self-preservation became
abundantly clear to me. Now that the Gathering is closed
and we look forward to next year’s event, I’m left with
an ongoing sense of inspiration from having witnessed
the new networks of support and friendship built
among participants.
Before I pass on the planning committee chair
position to the next elected peer among our dedicated
group, I want to give thanks to all the organizations and
individuals who gave so generously to make Positive
Gathering 2010 such a success. Positive Gathering 2010
was presented by ANKORS, BCPWA, Downtown Eastside
Consumers Board, Living Positive Resource Centre
Okanagan, Pacific AIDS Network, Positive Living
Fraser Valley, Positive Living North, South Fraser AIDS
Services Society, Vancouver Friends for Life Society,
Vancouver Island Persons With AIDS Society, and
YouthCO AIDS Society.
Funding was generously provided by the Public Health
Agency of Canada’s AIDS Community Action Program,
Pacific Region. 5
Willie Blackmore was the chair of the
Positive Gathering 2010 planning committee.
36 living5 MayqJune 2010

Volunteering at BCPWA
Profile of a volunteer:
“Don is technically
gifted and I regularly
call upon him to give
me assistance with
computers, software,
and more. He’s a patient
teacher. We keep discovering
more of his skill
set as he seems to be
able to do anything. He’s
a joy to have around.”
Richard Harrison
Member services coordinator
Don TenDen
Volunteer history
I started volunteering in IT with Marie, then assisted
Suzan setting up a housing kiosk. Now I’m with the
Retreat Team in the Support Department, doing general
administration work.
Started at BCPWA
Just over a year ago.
Why pick BCPWA?
I had become a member a few months prior, and it
seemed like a good fit for me as a way to get familiarized
with the organization.
Rating BCPWA
Excellent, of course.
BCPWA’s strongest point
The support, in all its forms for the membership. There really is
something there for every member of this diverse community.
Favourite memory
Being selected to be part of the Retreat Team.
Future vision at BCPWA
Continuing to expand programs for members to find a place to
socialize and build supportive ties with one another.
Polli & Esther’s Closet
Your peer-run, second time around store!
Bring your membership card
and pay us a visit at
1107 Seymour Street, 2nd Floor
Great selection!
Open Tuesdays, Wednesdays & Thursdays,
11AM to 2PM for your shopping convenience
MayqJune 2010 living5 37

where to find help
If you’re looking for help or information on HIV/AIDS, the following list is a starting point.
A Loving Spoonful
Suite 100 – 1300 Richards St,
Vancouver, BC V6B 3G6
604.682.6325
e clients@alovingspoonful.org
www.alovingspoonful.org
AIDS Society of Kamloops
P.O. Box 1064, 437 Lansdowne St,
Kamloops, BC V2C 6H2
t 250.372.7585 or 1.800.661.7541
e ask@telus.net
AIDS Vancouver
1107 Seymour St, Vancouver BC V6B 5S8
t 604.893.2201 e av@aidsvancouver.org
www.aidsvancouver.bc.ca
AIDS Vancouver Island (Victoria)
1601 Blanshard St, Victoria, BC V8W 2J5
t 250.384.2366 or 1.800.665.2437
e info@avi.org www.avi.org
AIDS Vancouver Island
(Cowichan Valley Mobile Needle Exchange)
t 250.701.3667
AIDS Vancouver Island (Campbell River)
t 250.830.0787 or 1.877.650.8787
AIDS Vancouver Island (Port Hardy)
t 250.949.0432
AIDS Vancouver Island (Nanaimo)
t 250.753.2437
AIDS Vancouver Island (Courtenay)
t 250.338.7400 or 1.877.311.7400
ANKORS (Nelson)
101 Baker St, Nelson, BC V1L 4H1
t 250.505.5506 or 1.800.421.AIDS
f 250.505.5507 e info@ankors.bc.ca
http://kics.bc.ca/~ankors/
ANKORS (Cranbrook)
205 – 14th Ave N Cranbrook,
BC V1C 3W3
250.426.3383 or 1.800.421.AIDS
f 250.426.3221 e gary@ankors.bc.ca
http://kics.bc.ca/~ankors/
Asian Society for the Intervention of AIDS (ASIA)
210 – 119 West Pender St,
Vancouver, BC V6B 1S5
t 604.669.5567 f 604.669.7756
e asia@asia.bc.ca www.asia.bc.ca
BC Persons With AIDS Society
1107 Seymour St, Vancouver BC V6B 5S8
604.893.2200 or 1.800.994.2437
e info@bcpwa.org www.bcpwa.org
Dr Peter Centre
1100 Comox St,
Vancouver, BC V6E 1K5
t 604.608.1874 f 604.608.4259
e info@drpetercentre.ca
www.drpetercentre.ca
Friends For Life Society
1459 Barclay St, Vancouver, BC V6G 1J6
t 604.682.5992 f 604.682.3592
e info@friendsforlife.ca
www.friendsforlife.ca
Healing Our Spirit
3144 Dollarton Highway,
North Vancouver, BC V7H 1B3
t 604.879.8884 or 1 866.745.8884
e info@healingourspirit.org
www.healingourspirit.org
Living Positive Resource Centre
Okanagan
101–266 Lawrence Ave.,
Kelowna, BC V1Y 6L3
t 250.862.2437 or 1.800.616.2437
e info@lprc.ca
www.livingpositive.ca
McLaren Housing Society
200 – 649 Helmcken St,
Vancouver, BC V6B 5R1
t 604.669.4090 f 604.669.4092
e mclarenhousing@telus.net
www.mclarenhousing.com
Okanagan Aboriginal AIDS Society
101 – 266 Lawrence Ave.,
Kelowna, BC V1Y 6L3
t 250.862.2481 or 1.800.616.2437
e info@oaas.ca www.oaas.ca
Pacific AIDS Network
P.O. Box 3102
Vancouver, BC V6B 3X6
t 250.537.4082
e evin@pacificaidsnetwork.org
www.pacificaidsnetwork.org
Positive Living Fraser Valley Society
Unit 1 – 2712 Clearbrook Rd.,
Abbotsford, BC V2T 2Z1
t 604.854.1101 or 604.556.6228
f 604.8541105
e info@positivelivingfraservalley.org
www.positivelivingfraservalley.org
Positive Living North
1–1563 2nd Ave,
Prince George, BC V2L 3B8
t 250.562.1172 f 250.562.3317
e info@positivelivingnorth.ca
www.positivelivingnorth.ca
Positive Living North West
Box 4368 Smithers, BC V0J 2N0
3862 F Broadway, Smithers BC
t 250.877.0042 or 1.886.877.0042
e plnw@bulkley.net
Positive Women’s Network
614 – 1033 Davie St, Vancouver, BC V6E 1M7
t 604.692.3000 or 1.866.692.3001
e pwn@pwn.bc.ca www.pwn.bc.ca
Purpose Society HIV/AIDS program
40 Begbie Street
New Westminster, BC V3M 3L9
t 604.526.2522 f 604.526.6546
Red Road HIV/AIDS Network Society
804 – 100 Park Royal South,
W. Vancouver, BC V7T 1A2
t 604.913.3332 or 1.800.336.9726
e info@red-road.org www.red-road.org
Vancouver Native Health Society
441 East Hastings St, Vancouver, BC V6G 1B4
t 604.254.9949
e vnhs@shaw.ca
Victoria AIDS Resource & Community
Service Society
1284 F Gladstone Ave, Victoria, BC V8T 1G6
t 250.388.6620 f 250.388.7011
e varcs@islandnet.com
www.varcs.org/varcs./varcs.nsf
Victoria Persons With AIDS Society
1139 Yates St., Victoria BC V8V 3N2
t 250.382.7927 f 250.382.3232
e support@vpwas.com www.vpwas.com
Wings Housing Society
12 – 1041 Comox St, Vancouver, BC V6E 1K1
t 604.899.5405 f 604.899.5410
e info@wingshousing.bc.ca
www.wingshousing.bc.ca
YouthCO AIDS Society
205 – 1104 Hornby St. ,
Vancouver BC V6Z 1V8
t 604.688.1441 1.877.968.8426
e information@youthco.org
www.youthco.org
For more comprehensive listings
of HIV/AIDS organizations and
services please visit BCPWA’s
website at www.bcpwa.org and
click on “Links and Services”
under the “Empower Yourself”
drop-down menu.
38 living5 MayqJune 2010

If you are a member of the BC Persons
With AIDS Society, you can get involved
and help make crucial decisions by joining
a committee. To become a voting member
on a committee, please attend three
consecutive meetings. For more information
on meeting dates and times, please
see the contact information on the right
column for the respective committee that
you are interested in.
Board & Volunteer Development
Contact: Marc Seguin
t 604.893.2298 e marcs@bcpwa.org
Community Representation &
Engagement
Contact: Paul Kerston
t 604.646.5309 e paulk@bcpwa.org
Education & Communications
Contact: Adam Reibin
t 604.893.2209 e adamr@bcpwa.org
IT Committee
Contact: Ruth Marzetti
t 604.646.5328 e ruthm@bcpwa.org
Living Positive Magazine
Contact: Jeff Rotin
t 604.893.2206 e jeffr@bcpwa.org
Yes! I want to receive living5 magazine
Name_________________________________________________________
Address ____________________________ City _____________________
Province/State _____ Country________________ Postal/Zip Code________
Phone ___________________ E-mail _______________________________
Upcoming BCPWA Society Board Meetings:
Date Time Location Reports to be presented
June 2, 2010 1:00 Board Room Standing Committees/Director of APT
June 16, 2010 1:00 Board Room Written Executive Director Report / Director of HR
Complete Board Evaluation Chart
June 30, 2010 1:00 Board Room Executive Committee
Financial Statements—April / Audited Financials
July 14, 2010 1:00 Board Room Written Executive Director Report / Standing Committees
Director of Communications
July 28, 2010 1:00 Board Room Financial Statements—May/Quarterly Department Reports / 1st Quarter
Director of IT
BCPWA Society is located at 1107 Seymour St., 2nd Floor, Vancouver.
For more information, contact: Alexandra Regier, director of operations Direct: 604.893.2292 Email: alexr@bcpwa.org
BCPWA Standing Committees and Subcommittees
Positive Gathering Committee
Contact: Stephen Macdonald
t 604.893.2290 e stephenm@bcpwa.org
Health Promotion
Contact: Elgin Lim
t 604.893.2225 e elginl@bcpwa.org
Support Services
Contact: Jackie Haywood
t 604.893.2259 e jackieh@bcpwa.org
Advocacy & Prison Outreach
Contact: Adriaan de Vries
t 604.893.2284 e adriaand@bcpwa.org
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b c p w a .
o r g
1107 Seymour Street
2nd Floor
Vancouver BC
Canada V6B 5S8
For more information visit
www.bcpwa.org
e-mail to living@bcpwa.org
or call 604.893.2206
MayqJune 2010 living5 39

Last Blast
The plane truth
Air travel can be either death-defying or life-confirming—
it just depends on your perspective
by Denise Becker
My father was a geography
teacher and during our
summer vacations in the
1960s he would take groups of
students to Italy. He knew if he
got enough students to go, our
family could all fly free of
charge. So I was lucky
enough to travel to
Italy ten times.
The journey could be pretty hairy.
The planes were propeller driven. Crossing
the Alps was a jolting experience, often
with terrible turbulence. While most of
the passengers were white knuckled, my
brother and I loved every minute—it was
better than any fairground ride. We
would giggle and pretend we were on
a roller coaster.
As I’ve grown older, the rush of air
travel has worn off. I get more and more
nervous each time I fly. And flying between
Kelowna and Vancouver for regular
board meetings, I’m now travelling much
more. I’ve also attended various national
conferences and workshops. And I seem
to be getting into more hair-raising
situations. The statistics of going down
in a plane don’t help. Yes, I know you
have more chance of getting killed crossing
a road and that very few planes have
crashed on Canadian soil, but then I
always wonder if I’ll be on the plane that
finally evens up Canada’s score relative
to the rest of the world.
Once I was flying to an HIV conference
in Toronto, and the pilot told us
we were heading into bad weather. Sometimes
I wonder if pilots say that, turn off
the microphone, and then have a good
laugh at all the passengers rushing back
from the bathroom and hurriedly buckling
up. I started to use my
deep breathing exercises
that I learned to cope with
panic attacks and stress. On this
occasion, it seemed we circled the
airport forever and the snowstorm
outside wasn’t getting any better. Finally,
we descended and landed very close to
the cloud line. I had no idea the cloud
was so low but was very glad to finally
get off the plane.
Then there was the time I was in row
13 and the plane started up and then
stopped. The pilot announced that he
didn’t have enough fuel! On my next
flight, I was heading back to Kelowna
from Vancouver when the turbulence
felt like we were riding up and down on
a big wave. I was petrified. The pilot
announced that there was fog at the
Kelowna airport. He attempted to land
the plane three times and on the third
attempt the pilot said he was headed for
Calgary. I had a fleeting thought of the
previous flight and wondered how much
fuel the plane had left in the tank.
Recently, a number of us were flying
back to Kelowna from BCPWA’s Positive
Gathering. Before we boarded the plane,
I joked with my friends that if our plane
crashed, most of the Okanagan volunteers
would be wiped out. It wasn’t so funny
30 minutes later, when we
were in the midst
of some of the
worst turbulence I’ve
ever experienced. The girl
next to me looked
very nervous, and
we held hands. The
man across the aisle also
looked frightened and I
reached over to him,
though I wasn’t sure if it was
for his comfort or mine. Then
the plane fell a distance and everyone
cried a nervous “ugh!” When we finally
landed, we were all thankful to the pilot
for getting us home safely.
It wasn’t until I was driving from the
airport that I started to laugh. What an
ironic situation had just occurred: we
were all fearing for our lives, and yet we
were people who had been diagnosed as
terminally ill. It was obvious we still
believed we could live and weren’t going
to die from HIV/AIDS. I recalled my
initial diagnosis in 1994 and how at the
time I wondered if I’d make it another
five years. Suicide was an option—I
stopped wearing my car seatbelt and
hoped for a quick end.
But now? Well, now things are different.
And it made me happy as I drove
home to think I was experiencing hope
and a belief in a longer life. It felt good
to be scared again. 5
Denise Becker is a board
member with BCPWA.
She lives in Kelowna.
40 living5 MayqJune 2010