liv poz mag.qxd - Positive Living BC

Transcription

Issue96_in9_liv poz mag.qxd 2015-05-05 19:59 Page 1
I
N
S
I
D
E
GIRL TALK
Come to terms with depression
5
FIGHTING WORDS
Mental health in the BC correctional system
7
NUTRITION
The role of food in harm reduction
10
SHADES OF GREY
HIV, aging, and mental health
11
NEW FLU VACCINE Q&A
Dr. David Moore answers your questions about flu shots
13
GAY POZ SEX
Taking a holistic approach to sex
14
COVER STORY
Healthy heads: addressing the challenge of living with depression and HIV
15
HCV & DEPRESSION
A personal take
18
PHYSICIAN’S PROFILE
The doctor will see you now
21
LET’S GET CLINICAL
Updates on current clinical trials
23
LAST BLAST
Happy optimism day, Dr. Strangelove
28
HEALTH PROMOTION 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 Positive Living
Society of BC operates a Health Promotion 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 HIVrelated 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 Health Promotion Program endeavours to provide all research and information to members without
P5SITIVE LIVING
1
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 Positive Living Society of BC
do not accept the risk of, or the responsibility for, damages, costs, or consequences of any kind which may arise or result from the use of information d i s s e m i nated 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.
MAY •• JUNE 2015
think 5
opinion &editorial
The Positive Living Society of British Columbia
seeks to empower persons living with HIV
disease and AIDS through mutual support
and collective action. The Society has over
5,600 HIV-positive members.
Positive Living editorial board
Wayne Campbell - chair, Neil Self,
Romari Undi, Ross Harvey,
Elgin Lim, Jason Motz, Adam Reibin
Managing editor Jason Motz
Design / production Britt Permien
Copyediting Katherine Ackley, Robin Schroffel
Proofing Ashra Kolhatkar
Contributing writers
Denise Becker, Wayne Campbell,
Heiko Decosas, Paul Goyan,
Murray Hart, Suzan Kreiger,
Meenakshi Mannoe, David Moore,
Jason Motz, Lynden Neufeld,
Chrystal Palaty, Jonathan Postnikoff,
Marc Seguin, Shelly Tognazzini,
Romari Undi, Rani Wangsawidjaya
Special thanks Brendan Kergin
Photography Britt Permien
Director of communications and education
Adam Reibin
Director of programs and services
Elgin Lim
Treatment, health and wellness coordinator
Shelly Tognazzini
Subscriptions / distribution
Leah Giesbrecht, John Kozachenko
Funding for Positive Living is provided by
the BC Gaming Policy & Enforcement Branch
and by subscription and donations.
Positive Living BC
803 East Hastings
Vancouver BC V6A 1R8
RECEPTION 604.893.2200
WWW.POSITIVELIVINGBC.ORG
EDITOR 604.893.2206
EMAIL [email protected]
© 2015 Positive Living
Permission to reproduce:
All Positive Living articles are copyrighted.
Non-commercial reproduction is welcomed.
For permission to reprint articles, either in
part or in whole, please email
[email protected]
A special issue for
a special cause
By ◆ Wayne Campbell ◆
M
ental health is a daunting
concern for people living with
HIV (PLHIV) in our province.
That is why we gave this issue a cheeky
title. Sometimes, when circumstances are
exceptionally dire, it helps to smile.
“Dire” is a word many PLHIV might
use to describe the availability of mental
health services in BC. While conditions
like anxiety, low self-esteem, and poor
sleep are commonplace amongst PLHIV,
professional support can be hard to find
and is not always easily accessible. The
picture of mental health painted by our
cover story (pages 15-17) is realistic, but
not very pretty. When you read this
article, I advise you to do so through a
lens of hope. Things can get better,
especially if PLHIV are committed to
fighting for their cause. The Society’s
Positive Action Committee is a great
place for us to get started. If you have a
specific matter you think the Society
needs to spearhead (whether or not it is
related to mental health) please contact
[email protected].
When planning this issue, the
editorial board realized that there are
certain themes among our community’s
many concerns. We determined that—
beyond mental health—many of the
story ideas we were discussing could be
categorized under umbrella terms like
“sex and HIV”, “women and HIV”,
“HIV history”, etc. The end result is that
P5SITIVE LIVING
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“Check Your Head” is the first in a
series of themed editions of Positive
Living magazine. Next up is our
“Kinkformation” issue. Readers can look
forward to a lot of sexy reading care of
Positive Living BC during the long, hot
summer nights to come.
Members can also look forward to a
summer filled with fun, free, and informative events, courtesy of the Society and
our community partners. Please visit our
new website (positivelivingbc.org) to
view our up-to-the-minute events calendar
and to design a schedule of activities
tailored to your needs. I’ve already set
aside August 20 in my schedule for
attending the Society’s Annual General
Meeting and the catered community
forum directly afterward (see ad on
page 12 for more information). Your participation at the AGM is essential to
Society operations—this is where board
directors are elected and the Society’s
major business is addressed. Board
directors serve as representatives of
the entire membership. We can only
act on your behalf if you make your
voices heard. 5
Wayne Campbell is Chair
of Positive Living BC.
Pharmacare could save billions
A report released in March by the
Canadian Medical Association Journal
could change the political discussion
about Pharmacare in this country, and
in so doing, make the dream a reality.
The report claims that implementation
of a long debated Canada-wide
prescription drug coverage plan could
save the country billions. An estimated
$7.3 billion could be saved on prescription
drugs. The report estimates that the
private sector could save anywhere
between $6.6 billion and $9.6 billion.
Government costs could increase by as
much as $1 billion, defined in the
report as a $5.4 billion net increase or
$2.9 billion net savings. (Any such
increase would stem from a “small
number of drug classes.”)
The report’s authors contend that
“the long-term barrier to the implementation
of universal Pharmacare owing to its
perceived costs appears to be unjustified,”
adding that a universal plan would be a
positive boon that would “yield substantial
savings to the private sector with comparatively little increase in costs to government.”
The report further argues that “reducing
the need for work-related private drug
insurance plans would also reduce administration costs and eliminate the need for
the tax subsidies currently given to
encourage employers to offer such plans.”
In 2012/13, Canadians spent $22
billion for their prescription drug needs.
This report suggests that under the
umb rella of a universal prescription
plan, expenditures over that same period
could have totalled a more palatable
$15.1 billion.
First recommended (but not promised,
as that is not within the domain of
Commissions) by the 1964 Royal
Commission on Health Services,
Pharmacare has been a political hot
potato for decades, moving in and out
of favour with a tax-weary nation.
Under the current scheme, prescription
drug funding comes from a hodgepodge
of provincial plans, both private and
public. Universal coverage would kibosh
bureaucracy and give all Canadians
access to their prescription medication.
Under the current format, many
Canadians are denied access to their
drugs by economics.
The report dismisses the commonly
held criticism that a universal drug
plan would require a draconian tax
increase. Rather, implementing this
type of blanket coverage would
“achieve access and equity goals while
also achieving considerable economies
of s cale that stem from better pricing
and more cost-conscious product
selection under a single-payer system.”
Source:
http://www.cmaj.ca/content/early/201
5/03/16/cmaj.141564.full.pdf+html
Vatican adopts BC-based
HIV treatment model
In another sign that he is the most
radical pope of the past thirty years,
Pope Francis has tapped a Vancouverbased HIV/AIDS treatment model for
wider use. This March, while in
Geneva, Vatican off icials met with
Dr. Julio Montaner, of the BC Centre
for Excellence in HIV/AIDS
(BCCfE), to discuss how Treatment as
P5SITIVE LIVING
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Prevention (TasP) could be rolled out
to regions where HIV/AIDS
infections are at critical mass—specif ically, a tria l project in Tanzania
involving some 140,000 patients. (As
of this writing, the specif ics of the
plan were still being drafted and are
likely some ways off from being publicly announced.) With 35 million
PLHIV all across the globe, the f ight
against HIV/AIDS requires powerful,
global forces.
With, conservatively, over a billion
members in the Catholic Church,
adoption of TasP by the Pope
would be a monumental movement
towards the United Nations’ 90-90-90
target by 2020 (ED. NOTE: for more
information see issue 17.2,
March/April 2015 for the article, 9090-90: Insights and implications by
Dr. Hasina Samji). Dr. Montaner
emphasizes that the Vatican’s backing
could result in “impor tant implications for the expansion of [TasP]
around the world.”
TasP relies on early aggressive
treatment, administering a cocktail
of three drugs that suppress the virus
to the point that it is undetectable.
Since 1997, there has been a 67 percent
reduction in new HIV diagnoses, an
87 percent drop in AIDS-related
deaths, and, perhaps most heartening,
an overall increase in the longevity
of PLHIV.
Source:
http://www.cfenet.ubc.ca/news/
in-the-news/vatican-adopts-hivaidstreatment-model-developed-bc
continued on next page
Newly approved drugs will
fight hepatitis C
In late March, the BC government
announced the public coverage of two
hepatitis C curative drugs effective immediately. The new drugs are Sovaldi and
Harvoni, first approved for sale by Health
Canada in 2013 and 2014 respectively.
However, it is still up to participating
jurisdictions whether or not to cover these
drugs as part of their public drug plans.
Solvaldi, which treats hepatitis C
genotypes 1, 2, and 3, and Harvoni,
which treats genotype 1, join Galexos
(simeprevir) as the third hepatitis C
agent to meet approval in the past six
months. Unlike some older treatments,
like peginterferon, both Solvaldi and
Harvoni are taken in pill form.
The two new drugs could go a long way
to helping the roughly 80,000 residents of
BC who have hepatitis C. BC Health
Minister Terry Lake expects 1,500 people
will be covered by treatment in the first year.
This is a significant number considering
the number of British Columbians who
received medical treatment for hepatitis C
in 2013-2014 was approximately 1,200.
In a press release, Lake declared that
“these two new drugs can utterly change
the lives of people with hepatitis C for
the better.” He added that both drugs
“represent a significant advance in the
treatment of chronic hepatitis C, and
more British Columbians affected by this
virus now have significantly better odds
of becoming free of the disease.”
Several prominent health officials,
including Daryl Luster, president of the
board of the Pacific Hepatitis C Network,
echoed Lake’s confidence: “This is incredibly
welcome news for people living with hepatitis C in BC and their families,” he said
in the same release. “As a person who was
treated with interferon and ribavirin, I
know how difficult those older therapies
are. The hepatitis C community is excitedly
anticipating the change these new gamechanging medications will bring to thousands of people living with hepatitis C in
British Columbia.”
According to the release, “PharmaCare will cover Sovaldi or Harvoni for
people who meet certain criteria. For
example, people who have never before
been treated for hepatitis C or who have
failed treatment with older drugs may be
eligible for coverage.” As a component of
their coverage, PharmaCare will keep a
close watch on the efficacy of the new
drugs as well as the treatment results.
Source:
http://www2.news. gov.bc.ca/news_
releases_2013-2017/2015HLTH0014000386.htm
Out-of-country health care
In general health news, BC’s Fraser Institute
released a revealing study in March that
shows that rising numbers of Canadians are
leaving the country for medical care and
other treatment options. Neurosurgery and
oncology are the two types of health care
that best illustrate where the exodus is
being recorded. Neurosurgeons reported
the highest proportion of patients (in a
specialty) travelling abroad for treatment at
2.6 percent, while the largest number of
patients (in a specialty) travelled abroad for
internal medicine procedures (6,559).
Although the Fraser report does not
indicate treatment for HIV-related illnesses,
the report is a sobering comment on the
country’s ability to provide affordable,
timely, and quality care and services. In 2014,
according to the report, 52,000 Canadians
P5SITIVE LIVING
4
received non-emergency medical treatment
outside of our borders. The report suggests
prolonged waiting times as a major factor
in the outflow of Canadians. The report
states that “patients could expect to wait
9.8 weeks for medically necessary treatment
after seeing a specialist,” a sharp contrast to
the 6.5 week waiting period physicians
consider to be clinically “reasonable.”
The report’s conclusion is a clear
indictment of the overall health care system:
“Clearly, the number of Canadians who
ultimately receive their medical care in
other countries is not insignificant. That
a considerable number of Canadians
travelled abroad and paid to escape the
well-known failings of the Canadian
health care system speaks volumes about
how well the system is working for them.”
Sources:
http://www.cbc.ca/news/canada/windsor/estimated-52-000-canadianssought-medical-care-outside-canada-fra
ser-institute-says-1.2997726;
http://www.fraserinstitute.org/research
-news/display.aspx?id=22339 5
Mea culpa from the editor
In the March/April issue of Positive
Living magazine, we neglected to
give Pacific AIDS Network (PAN)
their share of credit as being one of
four signatories, not the three w e
reported, on a letter to Minister Rona
Ambrose. [See item Will the Minister
pony up the dough?] We regret this
slight to PAN and offer this correction
to set the record straight.
Girl Talk
Come to terms with depression
By ◆ Denise Becker and Romari Undi ◆
I
often wonder how many women with HIV have suffered
mental illness in silence. Never telling their friends with HIV,
their family, or their doctors—perhaps not even admitting it to
them selves. The stigma of HIV is bad enough without it being
compounded with the stigma associated with mental health.
An HIV diagnosis is an overwhelming and emotional trauma.
So much so, that it may hinder a patient from mentioning any
underlying mental health issue or concern to their doctor or specialist. Yet people living with HIV (PLHIV) are much more vulnerable to other illnesses, especially those dealing with mental
well-being. Given that HIV can cross the blood brain-barrier,
resulting in memory loss, difficulty with concentration, and clear
thinking, mental illness is obviously a secondary diagnosis.
Post-Traumatic Stress Disorder (PTSD) is quite common in
PLHIV. PTSD is the sensation whereby someone feels as though
his or her life is threatened and that there is a real chance of
death. Following the trauma of their diagnosis, the support of
newly diagnosed HIV-positive people can influence whether or
not they develop PTSD. Many PLHIV are afraid that divulging
their diagnosis will leave them even more socially isolated. PTSD
can cause sufferers to re-live the trauma over and over in nightmarish exactness to the original event. (Many of us with HIV
can remember the precise moment we received our diagnosis.)
Nightmares of impending doom or bouts of insomnia can
disrupt concentration. Most depressive illnesses can result in
risky behaviours, like careless medical adherence.
Research has shown that those most at risk of depression
after an HIV diagnosis are those who have not disclosed their
status, who have lost loved ones, or who have experienced
advanced stages of the illness. However, it is difficult to measure
the number of people who suffer depression as a result of HIV
because other underlying factors may be at work. An individual
might misdiagnose depression because the symptoms can
appear to be similar to those of HIV: exhaustion, loss of
appetite, malaise, anger, and sadness. As a result, PLHIV may be
slow to report to their doctors that they are feeling depressed.
Depression is an important consideration for specialists
when deciding on appropriate medication for their patient.
Some medications used by PLHIV cite depression and anxiety
as potential side effects. Psychiatrists should ensure that any
medication they give to a patient does not interfere with the
HIV medication the patient is taking. If a patient is unsure, he
P5SITIVE LIVING
5
or she needs to ask for clarification about the potential drawbacks to any medication.
The March 2001 Yale School of Medicine’s findings on
“Chronic Depression Among Women with HIV,” as printed in
the Journal of the American Medical Association, found that depressed
HIV-positive wome n are twice as likely to die than HIV-positive
women who experienced limited or no depression symptoms.
A study by Johns Hopkins University found that women with
HIV are seven times more likely to be depressed than non-HIVpositive women and are more often affected by depression
compared with men at every stage of the disease. The same study
revealed that nearly one-third of women with HIV reported
suicidal thoughts. And, women with HIV showed a greater risk for
having a majo r depressive disorder (MDD) than men with HIV.
The picture this study paints is grim. Women with HIV,
particularly those vulnerable to depression (family history, domestic
issues, drug/alcohol problems, or financial burdens) should be
asked if they have ever felt depressed or suicidal. Women need to
be aware that the symptoms they are experiencing might be
associated with depression, and should consider self-reporting to
a physician, counselor, or other trusted resource. Diagnosing and
treating depression early is crucial because, for at risk women,
chronic depression needs investigation and close monitoring. 5
Denise Becker (I) is a former board member of Positive Living
BC and an accomplished public
speaker. Romari Undi (r) is
a member of ViVA, a board
member of Positive Living
BC, and a volunteer with
Vancouver Island Persons
Living with HIV/AIDS Society.
What is mental health?
Mental health refers to your emotional, psychological, and
social well-being. Your mental health affects how you think,
feel, and act, and it also determines how you handle stress,
relate to others, and make choices. Some people already have
a mental health issue when they are diagnosed with HIV,
but others develop serious issues only after their diagnosis.
Encountering stigma, hiding your condition, and changes to
their social life are common barriers to sound mental wellness.
Fighting Words
By ◆ Meenakshi Mannoe ◆
Mental health in BC’s
correctional system
“
If
you wish to accept t his call, please stay
on t he l i n e . O t h e r w i s e h a n g u p . Yo u c a n
l e a v e a m e s sage for t his inmate by calling... Please
go ahead wit h your call.” Callers from a provincial
institution hear t he preamble ever y time t hey call
t he Pr ison Outreach P r o g r a m ( P O P ) . A h o t l i n e f o r
i n c a r c e r a te d Po s i t i v e L i v i n g BC members, t his call is
a lifeline. POP suppor ts incarcerated members across
t he province. Last year, we received over 500 calls on
t he POP line. Many of t hese calls revolve around
suppor ting members as t hey deal wit h day-to-day
living in a cor rectional centre.

I am one of many recovering addicts,
struggling time and time again. In my
case, my mental health is related to
where I’ve come from. I had a rough
up-bringing: sexual, alcohol, and drug
abuse all took a toll on my innocent soul.
I’m now faced with the realization that
I cover up my anxiety, depression, and
my fear of being alone or rejected. At
sixteen, I lost my mom to a heroin overdose,
so I covered that up with a needle, the
fastest way the soul will numb. Not to
mention the addictive lifestyle itself.

For t hose incarcerated, accessing basic healt hcare
is a str uggle. Compounding t hings are issues wit h
mental healt h, substance use, HIV, and hepatitis C
to name a fe w. For people living wit h HIV (PLHIV)
who are involved wit h t he cr iminal justice system,
incarceration has been demonstrated to negatively
impact ability to access HIV/AIDS care. The attendant
layers of incarceration represent t he abundance of
P5SITIVE LIVING
people living wit h mental healt h issues who are being
funnelled into t he cr iminal justice system. A recent
ar ticle by Dr. Thomas Ker r and Jade Boyd in t he
jour nal Cr itical Public Health descr ibes “t he blendi n g
o f c r i m i n a l j u s t i c e a n d m e n t a l h e a l t h p o l icy in
Canada.” This blend has become apparent as local
police forces become frontline responders to a “mental
healt h cr isis” (VPD 2013). Many of our members who
are working with POP cycle in and out of corrections,
only tangentially receiving healthcare while in custody
or on t he street.
According to BC Cor rections, which is responsible
for eight provincial institutions, 56 percent of offenders
likely have a substance abuse and/or mental health
disorder: “In addition to their involvement in correctional
sy stems, individuals wit h mental healt h problems
and/or mental illnesses exper ience a compounded
stigma t hat creates barriers in their ability to obtain
ser vices, and also inf luences the types of treatment and
suppor ts received, reintegration into t he community
and t heir general recover y (“Mental Health Strategy
for Cor rections in Canada, 2012”).
7
Using needles and being careless about
myself l contracted HIV. I was doing coke all
the time and at one point I thought I already
had it, which led me to be even more careless.
It was during this time that I actually got the
virus for real. At eighteen, I was flush with
cash after a settlement, but eventually the
money ran out. After that, the theft, B&Es,
and robberies were just to get money so I
could resume an emotionless life. And now,
I’m institutionalized.

continued next page
The members we suppor t in pr ison have a range of
experiences. What many of them share is a personal
histor y that includes trauma. These traumas range from
persecution dur ing war and genocide, childhood
wit hin t he foster care system, sexual abuse, and
incarceration in general. S o m e h a v e h a d a c c e s s to
c o u n s e l l i n g , s u p p o r t , a n d p s y chiatr ic care while in
t he community, while ot hers have led chaotic lives
t hat rarely intersect wit h suppor tive healt hcare and
community-based resources.

I feel that the system does not want
offenders to ever get fully better. We,
as addicts, employ millions–jail guards,
judges, lawyers, cops, probation officers,
welfare workers, pharmacists, and
advocates. They don’t want us to understand that all of our drug and alcohol
suffering comes from conflict within
our minds. I wish we could abandon our
guilt and shame–it’s all normal. Once
we can understand why it is we hurt,
then we can learn to fix it. But anything
that’s easy in life is not serving a
purpose; chances are if it seems
uncomfortable it will be the right way
to go. Nobody ever got sober by doing
what they’ve always done. As an addict,
I always wanted things now. Today
I’m glad I only want one day at a time.
Stressing about tomorrow is silly; we
may not even make it that long, and
so my advice is to only make plans for
today. I’m thankful that I‘ve been
blessed with a gift of seeing into a
person’s soul, whether they are hiding
behind a bottle or a spoon or a pipe.
I‘m still trying to figure my shit out,
and somehow trying to heal people
through my wounds.

Alt hough t here is g rowing recognition of t he
institutionalization of people wit h mental healt h
issues in correctional settings, what are the conditions
of t heir daily lives? For individuals wit h a mental
healt h disorder, t he cur rent model of ten leaves t hem
isolated and fur t her punished by t he lack of robust
programs and ser vices. One member of Positive Living
BC told me t he challenges of getting his psychiatr ic
P5SITIVE LIVING
8
medication while on remand earlier this year—he was
advised by the institutional doctor t hat “paranoia is
par t of being in pr ison.” Responses such as t his discourage individuals from disclosing t heir mental
healt h needs. Our members car r y a burden of shame,
related to t he inter woven exper iences of mental illness and living wit h HIV. Simply doing one ’s bit is
impossible when p r i s o n e r s f e a r re t a l i a t i o n f o r b e i n g
o u te d a s HIV-positive or labelled as “mentally disordered offenders.” Anyt hing t hat deviates from t he
“nor mal inmate” sets people apar t and may have
material consequences on their daily living. Or sur vival.
An awareness of stigma has helped trauma-informed
care gain traction in the helping professions as of late,
but how do we build this philosophy into worki n g w i t h
o f f e n d e r s ? T h e 2 012 p u b l i c a t i o n “ M e n tal H e a l t h
St ra te g y f o r C o r re c t i o n s i n C a n a d a ,” a c o l l e c t i ve
re p o r t t h a t re f l e c t s t h e e x p e r i e n c e s of staff,
stakeholders, and offenders across Canada, contains no
mention of trauma, although it emphasizes the recover y
model. The recover y model is described by the Canadian
Mental Health Association (CMHA) as a personal
process to gain control, f ind meaning, and develop
purpose in one’s life. These values, optimistic and lofty,
are diff icult to weave into correctional settings. B y t h e i r
ve r y n a t u re , c o r re c t i o n a l s e t t i n g s l i m i t i n d i viduals’
autonomy and self-determination.
I asked Tyler, currently on remand, to descr ibe the
obstacles he faces. Like many members who have
become institutionalized, Tyler f inds it dif f icult to
balance his health, and social needs upon release.
Of those lucky enough to walk away from the razor wires
of a correctional facility, many will carr y an internalized
fear of suppor t and a deep distr ust of Justice system
professionals. For outreach workers like myself, repatriating
people into supportive healthcare becomes more challenging
when one considers the minimal amount of suppor t
former pr isoners walk out to.
For so many members who have become institutionalized,
it’s hard to imagine anything different for those like Tyler, who
are forced to live in the moment. 5
M e e n a ks h i M a n n o e is a prison outreach
worker with Positive Living BC.
By ◆ Mick Mancave◆
Food feeds
harm reduction
By ◆ Rani Wangsawidjaya ◆
As
a dietitian, I am resolved to finding the best
and anxiety might occur without a balanced diet. Not
use for food and nutrition education to
having enough carbs can lead to low serotonin levels,
promote the principles of harm reduction. Harm
which can make one irritable, depressed, and can
reduction is a popular topic of discussion with policy
cause sleeping problems. Amino acids, the building
makers across Canada, especially here in British
blocks of protein foods like meats, eggs, fish, or beans,
Columbia, which has been at the forefront of harm
are needed to make dopamine. Low levels of dopamine
reduction since the first needle-exchange pilot project
can also lead to aggressive and irritable behaviour.
was delivered in Vancouver’s Downtown Eastside.
Any dietary def iciencies in iron, vitamin B6 or
Harm reduction is a set of strategies and principles
vitamin B12 can also inspire spells of depression,
that can help reduce harm cau sed by drug use.
fatigue, poor attention, and poor sleep. Having people
Harm reduction came into vogue in 2007 when Drs.
attend a harm reduction program in this state can
Thomas Kerr and Evan Wood of the BC Centre for
make the environment hostile and uncomfortable
Excellence in HIV/AIDS (BCCfE) published a document for all parties involved. By providing food in the
reporting that safe injection sites, needle-exchange
same location as the harm reduction program,
programs, and methadone and heroin therapy are
this environment can feel less threatening and
effective strategies in reducing
more secure for
negative consequences associated
the community.
Providing a space
with injection drug use.
One of the principles of
for drug users to eat
Safe, high quality, and
harm
reduction is active
together encourages
nutritious foods heal and
involvement and decisionsocialization and
nourish the body. Drug use
making from drug users.
empowers them
can negatively affect how
Food can be a positive
to feel a sense
people eat, leading to vitamin
way to engage with the
of belonging.
and mineral deficiencies.
community. Providing
Drug users may replace dietary
a space for drug users to
nutrients with drugs, forget to eat, eat unsafe and
eat together encourages socialization and empowers
poor quality foods, or have poor eating patterns.
them to feel a sense of belonging. This, in turn,
Drugs can affect the body’s ability to absorb or use
can develop a community of peers who, with their
service providers, could determine the best care and
the nutrients consumed. Drug abuse is associated
plan to reduce harm from drug use.
with deficiencies in vitamins and minerals including
Every person has the right to be free from hunger.
thiamine, niacin, vitamins B6 and B12, calcium,
The food that frees peo ple from hunger should be
zinc, iron, and potassium, just to name a few (this
clean, safe, and nutritious. By integrating food and
according to guidelines laid out in Dietitians of
nutrition into a humane and altruistic strategy, we are
Canada, 2012). It is important to resolve these nutrient
respecting the basic human dignity and rights of people
deficiencies to reduce harm caused by a weakened
who use drugs. This is not a new approach, however,
immune system, digestive problems, brittle bones
an increased awareness of how food plays a role in a
and teeth, and muscle loss.
successful harm reduction strategy has nothing short
Nutrition plays a key role in brain chemistry.
of positive implications. 5
Proper nutrition can normalize neurotransmitters,
like serotonin and dopamine, and improve mood.
For example, someone who doesn’t get enough
carbohydrates in their diet, the sort found in grains,
Rani Wangsawidjaya is a
vegetables, and fruits, will find that their brain cannot
Nutrition Services Coordinator at the
function as required. Blood sugar levels become unstable
Dr. Peter AIDS Foundation in Vancouver.
without an intake of carbohydrate. Feelings of frustration
“
P5SITIVE LIVING
10
Mental health for aging survivors
By ◆ Chrystal Palaty ◆
People 50 and over who are living with HIV are more profoundly
affected by the diseases of aging, including cardiovascular disease,
diabetes, chronic kidney disease, osteoporosis, and cognitive
impairment. Researchers believe that HIV causes accelerated or
premature aging. This series aims to explore different health
aspects of aging with HIV, one body part at a time.
Mental health: who’s at risk?
The Canadian Mental Health Association (CMHA) says 20
percent of Canadians will experience mental illness in their
lifetime. An aging HIV-positive population is even more
vulnerable to mental health disorders. US Center for Disease
Control and revention surveillance data says, “people over
the age of fifty with HIV…account for fifty percent of total
infected population…and will predictably rise to more than
seventy percent by 2020.”
The most common mental health challenge for people living
with HIV (PLHIV) is depression, which can affect people at
all phases of the infection, ranging from mild to severe.
PLHIV may experience mood, anxiety, and cognitive disorders
disproportionate to non-HIV-positive people. HIV infection
can cause inflammation of the central nervous system, which
can lead to HIV-associated neurocognitive disorders (HANDS).
Opportunistic infections may impact the nervous system,
leading to changes in function and behaviour. Aging is a risk
factor for many forms of neurocognitive impairment and
mental health disorders in PLHIV.
One reason people may not have their mental health
treated properly, is that these disorders are not always
recognized in older PLHIV. A number of conditions can
mimic depression, including hormonal imbalances, anemia,
substance abuse, liver disease, dementia, and the side effects
of efavirenz and interferon.
There are gaps in research for depression an d aging with
HIV. Indeed, virtually every article consulted on the subject of
mental health suggests the lack of qualitative and quantitative
understanding of mental health. In the context of HIV and
older populations, this terrain is even muddier. During the
P5SITIVE LIVING
11
research for this article, few relevant clinical trials or studies
were underway in this area. Science is playing catch up.
A positive mental state is essential to all aspects of aging.
Depression in PLHIV is associa ted with higher rates of disease
transmission, increased distress, reduced treatment adherence,
and a lower quality of life. In contrast, positive mental health
promotes resilience, improves adherence to antivirals, and
supports healthy lifestyle choices.
Handling the stigma
Poor mental health can affect anyone. Yet, mental health
carries a pervasive stigma. The use of the term “mental
health” as an alternative to “mental illness” is commonplace,
but this has not eliminated the stigma. Fear of discrimination
leads many to hide or ignore their mental health issues
rather than getting treatment.
Two critical factors for optimal mental health are being
aware of your feelings and speaking to a doctor. Discuss
changes in the way you are thinking or feeling about yourself: decreased sex drive, disrupted sleep, loss of appetite,
feeling sad, withdrawing from social interaction, memory
impairment, fatigue, panic attacks, excessive worry, the
impulse to hurt yourself or others, or inexplicable rage.
Speak to your doctor if you are having issues with alcohol or
prescribed medications. Depression often presents as somatic
symptoms, so mention if you’ve been having headaches or
gastrointestinal disturbances.
PLHIV already know all too well about painful, isolating
stigmas. Society is opening up to the conversation about
mental health. As awareness of, and treatment for, mental
health emerges as a health initiative, can an HIV-positive
specific approach be far off? 5
Chrystal Palaty is a Vancouver-based
technical writer.
PO
POSITIVE
SITIVE LIVING S
SOCIETY
OCIETY OF BRITISH COLUMBIA
COLUMBIA
THURSDAYAUGUST
THURSDAY
AUGUST20
FIRST
mail-out sent
not later than
Nominee
information and
the text of
any special
resolutions to be
received by
the Returning
Officer by
SECOND
mail-out sent
not later than
JUNE 2
25
5
JULY
JULLLY
Y 17
JULY
JULLY 23
23
IMPORTANT
IMPOR
TANT
DATES
D
ATES 22015
015
Voting for the Board of Directors and any Special
Resolutions is done by mail-in ballot. The results of the
voting will be announced at the AGM by an Independent
Returning Officer, who will also count the votes.
All members who accept mail from the Society, and for
whom the Society has current mailing addresses for, will
receive two mail-outs, one in June and one in July.
The first mail-out (in June) will include: information about
the AGM; an invitation to members to submit special
resolutions for consideration by the membership; and an
invitation to members who want to run for the Board of
Directors to submit the necessary nomination materials. The
text of any special resolutions and the information provided
by members who want to run for the Board must be received
by the Returning Officer by July 17, 2015.
AT THE
CHATEAU
GRANVILLE
HOTEL
1100 Granville St.
Vancouver
Pick up
of ballots (from
the Society’s
Reception Desk)
by individuals
who do not
receive mail
starting on
JULY
JUL
LY 27
27
Completed
ballots to be
received by
the Returning
Officer
by 4PM on
AUGUST
AUGUST 17
The second mail-out (in July) will include: the ballot to vote
for the Board of Directors; the statements and biographical
information of those candidates for election to the Board who
have supplied them; if applicable, the ballot required to vote for
or against any special resolution(s) submitted; and a postage-paid
return envelope. All mail-in ballots must be received by the
Returning Officer no later than 4PM on August 17, 2015.
SIX two-year term positions on the Board of Directors of
the Society are to be elected for the period 2015-2017.
If you have any questions or would like to receive a copy of
the Society’s Annual Report, please call Keith Morris,
Secretary, at 604.893.2214 (1.800.994.2437 x 214) and
leave a confidential message. All documents relating to the
AGM will also be available on the Society’s website at:
www.positivelivingbc.org
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AGM, please contact
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Society.
A shot of truth
Understanding your vaccinations
By Dr. David Moore HIV
treatment is complicated. The last thing you need
is an illness that could make it even more difficult.
That’s why the BC Centre for Disease Control (BCCDC) has
updated their vaccination recommendations for people living
with HIV (PLHIV)—to help you manage your treatment and
keep yourself healthy.
One of the new recommendations addresses bacterial pneumonia,
which continues to be a cause of illness—and in extreme cases,
death—among PLHIV. As of April 1, 2015, PVC13 ( brand name
Prevnar 13) will be available free for PLHIV. This vaccine will
provide you with added protection against bacterial pneumonia,
and is an important addition to your vaccination schedule.
In Positive Living BC’s community engagement campaign, you had
questions about vaccinations, so we asked Dr. David Moore, physician
lead of BCCDC’s HIV program, about vaccinations and HIV.
Q: Why is this vaccine being recommended for people living
with HIV now? Are there any r isks associated with it?
A: Even though the risk for acquiring pneumonia has
decreased substantially since effective anti-retroviral treatment
(ARV) was introduced in the mid-1990s, PLHIV are still at higher
risk of contracting pneumonia than the general population and
bacterial pneumonia continues to be an important cause of
illness and, occasionally, death among PLHIV.
The reasons for this are not entirely known, but likely relate
to an incomplete restoration of i mmune function even after
effective treatment, as well as the higher prevalence of cigarette
smoking and other risk factors for pneumonia among PLHIV.
For many years, a vaccine for pneumococcal disease, known
as PNEU-P-23 (brand name Pneumovax 23), has been recommended and publically funded for HIV-positive individuals in
BC. However, Pneumovax 23 does not provide complete
protection against pneumonia and Prevnar 13 will provide
HIV-positive individuals with add itional protection than being
immunized only by Pneumovax 23.
The main side effects that patients may experience from the
vaccine are a sore arm or redness at the site of injection.
Dr. David M. Moore is a research scientist at the
British Columbia Centre for Excellence in HIV/AIDS,
and an associate professor in the Department of
Medicine, Division of AIDS at the University of
British Columbia. He is also the physician lead of
the Provincial Health Services Agency HIV Program
at the BC Centre for Disease Control.
P5SITIVE LIVING
13
Q: Many HIV-positive people change doctors multiple
times in their lives. Do you think it’s important for people to
track their own vaccinations and proactively ask their care
providers for them?
A: Having patients actively participate in their own
health care is quite valuable, and asking your care provider if
your vaccines are up-to-date at each visit is a great way to
ensure that this is being monitored. Most clinics or practices
have developed some sort of tracking system to assist care
providers in tracking vaccinations and other preventive
healthcare interventions, but it is very helpful if patients ask
about this as well.
Q: Should someone still be vaccinated even if they’re not
immune-compromised or undetectable?
A: Absolutely. Even though your risk for acquiring
pneumonia increases as your CD4 count drops or the level of
your virus increases, those with HIV are still at a higher risk for
acquiring pneumonia than the general population, even if they
are receiving effective HIV treatment. Of course, even people
without HIV can become infected with pneumonia and the risk
increases as people age. PCV-13 requires only one injection and
no booster is required.
Q: Can someone with HIV get sick by receiving the
f lu vaccine?
A: Getting vaccinated once per year against influenza is
recommended for everyone—especially for PLHIV. While some
people may feel that the flu vaccine gave them a cold or flu,
this is actually not possible. There are no live organisms in the
flu vaccine, only chopped-up bits of the virus that cannot
replicate and cause infection.
Q: Is a shingles vaccination recommended for people who
live with HIV?
A: There is some concern about using the shingles vaccine
in people with immune system problems. Certainly the shingles
vaccine should not be given to anyone with very low cell
counts, as the vaccine contains a live virus, which can actually
cause illness in some people. Whether the vaccine is safe and
effective for people with high CD4 counts is currently an
important area of research. This vaccine is not publically
funded in BC, meaning that people who want it have to pay
for it themselves.
BCCDC has created resources to help you understand your
vaccinations—what you need and when. To find out more, visit
www.immunizebc.ca 5
Gay Poz Sex
Taking a holistic approach to sex
It’s
not very often that gay and bisexual HIV-positive men
get a chance to look at the role sex plays in their
lives. Usually when we talk about our sexual escapades we like to
focus on how hot the guy was, or how ‘big’ he was, but what we
don’t often acknowledge is the affect of these experiences on our
lives; how that event left us feeling days, weeks, even months
after. The Gay Poz Sex (GPS) program works with guys to find
answers to these questions from each participant’s perspecti ve so
they can keep what’s good, get rid of what’s not so good, work
on strategies surrounding any challenges to change, and ultimately
move in the direction of what they hope for their sexual health.
This project has now been in the randomized control trial
for over a year in Vancouver and Toronto and we have had
some great results. Guys who have completed the program
report more confidence when disclosing (telling someone of
their HIV status), an increased capacity to talk to s exual partners
about HIV, and in some cases increased connection to other
members of the HIV-positive community.
Following each eight-week GPS program, participants complete three online questionnaires and one qualitative, face-to-face
interview. While the online questionnaires are more quantitative
in nature–asking questions ranging from depression and HIV to
sexual health and practices–the qualitative interview offers participants the opportunity to provide the GPS team with feedback.
This feedback is important for improving the program, assessing
individual-level program impacts, and evaluating whether or not
participants benefitted from the social aspect of the GPS group.
From these qualitative interviews the one critique of GPS is
that the eight week-period is not long enough and guys would like
the program length to be increased. Unfortunately, because we are
a research project we are limited to those eight weeks, but there is
hope that this program, or some variation thereof, will continue
on at Positive Living BC after the research has concluded.
In Vancouver, we have just randomized our third cohort of
guys. Participants come from a variety of backgrounds and experiences. Because we have created a safe space for them, they feel
P5SITIVE LIVING
14
By ◆ Jonathan Postnikoff ◆
comfortable disclosing their personal information, sometimes for
the first time, out loud. As facilitators we are always overawed by
how much guys are willing to share. Evidently, these conversations need to be had and doing so allows us to address some of
the major stressors in our lives. Facilitator Michael Crate says,
“there is no better feeling than watching one of our participants
find clarity around an issue that has had a significant impact on
his life. It truly is the best part of my job.”
According to Toronto facilitator Scott Simpson, the impact of the
program is similar to what we are seeing in Vancouver. “GPS continues
to respond to the social, legal, and medical dynamics within the gay
men’s community. Each group echoes their appreciation of a safe
space to talk meaningfully about what it’s like to be a gay man living
with HIV. They talk about the importance of unpacking their issues,
the similarities with other gay, poz men and validating their lived
experiences with stigma, disclosure, and isolation.”
Often we feel alone in our experiences but this group allows
guys to see that gay, HIV-positive men often have more in common than we may think. We see this several times in each group
where one guy feels isolated in an experience and when we ask
the group who has had a similar occurrence, usually everyone
raises their hands, including us facilitators. We realize that for
many guys even the thought of opening up to a group of
strangers is a real barrier and to those who may be interested but
share this sentiment, we are here and ready when you are. There is
clearly a need for this type of group and we are hopeful that it
will continue on to help more and more people find their way to
their sexual health goals. Whatever those may be.
For more information, contact me, Jonathan Postnikoff, GPS
Facilitator. Visit our website (www.gaypozsex.org), call us at
604.240.7205, or email [email protected]. 5
Jonathan Postnikoff is Positive Living BC’s
treatment outreach coordinator.
By ◆ Murray Hart ◆
My
family would whisper to each
other when they talked about
people who had depression. They did not
regard it as a sickness—it just meant that
the person was lazy, a loner, or working
the system. My father had a brother who
committed suicide because of his depression,
P5SITIVE LIVING
15
but this was rarely discussed among the
extended family and never with outsiders.
I adopted my family’s view of depression,
which hindered me from getting help as a
young adult. Each time I became depressed,
I found it harder to fight back.
continued next page
When I was diagnosed with clinical depression, my therapist
and I started looking at patterns, events, and habits that have
occurred in my life. When life became too difficult, my response
was to f lee. I moved to various provinces in Canada, then
London, England to escape, hoping that a fresh start would
solve my problems and make me happy. Things would go well
for a time, but old habits, feelings, and thoughts would
creep into my psyche, and, once again, I would lapse into
depression. While living in London, the same patterns, events,
and habits soon reemerged. I would work long hours, go home
to sleep, and then go back to work. I had a nice apartment
and a good job, but I was unhappy. With few friends, I relied
on the gay baths for my sexual relief. I allowed myself to get
into situations where I chose not to have safe sex.
The week I tested positive for HIV, I learned that my best
friend had died of cystic fibrosis and that my father’s prostate
cancer had spread to his bones, leaving him with about 18
months to live. Months later, another close friend of mine
would drink himself to death. I used these events as an excuse
to flee. I moved back to my childhood town and began to care
for my ailing father.
My f ather died a month after I returned home. Soon after,
I had a falling out with my sister and I fell into another deep
depression. I then made a serious attempt to end my own life.
While saving my life, the staff at the hospital told my family
that I was HIV-positive—my sister spared no time in telling our
family and her friends. A few months after my father’s death, I
reasoned that there was no safety o r anonymity in the community and contemplated suicide again. I resorted to the habit of
flight instead and moved to Vancouver.
Once here, things started out well. I had a small pension
and savings and could afford to take some time to settle. I
registered at the Immunodeficiency Clinic (IDC) at St. Paul’s
Hospital and got to know the city. I also began to meet people
on the Internet and soon learned what the initials PNP (party
and play) meant. Within a very short time, I discovered that
the highs were not quite high enough and that there was no
bottom to the lows. My money began to dwindle, and old
Understanding
“
The week I tested positive for
HIV, my best friend died of
cystic fibrosis and my father’s
cancer spread to his bones,
leaving him with about 18
months to live.
I wish that controlling clinical depression was as easy as
controlling my HIV. I am on a one-a-day tablet regime, my
viral load is undetectable, and my CD4 count is above 500.
For my depression, I take four different tablets a day and,
some days, still find it almost impossible to get out of bed,
never mind getting out of the house or cleaning dishes. There
is no easy fix. I have had to come to terms with my own
stigmas about mental health and HIV. My depression left me
vulnerable to getting HIV and having HIV made me more
depressed. I need to control my depression as I do my HIV
and other health issues. It seems like a long struggle but I a m
taking steps and moving forward one day at a time.
your mental health HIV
is difficult enough to handle alone, but the added
burden of poor mental health exacerbates an
already challenging health concern. People with HIV (PLHIV)
are more vulnerable to mental health emergencies than people
who are not HIV-positive. The vulnerability stems from the
high-risk activities (unsafe sex and intravenous drug use) PLHIV
often engage in. Risky behaviour often results from an HIV
diagnosis and its resultant stigma.
Anyone can experience short peri ods of sadness from time
to time. Some people develop recurrent states of sadness,
P5SITIVE LIVING
habits and feelings began to flood back. I wanted to run, but I
didn’t have the energy or the finances to escape.
My doctor referred me to a social worker at IDC, who
referred me to the mental health nurse, who in turn referred
me to a psychiatrist. My journey to control my depression
began. I was connected with a therapist and started attending
various groups. IDC offers a program called Changeways that
helps people like me to understand what depression is and
how to make cognitive choices to change the way I think.
Today, I understand better how thoughts can feed depression.
I have discovered tools to help change my thought patterns
for the better. Getting help for my mental health has been the
hardest and, at the same time, the most rewarding thing I
have done.
16
helplessness, and the inability to enjoy things for long periods
of time. These states are often accompanied by lethargy,
somnipathy (sleep disorder), loss of appetite, and—in rare
cases—suicidal impulses. This is depression. And it is a common
emotional health concern for PLHIV.
“All of the people we see are individuals living with HIV,”
says Maxine Davis, Executive Director of Vancouver’s Dr. Peter
Centre in Vancouver, BC “who are also coping with multiple
other health issues such as mental health conditions.” Davis
says the reality of concurrent health problems is dire. “When
these conditions and issues are co-occurring, they can have the
impact of magnifying and complicating each of the individual
conditions.” The contributing factors to depression are
manifold: family history, survivor’s guilt, social isolation, or
drug addiction. Depression may seem concurrent to being
diagnosed with HIV/AIDS, but it is a separate illness that
should be treated as such. “Managing ones mental health,
in particular, can become very challenging when a person
has other health and social conditions. This in turn can
complicate engagement in HIV care and adherence to HIV
treatment,” Davis adds.
One common treatment for depression is cognitive
behavioral therapy (CBT)—“talk therapy”—a process that
assists people in altering negative thought and life patterns.
However, therapy alone is no cure for depression, and it may
not be suited in all cases. (Ed. Note: for more on the good
and bad of doctor-patient relationships, see this issue’s Last
Blast, on page 28).
Drugs are another option. Antidepressant cocktails of
Celexa, Zoloft, and Prozac or Effexor and Cymbalta are
common but neither is a cure. Drug treatment can be quite
effective; anyone who is HIV-positive and suffering from
depression should speak with their doctor. Medications can
take several weeks to work, may only work in conjunction with
ongoing talk therapy, or may require adjustment to minimize
side effects. The measure of a successful treatment is based
on a person’s ability to take medication exactly as directed.
“Medication alone is totally insufficient,” said Edward L.
Machtinger, director of the Women’s HIV Program at University
of Ca lifornia San Francisco, in 2014. Machtinger was speaking
about a UCSF study on the “expressive therapy” model initiated
by The Medea Project. “Over 90 percent of our patients,”
Machtinger said in a UCSF news item at the time, “are on
effective antiretroviral therapy but far too many are dying from
suicide, addiction, and violence.”
Our bodies and minds are intricately connected, allowing
for stress and a nxiety to affect our physiology in equally
positive and negative measures. HIV, a major stressor, impairs
emotional health. Emotional fitness allows us to enjoy life despite
a difficult period. There are many supportive community counselling and support services that you can turn to, usually free
of charge: hospitals, clinics, AIDS service organizations, or
telephone help lines. You can meet with other PLHIV through
these services, where peer support and social events bring the
HIV community together. Meeting other survivors can help you
develop a positive outlook, improve your self-esteem, and build
a social network you can rely on for companionship and support.
PLHIV often have an unf lattering body image or poor
self-esteem. This negative perception can be compounded
by weight loss associated with HIV or by lipodystrophy, a
common side effect of HIV medication. Exercise is effective
for treating mild to moderate depression and for reducing
anxiety by counteracting the withdrawal, inactivity, and
despair that characterize depression. In some cases, exercise
P5SITIVE LIVING
17
may also reduce anger and anxiety, leading to clearer thinking.
Outdoor activity has the added bonus of giving your body
the much-needed vitamin D sunlight offers.
There are stigmas attached to seeking professional help
but a trustworthy and supportive doctor can help you navigate
your way back to fine emotional health. Vancouver’s IDC is
one place to start. “The IDC offers comprehensive HIV
care which includes mental health and addictions services,”
says Mary Petty, of the IDC. “A mental health team [of]
psychiatrists, social workers, a psychologist and a psychiatric
nurse” is open to “PLHIV [who] can work with the professionals
on this team to address mental health problems through
assessment, treatment, and ongoing support.”
“
As a person living with HIV,
you may at times feel lonely
or isolated. Your feelings of
loneliness may become even
more pronounced.
The research community has been working to unlock the
doors to mental illness, as it relates to HIV. A 2001 study
concluded that, “Although the majority of HIV-positive
individuals appear to be psychologically resilient, this metaanalysis provides strong evidence that HIV infection is associated
with a greater risk for major depressive disorders. Future
research should focus on identifying pathways of risk and
resilience for depression within this population.” (This study,
by Jeffrey Ciesla and John Roberts, can be accessed online
from The American Journal of Psychiatry.)
Yet as recently as 2014, similar conclusions and recommendations were still being sounded. Matthew Mimiaga of Harvard Medical School told Reuters in December 2014, “Future
research should also examine whether these mental disorders
and behavioral risk factors create barriers to men getting
treatment for HIV once they are infected.” The intersection of
mental health and HIV is still under construction.
Hope is infinite—even if you feel like you have no room
for hope. By maintaining a healthy mind in a healthy body,
you can look forward to not only a long life, but also a
fulfilling and meaningful life with HIV. You may feel lonely
or isolated. Your feelings of loneliness may become even more
pronounced. And though it can be difficult to do so, now is
the time to seek out friends, family, and peers who can help
you explore your options. And that is the key takeaway—you
have options. 5
Murray Hart is a former schoolteacher
who is new to the Vancouver area.
Hepatitis & depression:
A personal take
By ◆ Suzan Krieger ◆
F
or months, I had not been feeling well. Food was
unappealing and my energy was gone. After convincing
my doctor I was not a hypochondriac, she ran me
through a gauntlet of tests. I can still recall the day my doctor
told me I tested positive for hepatitis C (HCV). Without
applying, I had joined approximately 80,000 other British
Columbians in the HCV club. I was angry, and more than a
little scared. I felt faint, and could not believe it happened to
me. How? Why? And who is to blame? A fter the first few
weeks of depression, I picked myself up and demanded to
know how to fix this.
I went to the first clinic recommended to me and started
six months of anemia creating, stomach churning, and lifethreatening treatment. I got through it with the help of
friends, but no support from the medical community. Many
days I stood in a hot shower trying to scald the chills out of
me. There was nausea and appetite loss from the treatment of
interferon and ribavirin. My hemoglo bin was so low I could
not walk more than a block. My dog Charlie was ready to start
advertising for a new owner, one who would take him for
walks and play soccer. My hair was thinning. I developed a
rash all over, including on my face. I felt alone and scared that
the treatment would kill me rather than cure me. But in the
end, it did neither.
Sometimes I get stuck on the diagnosis and don’t know
how to move forward, or how to see the treatment through.
So, I decided just to live with the hepa titis C. After all, we’re
all going to die of something—right?
A few years later, I went to a workshop put on by Positive
Living BC that featured Dr. Brian Conway, the medical
director of the Vancouver Infectious Diseases Centre (VIDC)
and a Queen Elizabeth II Diamond Jubilee Medal honoree.
At the close of the workshop, I spoke with Dr. Conway and
explained how I had tried and felt I had lost on my
treatment. He gave me his card and with a confident voice
said, “I can help.”
The VIDC uses open discussion about feelings—treating one
with respect and dignity and providing stellar medical care in
as comfortable a surrounding as possible. The team’s approach
can be thought of as holistic medicine (a form of healing that
considers the whole person)—body, mind, spirit, and
emotions—in the quest for optimal health and wellness.
P5SITIVE LIVING
18
Dr. Conway helped me find Dr. Patricia Howitt, who is
now my primary physician, while Shawn Sharma, a registered
nurse, set up a conf erence call with Gilead and my healthcare
insurance company, clearing the way for treatment with the new
drug, Sovaldi (sofosbuvir) and ribavirin. The cost of the combination treatment is around $93,000 per year. Sharma also
started me on a vitamin program and made himself available
to me throughout the three-month treatment program.
“
My hair was thinning.
I developed a rash all over,
including on my face. I felt
alone and scared that the
treatment would kill me
rather than cure me. But
in the end, it did neither.
The new treatment had side effects like fatigue, moodiness
and irritability, but was only three months long. Charlie
remained with me. After all, he could not pay the advertising
bill he was sure to run up looking for a new home.
The VIDC did everything from blood testing to ultrasound
scans. Dr. Conway met with me and explained my new treatment
and, week by week, he kept my spirits up and encouraged me
that this treatment—this time—would work. VIDC’s waiting
room is a wonderful, chaotic haven filled with patients waiting
for their turn to be cared for. The staff provides TV, coffee,
snacks, information, and supp ort for the waiting room folk.
Four months after my treatment ended, I am no longer
infected with HCV. My health has improved and I have nothing
but a great future to look forward to. The biggest lesson I
learned is that for me to see treatment through, it requires a team
that includes doctors, specialists, nurses, receptionists, cohorts,
family and friends. And of course, a dog named Charlie. 5
Suzan Krieger has been employed at Positive Living
BC for 19 years. What motivates her is the love of
family and faithful companion Charlie, a blind dog
rescued from the New Orleans Katrina crisis and
flown to Vancouver to a new home and loving owner
by the charitable and kind Drew Barrymore. MAY •• JUNE 2015
My
name is Lynden Neudorf, and I hold a Master’s
degree in Clinical Social Work from the University of
Calgary. My previous clinical experience includes working with
adults at a community mental health agency, both as a therapist
and as an assessor. I also have experience working with gay men
and the LGBT community, as well as local and international
work in the field of HIV. My areas of practice include grief and
loss, trauma, sexuality and questions of personal identity,
depression, anxiety, and problematic substance use. I use a gay
affirmative and strengths based approach, while also utilizing
various therapeutic tools as appropriate.
This January, I began a new counselling role with the STOP
HIV/AIDS Team at Vancouver Coastal Health. This role was created for gay/bi men and other men who have sex with men
(MSM) as a way to provide mental health support to a group of
people with specific needs. People have asked me why we need a
gay men’s counselor, and what makes gay men’s counselling different from other kinds of counselling.
I, too, sometimes wonder what exactly makes gay men’s counselling different from any other counselling. In the end, we all share
the same universal human experiences of joy, grief and loss, heartbreak, success, connection, and vulnerability. Do gay men really
experience these things any differently from other people? What
kinds of unique experiences do many gay men share that impact
their emotional health and well-being?
When we think about trauma, we often picture stories of war,
violent physical assault, or childhood abuse. But the simplest
definition of trauma that I’ve heard is when a person’s capacity to
process an event or series of events is overloaded. This includes the
young gay person who is taunted or physically threatened for years,
and doesn’t have a safe person to talk to about what is happening.
These frequent and ongoing experiences of being in danger,
whether emotionally, verbally, or physically, have the power to
completely override our ability to process what is happening. We
can eventually learn not to trust and to even hide who we are.
Stories of trauma, often involving families of origin and
experiences of growing up in various communities across Canada,
seem to be the norm rather than the exception for many of the
men I work with. As they learn to distrust others, these parts of
their story stay buried inside. The high rates of HIV infection
P5SITIVE LIVING
20
among gay men can exacerbate these negative feelings even more.
It is essential to understand and listen for those experiences, because
they shape gay men’s choices, the ways in which they see themselves,
and perhaps lifelong feelings of deep shame and inadequacy about
who they are. These worldviews aren’t easily dismantled, especially
when people struggle to find alternative ways of seeing themselves
and relating to others.
In order to explain how these experiences alter the way we see
and present ourselves to others, we sometimes use the term
“internalized homophobia.” This concerns me because I think it
turns society’s sickness into our own. I like to think of gay people
who need to pretend that they aren’t gay as being smart and
committed to their own survival. It’s a strategy that isn’t going to
hold up over the full course of an adult life, but I know that it has
saved numerous lives when nothing else was available.
Earlier on, I asked if gay men have a unique shared experience
that makes us see ourselves, and the world, any differently from others.
But I also wonder if we need to find and experience hope and
meaning differently in the face of adversity. Gay resources are limited,
and often only found in major urban centres. Current options can
largely depend on what resources are available. Future possibilities,
on the other hand, can be endless and are limited only by someone’s ability to dream big. Exceptions look at the way people have
survived and thrived in spite of overwhelming difficulty. And lastly,
solutions build on past and current successes.
I do not want to come across as victimizing gay men and presenting
us as helpless and weak. I believe that nothing could be further from
the truth. The counselling work I do is extremely varied, and everyone
has his own individual story, strengths, and way of seeing the world. I
do think that it is essential to recognize common threads in the stories
of the men I work with, both past hurt and future possibility. If we
want liberation and freedom in our lives, we need to be able to be
honest about where we have been and where we want to go.
For more information, please contact STOP
HIV/AIDS team at 604.838.1331 5
Lynden Neudorf is a counselor with the
STOP HIV Team at Vancouver Coastal Health.
The Doctor will
see you now
By ◆ Shelly Tognazzini ◆
I
remember meeting Dr. Andrea Szewchuk at the John Ruedy
Immunodeficiency Clinic at St. Paul’s Hospital (IDC) last
year and being taken aback by her youth, confidence, and,
in her words, “person-centered” approach. Extremely calm,
approachable, and down to earth, she had a very natural nonjudgmental demeanor, right down to the lack of a white coat in
clinic. When I meet up with her for lunch to interview her in
Victory Square on a glorious sunny day, it is obvious she is
passi onately committed to inclusive patient-centric care.
We sit down on the ledge in the park, observing the activity
around us, ensuring we can carve out a little space and time to
talk and enjoy the sun. It’s easy to see she knows the ‘hood, and
the people in it. She smiles and enjoys the interactions and urban
noises around us. “I am interested in how people experience the
world and how that works within institutionalized oppression,”
she says. Her work and volunteerism reflect t hat.
Dr. Szewchuk works at the IDC providing primary care for
people living with HIV, and at the Pender Community Health
Centre, and through the VCH Transgender Healthcare Clinic.
She is also a centre organizer with the Catherine White Holman
Wellness Centre, a low-barrier volunteer centre providing care to
the transgender and gender-diverse community.
“I think that as a family doctor and a person who identifies
as queer, I feel a responsibility to engage and empower people in
care, particularly those that have often not had the best experience
with healthcare providers and the healthcare system. From a
social justice perspective, we have the opportunity to help those
most marginalized and that is something very important to me.
Also, from a medical perspective HIV interests me, particularly
in some of the most marginalized in the trans community. It is
impossible to look at the health care of an individual without
looking at the health of the community,” she says.
Positive Living BC’s Care Registry (www.careregistry.ca) is
an online database designed to connect people living with
HIV/AIDS with care providers in BC. It provides contact
information for care providers including physicians, dentists,
massage therapists, nurse practitioners, counsellors, and
dietitians who welcome clients living with HIV/AIDS, and who
will provide respectful, supportive care. Healthcare
providers listed on the registry have the medical knowledge
to meet the needs of people living with HIV/AIDS. The
Care Registry is for information purposes only and does
not recommend, advocate, or endorse any particular service.
P5SITIVE LIVING
21
Providing service on the Downtown Eastside, she sees so
many clients who are dealing with much more than HIV.
Poverty, homelessness, racialization, mental health issues,
and addictions only multiply the barriers to, access to, and
engagement with care.
Dr. Szewchuk works with an open mind, a curious nature,
and meets her patients where their needs are at today, at this
moment, in this appointment. She wants her clients to feel
heard, and goes out of her way to make sure they are. Whether
that is for HIV care or transgender support and referral, Dr.
Szewchuk is a welcome addition to both the LGBT and the
HIV community.
“Historically, transgender health has not really been as well
supported as it should be. I think that is shifting–it just needs
to shift more quickly. I am concerned with providing more
accessible, safe, and healthy care for trans and gender-expansive
people in our health system. Outside of her clinic schedu le and
volunteer work, Dr. Szewchuk loves to be outdoors, camping,
gardening, riding her bicycle, and applying social justice to her
practice and principles.
As we wrap up our interview, Dr. Szewchuk says, “I feel
extremely lucky and privileged to do what I do. Yeah, I am new
and young, but I love working with the eclectic and diverse
community I do–it’s work that has value, and I love the challenges
it presents.”
Szewchuk is available for drop-in at the IDC at St. Paul’s on
Tuesd ay afternoons providing HIV primary care, at the Pender
Community Health Centre Mondays and Fridays, and at the VCH
Transgender Clinic. She is listed on the HIV Care Registry
(www.careregistry.ca) and can be reached through any of the
three clinics and organizations listed below. 5
Shelly Tognazzini is the treatment, health, and
wellness coordinator at Positive Living BC.
 John Ruedy Immunodeficiency Clinic
5th floor, St. Paul’s Hospital, 604.806.8060.
 Pender Street Clinic
59 West Pender St, 604.669.9181
 Catherine White Holman Wellness Centre
1145 Commercial Drive (in the REACH Clinic), 604.442.4352
The TriiAdd study is improving adherence
and suppression
By ◆ Heiko Decosas ◆
O
ver the last decade, treatment for HIV has improved
significantly, with an increase in treatment options.
However, according to TriiAdd study (CTN 286)
principal investigator Dr. Marina Klein, “close to 30 percent
of Canadians living with HIV (PLHIV) who have a prescription for HIV medications struggle with adherence: starting
and stopping, or switching treatments frequently.” These people are unable to consistently suppress the virus, leading to
health complications and a further risk of transmission. The
TriiAdd study will test to see if using a new single tablet
regimen (STR) called Triumeq with counseling support can
improve adherence and virus suppression for PLHIV.
“With this study, we hope to show that one-on-one
counseling alongside a well-tolerated single-tablet HIV regimen
provides a level of healthcare that meets people where they
are at and improves their health outcomes,” says Dr. Klein.
Dr. Brian Conway is lead doctor and researcher at the
Vancouver Infectious Diseases Centre (IDC) and a co-investigator for the study. “We focus specif ically on engaging
more vulnerable patients into a multi-disciplinary healthcare environment. We deal with the challenges of adherence
on a daily basis and, given our focus on HIV and hepatitis
C, this new study is well suited to our centre’s communitybased research approach.”
Researchers hope to recruit 100 participants from ten
Canadian CTN-affiliated sites. PLHIV who are 18-years old
or older with documented evidence of non-adherence and
poor virologic control are eligible. Participants will be
randomized in a one-to-one fashion to the experimental arm,
switching immediately to the Triumeq tablet along with
adherence counselling, or to the control arm, continuing on
with the currently prescribed HIV treatment regimen, as
well as additional adherence counseling. People randomized
in the control arm will be offered the possibility of switching
to Triumeq after 24 weeks so everyone will have a chance to
make the switch to the STR.
Jonathan Roger, the new study coordinator, says, “The
research team is currently conducting site feasibility
assessments across Canada and is looking to open between
two and four recruitment sites in BC early this summer.” For
more information contact [email protected] 5
P5SITIVE LIVING
23
Studies enrolling in BC
CTNPT 003
Bone and renal outcomes in tenofovir-exposed infants
BC site: Oak Tree Clinic, Vancouver CTNPT 011
Monitoring penicillin levels for syphilis
BC site: St. Paul’s Hospital, Vancouver
CTNPT 014
Combination therapy for HIV in the setting of HCV co-infection
BC sites: Vancouver Infectious Diseases Centre (VIDC), Vancouver |
Cool Aid Community Clinic, Victoria
CTN 222
Canadian co-infection cohort
BC site: St. Paul’s Hospital, VIDC, Vancouver
CTN 240
Valacyclovir in delaying antiretroviral treatment entry (VALIDATE) trial
BC sites: VIDC, Oak Tree Clinic, Vancouver |
CTN 248
Incentives stop AIDS and HIV in drug users
BC site: VIDUS/ACCESS Project, Vancouver |
CTN 262
Canadian HIV women’s sexual and reproductive health cohort study
(CHIWOS)
BC contact: 604.806.8615, 1.855.506.8615 (toll-free) |
[email protected]
CTN 264
Investigating access to food for people living with HIV-HCV co-infection
BC Site: VIDC, St. Paul’s Hospital
CTN 26
HIV canquit smoking study
BC site: St. Paul’s Hospital
To find out more about these & other CTN studies, visit the CIHR
Canadian HIV Trials Network at hivnet.ubc.ca or call 1.800.661.4664.
Heiko Decosas is the communications and
knowledge translation officer at the CIHR
Canadian HIV Trials Network in Vancouver.
POZ
In grateful recognition of the generosity of Positive Living BC supporters
Gifts received January – February 2015
C NTRIBUTI NS
$5000+
LEGACY CIRCLE
Peter Chung*
TD Bank Financial Group
$2500 - $4999
VISIONARIES
The Shooting Stars Foundation
$1000 - $2499
CHAMPIONS
Metropolitan Pharmacy*
Dean Nelson*
Kumar Shahani*
Harvey Strydhorst*
Bramwell Tovey*
Paul Goyan*
Gary R. Bell
Gaynor C. Yeung Law Corporation
Docusystems Integrations INC
Dragonwires Telecom INC
$500 - $999
LEADERS
Brian Lambert*
Deborah Bourque*
Emet G. Davis*
Christian M. Denarie*
Scott Elliott*
James Goodman*
Silvia Guillemi*
Cliff Hall*
Ross Harvey*
Mike Holmwood*
Fraser Norrie*
Leslie Rae*
Donald G. Seaton*
Blair Smith*
Chris Staples
Mahmoud Virani*
Kasey Reese
Marthinus Wasserfall
Henry Wozniak
Fraser King
$150 - $499
HEROES
Jeffery Alexander*
Wayne Avery*
Cheryl Basarab*
Ryan Bernhauser
John Bishop*
Kevin Bougher
Elizabeth Briemberg*
Susan C. Burgess*
Len Christiansen*
Vince Connors*
Ken Coolen*
Edith Davidson*
Maxine Davis*
Carmine Digiovanni*
Caryl Dolinko
Gretchen Dulmage*
Patricia Dyck*
Dena R. Ellery*
Don Evans*
Stephen French*
Gap Inc
Jean Sebastian Hartell*
Wayne Hartrick
Jaqueline Haywood*
Alexander Hird
Ron J. Hogan*
Leah K. Iverson
Pam Johnson*
Rebecca Johnston*
Elaine Jones*
Helen Kang*
Knights of Malta Dogwood Chapter
Mona Kwong
Rick Laird
David Love
Colin Macdonald*
James McLean
Kate McMeiken*
Carl Meadows
Mark Mees*
Laura H. Morris*
Cameron Murton
James Ong*
Dennis Parkinson*
Anil R. Patade
Bonnie Pearson*
Mary Petty*
Pharmasave #87
Neil Power*
Katherine M. Richmond*
Caterina Rizzo
Alin Senecal-Harkin*
Lillian M. Soga*
Keith A. Stead*
Ronald G. Stipp*
Jane Talbot*
P5SITIVE LIVING
24
Lara Manierka
Salvatore Martorana*
Angela McGie*
Mitchell McKamey
Lindsay Mearns*
May Mehrabi
Roger Merkosky
Bea Miller
Grant Minish
Felipe Mollica
Austin Neaves
Valerie Nicholson
Sam Omidi
Penny Parry*
Leo Patierno
John Pedersen
Lorne Prupas
Lisa Raichle*
Sheldon Rennie
Adrian Smith*
Daphne Spencer
Stephanie Tennant
Stephanos Tsungaris
Carolyn Unsworth
Vancity Community Foundation
Flora Ware
Ross Waring
Fred West
Ron Wilson
Adrienne Wong*
Dean Thullner*
Stephanie Tofield*
Top Drawers Apparel Inc.
Glyn A. Townson*
Ralph E. Trumpour*
Louella Vincent*
$20 - $149
FRIENDS
Belle Ancell
Bernard Anderson*
Patricia G. Barlor*
Be the Change Group
Jag Bilkhu
Richard Bing
Scott Blythe
Lisa Bradbury*
Shelley Bridge
Sandra Bruneau*
Leonora Calingasan
Ernesto Caranto
Adriane Carr
Ann Caulfield
Chris G. Clark*
Melissa Clarkson
Barry DeVito*
Tobias Donaldson*
Explorer Software INC
Solomon Gauthier
Carolien Geiger
Kerry Gibson
Frank Gillespie*
Leah Gregg
Amanda Groves
Todd Hancock
Tracey L. Hearst*
HEU Support Services
Facility Local
Richard Housser
Heather Inglis*
Chris Kean*
Ryan Kreut
Catherine Lamb
Teresa Laturnus
Miranda Leffler*
Lori Leung
Gerry Lising
William Liu
Sharon E. Lou-Hing*
*
Denotes monthly donors
(reflects the total contribution
for the year)
To make a contribution to Positive
Living BC, contact the Manager of
Major Gifts and Donor Relations,
Zoran Stjepanovic.
e [email protected]
t 604.893.2282
PROFILE OF A
VOLUNTEER
Noli has the ability to make every moment
breathe with integrity and respect. His
commitment to Health and Wellness
through his volunteer time is not only
commendable, but resounding in the
ripple effect it has on each person he
treats. His smile could light the darkest
day from a mile away.
SHELLY TOGNAZZINI,
TREATMENT, HEALTH AND
WELLNESS COORDINATOR
* NOLI CATAPANG*
WHAT IS YOUR VOLUNTEER HISTORY?
HOW WOULD YOU RATE POSITIVE
LIVING BC?
Since becoming a registered
acupuncturist, I’ve been a regular
volunteer acupuncturist for Vancouver
Homeless Connect and Under One Umbrella. Currently my only volunteer
work with PLBC is as an acupuncturist.
I love PLBC. There are many worthy organizations where I could volunteer my skill
set but I opted to continue to volunteer here
because I was so impressed by the members, volunteers, and staff.
WHY DID YOU PICK
POSITIVE LIVING BC?
WHAT IS POSITIVE LIVING BC ‘S
STRONGEST POINT?
I was originally just supposed to volunteer
on a temporary basis until the previous
acupuncturist’s replacement would be ready
to start. The latter ended up not being able
to continue the work so I opted to stay on.
PLBC provides so many quality services to
its members. Furthermore, it strives to make
these accessible and is able to create a
strong sense of community while doing so.
P5SITIVE LIVING
25
WHAT IS YOUR FAVOURITE MEMORY
OF YOUR TIME AS A VOLUNTEER AT
POSITIVE LIVING BC?
It means a lot to me that folks are
allowing me to have an instrumental role
in managing their health. The work I do
here affords me access to conditions
and concerns that I rarely get to work on
in my private practice. It can be
c hallenging but I can’t help but feel that
it’s making me a better practitioner.
Where to find
HELP
If you’re looking for help or information on HIV/AIDS, the following list is a starting point.
For more comprehensive listings of HIV/AIDS organizations and services, please visit www.positivelivingbc.org/about-other-organizations
bA Loving Spoonful
bANKORS (West)
bPurpose Society for Youth & Families
bAIDS Society of Kamloops
bDr. Peter Centre
bRed Road HIV/AIDS Network
bFriends for Life
bVancouver Native Health Society
Suite 100 – 1300 Richards St,
Vancouver, BC V6B 3G6
t 604.682.6325
e [email protected]
www.alovingspoonful.org
101 Baker Street
Nelson, BC V1L 4H1
t 250.505.5506 or 1.800.421.AIDS
e [email protected]
www.ankors.bc.ca
1110 Comox Street
Vancouver, BC V6E 1K5
t 604.608.1874
e [email protected]
www.drpetercentre.ca
(ASK Wellness Centre)
433 Tranquille Road
Kamloops, BC V2B 3G9
t 250.376.7585 or 1.800.661.7541
e [email protected]
www.askwellness.ca
bAIDS Vancouver
40 Begbie Street
New Westminster, BC V3M 3L9
t 604.526.2522
e [email protected]
www.purposesociety.org
61-1959 Marine Drive
North Vancouver, BC V7P 3G1
t 778.340.3388
e [email protected]
www.red-road.org
1459 Barclay Street
Vancouver, BC V6G 1J6
t 604.682.5992
e [email protected]
www.friendsforlife.ca
449 East Hastings Street
Vancouver, BC V6A 1P5
t 604.254.9949
e [email protected]
www.vnhs.net
bLiving Positive
bVancouver Island Persons
713 Johnson Street, 3rd Floor
Victoria, BC V8W 1M8
t 250.384.2366 or 1.800.665.2437
e [email protected]
www.avi.org
168 Asher Road
Kelowna, BC V1X 3H6
t 778.753.5830 or 1.800.616.2437
e [email protected]
www.livingpositive.ca
1139 Yates Street
Victoria, BC V8V 3N2
t 250.382.7927 or 1.877.382.7927
e [email protected]
www.vpwas.com
bAIDS Vancouver Island (Campbell River)
bMcLaren Housing
bWings Housing Society
bOkanagan Aboriginal AIDS Society
bYouthCO AIDS Society
803 East Hastings
Vancouver, BC V6A 1RB
t 604.893.2201
e [email protected]
www.aidsvancouver.org
bAIDS Vancouver Island (Victoria)
t 250.830.0787 or 1.877.650.8787
e [email protected]
www.avi.org/campbellriver
bAIDS Vancouver Island (Courtenay)
t 250.338.7400 or 1.877.311.7400
e [email protected]
www.avi.org/courtenay
bAIDS Vancouver Island (Nanaimo)
t 250.753.2437 or 1.888.530.2437
e [email protected]
www.avi.org/nanaimo
bAIDS Vancouver Island (Port Hardy)
t 250.902.2238
e [email protected]
www.avi.org/porthardy
bANKORS (East)
46 - 17th Avenue South
Cranbrook, BC V1C 5A8
t 250.426.3383 or 1.800.421.AIDS
e [email protected]
www.ankors.bc.ca
Resource Centre Okanagan
200-649 Helmcken Street
Vancouver, BC V6B 5R1
t 604.669.4090
e [email protected]
www.mclarenhousing.com
200-3717 Old Okanagan Way
Westbank, BC V4T 2H9
t 778.754.5595
e [email protected]
www.oaas.ca
bPositive Living Fraser Valley Society
Unit 1 – 2712 Clearbrook Road
Abbotsford, BC V2T 2Z1
t 604.854.1101
e [email protected]
www.plfv.org
bPositive Living North West
3862F Broadway Avenue
Smithers, BC V0J 2N0
t 250.877.0042 or 1.866.877.0042
www.plnw.org
P5SITIVE LIVING
26
Living With HIV/AIDS Society
12–1041 Comox Street
Vancouver, BC V6E 1K1
t 604.899.5405
e [email protected]
www.wingshousing.bc.ca
205–568 Seymour Street
Vancouver, BC V6B 3J5
t 604.688 1441 or 1.855.968.8426
e [email protected]
www.youthco.org
POSITIVE LIVING BC SOCIETY BUSINESS
UPCOMING BOARD MEETINGS 2015/16
TUESDAYS
4.30PM
STANDING COMMITTEES & SUBCOMMITTEES
If you are a member of the Positive Living Society of BC, 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. Here is a list of some committees
you might be interested in and their contact information. More
committees are listed at www.positivelivingbc.org
BOARD ROOM
May 12, 2015
Financial Statements | February Executive Committee
Director of Human Resources
May 26, 2015
Board & Volunteer Development_ Marc Seguin
t 604.893.2298 e [email protected]
Written Executive Director Report Executive Committee
Director of Community Based Research
June 9, 2015
Complete Board Evaluation Chart Standing Committees
Financial Statements| March Director of Fund Development
June 23, 2015
Positive Action Committee_ Ben Fussell
Education & Communications_ Adam Reibin
e [email protected]
t 604.893.2209
Health Promotion_ Elgin Lim
e [email protected]
Written Executive Director Report Executive Committee
Quarterly Department Reports - 1st Quarter
Director of Operations & Administration
t 604.893.2225
History Alive!_ Marc Seguin
e [email protected]
t 604.893.2298
July 7, 2015
Executive Committee Membership Statistics
Director of Programs & Services
Positive Living Magazine_ Jason Motz
Positive Living BC is located at 803 East Hastings, Vancouver. For more
information, contact: Alexandra Regier, director of operations
t 604.893.2292 or e [email protected]
t 604.893.2259
Support Services_ Jackie Haywood
e [email protected]
803 East Hastings
Vancouver BC
Canada V6A 1R8
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Address ____________________ City _____________________
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contact > positivelivingbc.org • [email protected] • 604.893.2206
P5SITIVE LIVING
27
By ◆ Paul Goyan ◆
It’s
almost 5 am. I am at the computer trying to knock off
something personal and amusing for a mental health
awareness article. When people use the term mental health, what
they really mean is mental illness. I stumble upon an email that
reveals this doozy—“Happy Optimism Month! It’s Gonna Be
Great!” I almost puke. I try to be optimistic and avoid any
pessimism that can worsen my chronic depression. If I’m neither
wholly optimistic nor pessimistic, how then might my general
outlook be classified? Think of me as an optimist with a chip
on his shoulder. I may not yet be a full-blown optimist, but
I’ve come a long way from my sarcastic, cynical past.
I celebrated my 30 th anniversary last month. Three decades of
living with HIV—that’s half of my life. I’m grateful to be alive—
happy even, although I’d be happier if my body was younger and
lighter. With gentle determination and my daily doses of Effexor,
Vyvanse, and testosterone gel, I feel pretty good physically, and,
much of the time, mentally. None of this would have been possible
without the care I received from a number of therapists.
The late Dr. Merv McArthur, a gentle, smiling Buddha of a man
was the first to treat my depression. Next was Dr. Peggy Koopman,
a brilliant and charming psychologist who worked on my empathy,
finding me to be somewhat like the Tin Man from The Wizard of
Oz. For eight years now, I have been with Dr. Donna Dryer, a
Cortes Island psychiatrist who lives in a rainforest and researches
psychedelics. She accepts me for who I am while nudging me to
move forward. No promise of cures, just a better understanding of
whom I am and the tools to deal with the challenges of life.
But in-between Drs. Koopman and Dryer, and for five tumultuous
years, there was my very own Dr. Strangelove. A Kleinian psychoanalyst
and university professor, Dr. S was in his mid-fifties, a native of
Rio de Janeiro who moved to Canada after studying psychoanalysis
in London. I did not fool Dr. S and I feel as though he never liked
me. (“It’s not that I am indifferent,” he would say. How comforting.)
Middle-aged and balding, he wore clothes that suited his tall,
slim build. There was a little bit of Julio Iglesias in him, a
ladies’ man who was proud of it. We made it through five years
together, three fifty-minute sessions per week.
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I would bus to Dr. S’s house. Ushered into his office, I would
lay down on his black leather couch while he sat behind me drinking
espresso. We had a difficult relationship. I find it hard to connect
with a disembodied voice. Worse, according to him, everything
I did was wrong. He pushed my buttons, and I pushed his—
transference and counter-transference.
I had been HIV-positive for five years when we started. Dr. S
tried to crack my psychic defences. “You have AIDS,” he would
say. “You’ll be dead in six months.” Since my CD4 count at
the time was around 1200 per ml, I kept arguing that I had
HIV, not AIDS. He would have none of it.
I wouldn’t have stayed if I hadn’t been told that he was my last
chance. Ten years earlier, I would have rejected him outright as a homophobe. But with the start of the AIDS epidemic, I was concerned that
he was right. The fact is, Dr. S did not like homosexuals. “You
homosexuals,” he once said, “are all like chickens—you behave like you
have a cloaca: you shit where you have sex.” (Cloaca is the single opening to the chicken’s intestinal, reproductive, and urinary tracts.)
We would part ways eventually, but despite my reservations,
I learned much from Dr. S. But it is impossible for people like
me to make progress in therapy without knowing that the
therapist is on my side, and Dr. Dryer is, no question.
In today’s self-help culture, most people don’t need or want a therapist;
or if they do, they can’t find the right person or afford to pay. Therapy
or not, we have to live our lives by moving forward, not living in the
past. Often I find the lyrics of a song can serve as a mantra for selfempowerment and healthy living—physically, mentally, and spiritually.
Johnny Mercer’s “Ac-Cent-Tchu-ate the Positive” is one example:
You’ve got to accentuate the positive
Eliminate the negative
And latch on to the affirmative
Don’t mess with Mister In-Between.
I need to do more work ac-cent-tchu-ating the
positive aspects. I may be almost 60, but I am
a work in progress. 5
Paul Goyan is the past treasurer
of the board of Positive Living BC.