A Guide for Gay and Bisexual Men Living with HIV

Acknowledgements
Martin Blais, Department of Sexology, UQAM
Jacqueline Boudreau, CSSS Jeanne-Mance
Dr Pierre Côté, Clinique médicale du Quartier Latin
Éliocha Cournoyer, CSSS Jeanne-Mance
Dr Joseph Cox, Direction de santé publique, Agence de la santé et des services
sociaux de Montréal
Riyas Fadel, Coalition des organismes communautaires québécois de lutte contre le sida
(COCQ–Sida)
Marie-Ève Girard, Canada Research Chair in Health Education, UQAM
Daniel Lanouette, AIDS Community Care Montreal (ACCM) / Sida bénévoles Montréal
Bruno Lemay, Quebec HIV/AIDS Portal
Dr Danielle Longpré, Clinique médicale l’Actuel
Albert Martin, Fréquence VIH
Jean Lawrence Roy, Université de Montréal
Marie-Claude Roy, Clinique médicale l’Actuel
Jean-Marc Trépanier, Clinique médicale du Quartier Latin
A special thanks to all the men who attended meetings to review and
comment on the information presented in this document.
Published by:
RÉZO (formerly Action Séro Zéro)
You can consult this document at www.rezosante.org
Legal deposit – Bibliothèque nationale du Québec, 2009
Legal deposit – National Library of Canada, 2009
ISBN 978-2-9810490-4-9
(Original edition [French]: ISBN 2-9810490-3-2, RÉZO, Montréal)
Reproduction of this publication in part or in whole is authorized provided
that the source is mentioned.
Funding for this publication was provided by
LIVING
POSITIVE
A Guide for Gay and Bisexual Men Living with HIV
Contents
Introduction
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1) The First Days Following an HIV-Positive Diagnosis
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2) HIV
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2.1. What is HIV?
2.2. What are CD4 cells?
2.3. What is viral load?
3) Sexual Health
3.1 How is HIV transmitted?
3.2 HIV transmission and undetectable viral load
3.3 Post-Exposure Prophylaxis (PEP)
3.4 Reinfection
4) Disclosing Your HIV Status: To Tell or Not to Tell?
4.1 Four questions to ask yourself before telling someone
about your HIV status
4.2 Telling family members and close friends
Coordination
Robert Rousseau, Executive Director
RÉZO (formerly Action Séro Zéro)
Research and writing
Nicolas Hamel, Project Leader
Editing
Robert Rousseau, Executive Director, RÉZO
Thomas Haig, Research and Development Coordinator, RÉZO
Pierre-Yves Comtois, Outreach Worker, RÉZO
French revision
Isabelle Vialle-Soubranne, Les points sur les i
Translated by
Helen D. Elliot
Graphic design
Anik Rousseau, Nikitchi
Print
Mathieu Lanthier, limprimeur.ca
Review Committee
Sylvain Beaudry, Maison Plein Cœur
Pascal Brouard
Dr Pierre Côté, Clinique médicale du Quartier Latin
Dr Serge Dufresne, Clinique médicale du Quartier Latin
Riyas Fadel, Coalition des organismes communautaires québécois de lutte contre le sida
(COCQ–Sida)
Dany Leblond, CSSS Jeanne-Mance
Également disponible en français sous le titre
Vivre au positif
Guide d'accompagnement pour hommes gais
et bisexuels qui vivent avec le VIH
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4.3 Telling the people you live with
4.4 Telling your sexual partners
4.5 What the law says
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4.6 Telling your spouse or long-term partner
4.7 Telling former sexual partners
4.8 Some situations to consider
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5) General Health: Taking Care of Yourself
5.1 What will happen to my health now?
5.2 Physical health
5.2.1 Exercise
5.2.2 Sleep
5.2.3 Diet
5.2.4 Drugs, alcohol, and tobacco
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5.3 Mental health
5.3.1 Confide in someone
5.3.2 Avoid depression by staying active
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5.3.3 Take the time to relax
5.4 Sexual and emotional health
5.5 Spiritual health
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6) HIV Treatment
6.1 How is HIV treated?
6.2 At what point should you begin treatment?
6.3 What is treatment adherence?
6.4 What is drug resistance?
6.5 What are the side effects?
6.6 How do you know if you’re ready to go on treatment?
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List of Support Services
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Bibliography
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Introduction
HIV is no longer understood to be a fatal disease in the way it was at the
beginning of the 1990s. With the many advances that have been made in
research and treatment in recent years, HIV is now usually seen to be a
chronic and manageable illness.
Nonetheless, being diagnosed with HIV tends to come as a shock for most
people. Receiving this news can give rise to strong reactions and
emotions, all of which are legitimate and need to be taken into
consideration. Reactions vary from one person to the next, but most
people usually find themselves facing a number of questions: What
impact will this have on my health and my future plans? How will I go
about sharing this information with the people around me? Will the
people that I’m close to start treating me differently?
This guide has been created to help you find answers to the various
questions that are likely to come up in the days, weeks, and months
following a diagnosis. We ha ve designed it to provide information,
references and support so that you can make informed choices and work
through some of your next steps with less fear and anxiety.
Keep this booklet handy. The strategies it offers will support you in
getting used to the various changes and challenges you are likely to
experience. The news that you are living with HIV will require a period of
adjustment, and this guide can help you find ways to reduce the
impact of these adjustments on your physical, psychological, emotional,
and social well-being.
The staff and volunteers at RÉZO
1
You have just been told that you are
HIV-positive.
News that’s not easy to deal with...
Being told that you are HIV-positive can leave you in a state of shock,
sometimes accompanied by the feeling that you’ve been physically
wounded. You will no doubt need to take time to deal with the
diagnosis and begin a process of accepting and integrating a new reality
into your life.
In the days following the diagnosis, you may feel like you’re going through
a crisis. Your emotions may be sudden and intense. Give yourself time to
adapt. It’s best to avoid making any major decisions because you may not
be thinking as clearly as you normally would.
When revisiting this moment in their life, some HIV-positive men told us
that it felt like they were living in an altered state and were losing their
sense of self. They felt as if they had become spectators in their own lives
and had lost control over what was going to happen to them. Other men
told us about making decisions they later came to regret such as talking
about their diagnosis with colleagues, selling off their possessions,
ending a relationship, or distancing themselves from loved ones.
1)
The First Days Following an
HIV-Positive
Diagnosis
This section deals with the experience of receiving a
diagnosis of HIV infection and how this may affect you
emotionally and physically. It offers suggestions that can
help you accept and come to terms with this new and
challenging experience.
The important thing during the first few days is to give yourself the time
you need to absorb the shock, adjust to this new reality, listen to your
needs, and express your emotions. Try to gravitate towards things that are
comforting and give you a sense of calm. It may be as simple as
spending an afternoon at the movies, going for a coffee with a friend, or
just cocooning. Whatever you choose, treat yourself as someone special!
Remember, it is now possible for people living with HIV to live long lives
and enjoy a good quality of life.
After the first few days
The first days after receiving a diagnosis can be difficult. Many people
who have gone through this experience say that it was a time for taking
stock of their lives, thinking about what they might stand to lose, and
recognizing that they would have to make changes to some of their habits
and routines. Most also found that they had to go through a period of
grieving before they were able to adapt to such a major change in their
lives.
It’s normal for you to feel angry, and it can even be normal for you to want
to turn this anger against yourself. For instance, you may have regrets
about the times that you did not use a condom. Or you might be angry
with the person you think may have infected you. All sorts of ideas might
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rush helter-skelter through your head, such as thinking that he lied to you
or that he did it on purpose. Being angry with all gay men, feeling that you
can’t trust anyone, that all relationships are fleeting, that risks are not
talked about or that people pretend they don’t exist... all of these issues
can come up. In the end, you may simply be furious. Furious and
speechless.
Other feelings may follow: guilt, shame, sadness, fear, anguish,
discouragement. The range of possible emotions is broad. Regardless
of what you feel, there is one key thing to remember: avoid denying
your feelings.
Make room for these emotions rather than trying to escape from them or
hold them back. Find someone to talk to. Confide in the person or people
you usually turn to when you are going through a difficult time. The
emotions that may now be overwhelming are absolutely legitimate and
it’s important to get them out. Talk to a friend, to your partner or boyfriend,
to a family member, or a professional counsellor. Expressing your feelings
will help you to deal with them. At the end of this booklet, you will find a
list of support services that can be helpful in thinking about your next
steps.
In short, remember to take care of yourself and listen to your emotions.
Offer yourself a few creature comforts and enlist sources of emotional
support in the days following your diagnosis. While it’s certainly not
necessary to tell everyone (see Section 4. Disclosing Your HIV Status);
finding someone who will let you put your experiences into words will
help you to get through this difficult period.
Take care of yourself in the same way as you would anyone who’s
very dear to you.
2)
HIV
This section explains more about what HIV is and provides
some basic facts about HIV infection.
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Since the early 1980s, the HIV epidemic has had a major impact on the
gay community. In North America and in many European countries, gay
men remain the population today with the highest infection rate.
Since 1985, MSM (men who have sex with men) have accounted for
68.1% of positive HIV tests in Canada. In 2005, 45% of all new HIV
infections in Canada occurred among MSM. In Montreal, an estimated
12.5 to 15% of the MSM population is infected with HIV.
Some facts:
• Finding out that you are HIV-positive does not necessarily mean
that you are sick, that you have AIDS (the most
advanced stage of the infection), or that you are dying;
• Most HIV-positive people continue to live for many years
following their diagnosis, are in good health, and are able
to enjoy a good quality of life;
• A range of medications are available today that are less
harmful to the body, are effective in slowing down the
progression of HIV and, as a result, can considerably increase
life expectancy;
• Not all HIV-positive people need to go on treatment
immediately. The need for treatment can vary from one
individual to another. Your doctor and the other healthcare
professionals you consult can give you the information you
need, based on your situation and your state of health. With their
help, you’ll be able to make informed decisions and
find out which choices may be best for you.
2.1) What is HIV?
HIV stands for “human immunodeficiency virus.” This virus reproduces
using cells from the immune system, in particular a type of white blood
cell (lymphocyte) called a “CD4” cell. Cells infected by HIV gradually lose
their protective function, weakening the immune system
and allowing the virus to spread throughout the body. With the
immune system weakened, it becomes easier to contract other types of
infections.
In Canada, an HIV-positive person is considered to have developed AIDS
(acquired immune deficiency syndrome) if an opportunistic infection is
present. AIDS is the name given to one of the phases of HIV infection.
Reaching this phase does not mean that your immune system will no
longer function properly. In most cases, taking certain medications will
allow the immune system to regain its strength so that your body can
once again combat most infections.
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2.2) What are CD4 cells?
CD4 cells are an important component of your immune system, the
defense system that protects you when harmful microorganisms enter
your body.
Getting a test of your “CD4 count” involves measuring the level of CD4
cells in your blood. People who are in good health will generally have a
CD4 count ranging from 500 to 1200. Individuals with a weakened
immune system and a lower CD4 count can nonetheless live for a very
long time, but their health will usually be more fragile and they will be
more susceptible to contracting various infections.
Having your CD4 count tested is important because it provides
an indication of how HIV infection is progressing in your body.
This information enables your doctor to determine the right time for you
to begin treatment.
By taking blood tests every three to six months, your physician can keep
track of your CD4 count. The advice that your doctor gives you and the
recommendations that he or she makes will depend on whether your CD4
count is increasing, stable, or decreasing.
2.3) What is viral load?
Viral load is a measurement of the concentration of HIV virus in the blood.
It is calculated as the number of copies of the virus per millilitre (mL)
of blood.
Results of a viral load test can range from 50 copies per mL of blood
(an “undetectable” viral load) to several million copies per mL of blood.
Important note: An undetectable viral load does not mean that the HIV
is absent, but rather that the amount of virus in the blood is too
low for current laboratory procedures to detect. (See Section 3.2,
HIV transmission and undetectable viral load.)
Remember: The higher the viral load, the greater the risk that your
immune system will become weakened. A high viral load also increases
the potential for transmitting HIV during certain sexual activities
(such as anal sex without a condom, or oral sex if semen is ingested).
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As explained in the previous section, HIV affects your immune system
(your body’s defense system), making you more vulnerable to certain
other infections. It’s also important to remember that HIV can be
transmitted to other people, in particular through unprotected sex.
If you have contracted HIV, you may be asking yourself the following
questions:
• What do I need to do to maximize my chances of staying
healthy?
• How can I make sure that I don’t transmit HIV to
someone else?
• How can I protect myself from other sexually transmitted
infections (STIs) and still have an active and satisfying
sex life?
This section will provide you with some answers and
avenues for personal reflection.
3.1) How HIV is transmitted?
3)
Knowing how HIV is transmitted can help you to avoid transmitting the
virus to someone else or getting reinfected yourself. It’s useful to
remember that there are still many people who have very limited
knowledge about HIV. Unfortunately, this can perpetuate fears and
prejudices. Some of the people in your life may have preconceived
notions or incorrect information, and you may find yourself taking on a
role as an educator.
Sexual Health
This section deals how HIV is transmitted, what can be
done if a sexual partner comes in contact with the virus,
and whether it is possible to be reinfected with a different
strain of HIV.
HIV can be transmitted through contact with the following bodily fluids:
blood, precum, semen, vaginal fluids, and breast milk. The type of contact
is also important, and not all contact is risky. For example, there is no risk
of transmission if an HIV-positive person’s semen comes in contact with
healthy, unbroken skin on another person. On the other hand, there is a
far greater risk if the same semen comes in contact with a mucous
membrane (the moist skin that lines certain cavities and body parts such
as the eyes, nose, mouth, urethra, rectum, and vagina) because mucous
membranes are more delicate and easy to irritate, and are more
susceptible to having tiny cuts or tears that are invisible to the naked eye
(microlesions). These microlesions can provide a point of entry for
the virus.
The likelihood of transmitting the virus is greater for some sexual
activities than others. The following scale, divided into four levels, can
help you to determine the degree of risk associated with specific sexual
activities or practices: 1) risk-free activities; 2) activities with negligible
risk; 3) low-risk activities; and, 4) high-risk activities.
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Risk-free activities
Low-risk activities
The following sexual practices do not meet the conditions for potential HIV
transmission because they do not involve an exchange of bodily fluids
that pose a risk (precum, semen, blood, etc.).
The following activities present a potential for HIV transmission because
there is contact with bodily fluids that pose a risk (precum, semen,
blood, etc.).
There are no confirmed reports of HIV infection attributed to these
practices:
A few confirmed reports of HIV infection have been attributed to
these practices:
• Touching, fondling, masturbation
• Kissing
• Anilingus (oral stimulation of the anus, often called “rimming”)
• Performing oral sex (giving a blowjob) if precum or sperm is
taken into the mouth
• Anal sex WITH a condom*, for both the insertive partner (“top”)
and receptive partner (“bottom”)
• Fingering (insertion of the finger into the anus)
• Sharing toiletry items (nail clippers, razors, toothbrushes, etc.)
• Using sex toys (a new condom is necessary any time insertive
sex toys such as dildos are shared by a new person)
• Activities such as the use of whips, restraints, clamps, etc.
• Contact with feces (scat, etc.)
• Contact with urine (watersports, golden showers, etc.)
• Electrolysis, acupuncture, tattooing, body piercing, etc.
(if practised by professionals who take the necessary
precautions and comply with basic hygiene standards)
*Anal sex with a condom is considered to be low risk rather than
negligible risk because condoms can tear or slip during sex, thus
increasing the potential for HIV transmission. To reduce the chance that
this will happen, ensure that the condom is not past its expiry date and
use a water or silicone-based lubricant (oil-based lubricants such as
Vaseline or Crisco should be avoided).
High-risk activities
Activities with negligible risk
The following activities present a significant potential for HIV transmission
because there is contact with bodily fluids that pose a risk (precum,
semen, blood, etc.).
The following practices present the potential for HIV transmission
because there is some contact with bodily fluids that pose a risk (precum,
semen, blood, etc.). However, the amount and the type of contact are such
that the risk of transmission is considered to be negligible.
A significant number of scientific studies have demonstrated an
association between these practices and HIV infection:
There are no confirmed reports of HIV infection attributed to these
practices:
• Receiving oral sex (getting a blowjob, having the penis sucked)
• Performing oral sex (giving a blowjob, sucking the penis) on a
partner who is not wearing a condom if precum or sperm is not
taken into the mouth
• Fisting (inserting the hand into the rectum)
• Sharing items that are used to snort or smoke drugs (straws,
rolled bank notes, pipes, bumpers etc.)
• Anal sex WITHOUT a condom, for both the insertive partner
(“top”) and receptive partner (“bottom”)
• Sharing sex toys (unless they are disinfected and covered with
a new condom each time they are shared by a new person)
• Sharing needles or syringes (injecting drugs or steroids, etc.)
• Non-professional (“home”) body modification practices
(tattooing, body piercing, etc.) using unsterilized or improperly
sterilized needles and equipment
For more information about the risks associated with these various
practices, talk with your doctor or contact RÉZO
(see the list of support services found at the end of this booklet).
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3.2) HIV transmission and undetectable
viral load
In January 2008, the Swiss National AIDS Commission (EKAF) issued a
statement to the effect that HIV-positive individuals who are taking and
responding effectively to antiretroviral treatment and who are not
infected with another STI are unlikely to transmit HIV during sexual
intercourse (Vernazza, 2008). The statement was based on a review of
research and consultations with a committee of experts.
In theory, this means that if you do not have any other STIs and if your
anti-HIV treatment has been working effectively (i.e. your viral load is
undetectable) for a period of at least six months, the risk of transmitting
HIV to a sexual partner is negligible.
The World Health Organization (WHO) and a number of other agencies
have nevertheless advised caution. The Montreal Public Health
Department has stated that “a more in-depth study [is] necessary” and
has continued to recommend condom use as the best way to prevent HIV
transmission.
It is important to note that that most of the research studies examined by
the EKAF dealt with heterosexual practices.
All of this can be quite confusing, bringing many
questions to mind and leaving you unsure about what
to think...!
How and when will I know if my viral load is undetectable?
Your doctor will give you your viral load results during your check-ups.
How can I keep my viral load from increasing?
You will need to rigorously adhere to your medication schedule (See
Section 6.3 What is treatment adherence?). You should also get tested for
other STIs on a regular basis.
According to the EKAF statement, it’s important not to be infected
with any other STIs. Why?
If the viral load in your blood is undetectable, it will also normally be
undetectable in your semen. If you have another STI, however, the viral
load in your precum and semen can go up significantly—even if it
remains undetectable in your blood. As a result, an HIV-positive person
who is infected with another STI will be more likely to transmit HIV than
an HIV-positive person who does not have any other STIs.
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How can I tell if I have an STI?
If you have any of the following symptoms, you have most likely
contracted an STI: whitish or yellowish discharge from your penis, burning
sensation while urinating, painless or slightly painful sores or ulcerations
on your genitals. It’s important to know that STIs can cause few or no
symptoms in some individuals. For example, 50% of men who contract
gonorrhea have no symptoms. If you have more than one sexual partner,
you should get tested on a regular basis. The general recommendation is
to get tested between one and four times a year, depending on your
number of sexual partners.
Except in cases where a person rigorously adheres to anti-HIV treatment
and has a consistently monogamous sexual relationship limited to one
partner (who is also consistently monogamous), it may be premature to
conclude that an HIV-positive person will no longer be contagious solely
based on a periodic test measuring viral load in the blood. For this
reason, we do not advocate following the EKAF statement.
If both you and your partner are HIV-positive, you are in a monogamous
relationship, each of you is carefully adhering to an effective anti-HIV
treatment regimen, and the two of you no longer want to use condoms, it
would be best to consult with your doctor or someone on his or her team
before making the decision to do so.
Remember
• The risk of transmitting HIV increases if another STI is also
present.
• If you want to stop using condoms with your HIV-positive
partner, we strongly advise discussing this with your doctor
or one of the healthcare professionals with whom he works.
3.3) Post-Exposure Prophylaxis (PEP)
In general terms, prophylaxis is a drug treatment prescribed to prevent an
infection. In the case of HIV, post-exposure prophylaxis (PEP) refers to
specific medications (a combination of two or three antiretroviral drugs)
that can be taken by a person who has been exposed to the virus in order
to prevent an HIV infection from taking hold. The treatment needs to be
taken for about a month following the exposure.
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If you have sex with an HIV-negative partner (or with someone who does
not know his HIV status), and the condom tears or slips, you can give him
the following information.
He should see a doctor as quickly as possible to assess whether there is
a risk of transmission. If the doctor recommends that PEP be prescribed,
the treatment will need to be started right away. Ideally, it is
recommended that PEP be started within 24 hours of exposure (PEP is
believed have little effect if it is started more than 72 hours after
exposure).
To receive the best possible evaluation of the risk of transmission and to
get a PEP prescription, the person should go to a clinic that specializes in
treating HIV and other STIs (see the list of support services found at the
end of this booklet). Outside of regular clinic hours, it’s also possible to go
to a hospital emergency room. The person should tell the emergency staff
that he has been exposed to HIV (Quebec hospitals offer this service and
have the necessary protocols in place).
3.4) Reinfection
There has been ongoing concern that a person infected with HIV could get
reinfected with another strain of the virus (such as a strain that is
resistant to certain drugs). While some research has provided evidence
that reinfection is possible, to date few cases have been documented.
It is hoped that further research will shed more light on this issue. In the
meantime, continuing to use condoms (even if your partner is also
HIV-positive) seems to be the best course of action.
For more information about reinfection, talk with your doctor.
4)
Disclosing Your HIV Status:
To Tell or
Not To Tell?
This section outlines some important things to consider if
you are thinking about disclosing your HIV status to various
people in your life, such as a long-term partner and
regular or casual sexual partners.
Disclosing your status as a person living with HIV can be
complicated and there are a number of issues you will
want to consider. For instance, the way you go about
sharing this information with friends and family members
will likely be quite different than with regular or casual
sexual partners.
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The subject of HIV can cause some people to react with fear or prejudice.
These reactions might be based on what they know about the disease or
conversely, what they don’t know. As a consequence, you may feel
hesitant to tell people about your HIV status. Stress, shame, and a whole
range of other emotions can come into play. It’s normal to have such
feelings...
The fears you may be experiencing are only human. You might be afraid
of losing a longstanding friendship or the love and support of family
members. Perhaps you’ve had your eye on someone you find attractive
and you’re worried he’ll no longer be interested.
Certain feelings, at times painful, can be similar to what you may have felt
when “coming out” as a gay or bisexual man. The things that helped you
face that challenge can be a source of strength as you enter this new
phase in your life.
Finding the right person to confide in can be an enriching experience.
Among other things, you may develop a closer relationship with this
person and be able to count on his or her support.
Some reasons why you may want to tell others about your
HIV status:
• To discuss your fears, reduce anxiety, and find support and
reassurance when you are facing difficulties;
• To share your concerns and worries about the diagnosis and its
potential impact on your life, your plans, and your dreams for
the future;
• To feel that you are being true to yourself and honest
with others;
• To help you in finding the care and services that best meet your
needs;
• So that you and your sexual partners will have the information
you need to make informed decisions about your sexual
practices;
• So that, like those before you who have made the decision to
disclose their status, you can feel better physically, mentally,
and socially.
If you have just found out about your status:
• Did you tell anyone that you were going to get tested for HIV? If
so, this person will most likely ask you about the results;
• Remember that you are under no obligation to tell anyone about
your results. In the first instance, give yourself some time to process the news;
• You may be feeling lost or upset. These feelings are normal and
many people experience them after receiving an HIV-positive
diagnosis;
• You may also feel like you need to find someone to confide in. If
this is the case, talking with someone to you’re close to or
contacting a community worker or healthcare professional is a
good idea;
• Is there a person you instinctively turn to when going through a
difficult times? Be it a friend or a relative, this person will likely
be a good listener and source of support.
Further along in this section, four questions are provided that can help
you to gain some clarity and decide who might be the best person to
confide in. But first, here are a few important considerations.
As may have been the case when you told others about your sexual
orientation, the path ahead will contain obstacles, risks, and challenges.
By all means, do not assume that it is necessary to disclose your HIV
status at any price. Take stock of the issues and assess your
circumstances: you are the best judge of the pros and cons.
Some reasons why you may not want to disclose your HIV status:
• Because people can have reactions that are hurtful or unkind;
• Because some people may reject or discriminate against you;
• Because people may ask you intrusive questions about your
health, your feelings, your sex life, or your morals;
• Because the people you tell may become upset and put you in
the position of having to provide them with emotional support;
• Because you are afraid that people will look at you
differently, feel sorry for you, or treat you as if you are fragile
and vulnerable;
• Because you are afraid that it will no longer being possible to be
in a long-term relationship;
• Because you are afraid of being seen as someone whose days
are numbered.
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4.1) Four questions to ask yourself
before telling someone about your HIV status
Question 1: Why do you want to tell this person in particular?
You have decided to tell someone about your HIV status. What do you
hope will be the outcome of this conversation? Will he or she be able to
offer you the help and support that you need? To what extent do you feel
that this person needs to know? Answer these questions honestly and
decide if you have really chosen the right person.
Question 2: How is he or she likely to react?
Think about how this person is likely to feel when he or she learns the
news. Is there a chance that he or she will become seriously upset,
putting you in the position of having to provide support and
reassurance? Or is it more likely that the person will react calmly and be
empathetic? Do you think the person will offer you his or her support?
Question 3: Can the person keep a secret?
When you tell someone about your HIV status, you will need to be clear
about the extent to which you want this information to remain
confidential. Ask yourself if this person warrants your trust and if he or
she is capable of understanding and respecting the degree
of confidentiality that you feel is necessary. Make sure that he or she is
not the type of person who will put pressure on you if there are other
people you have, for the moment, decided not to tell.
That said, remember that the person you tell may feel somewhat
worried or upset, He or she may, in turn, want to talk to someone. If you
forbid this person to do so, he or she will be alone with your secret.
Question 4: In what setting will you have your conversation?
Choose a place where you’ll feel at ease, determine an appropriate time,
and think about how you will broach the subject. You might find it easier
to talk while taking a walk, while sitting on a park bench, or by going for
coffee. It’s possible that you will prefer to put things in writing. Use what
you know about the person to help you to create the right atmosphere.
Bear in mind, though, that keeping such a big secret to yourself and
hiding your HIV status from people you are close to could also be a major
source of stress.
The four questions listed above can help you to weigh the pros and cons
of telling family and friends. The key thing is to minimize any extra
sources of stress—you have enough to deal with already!
4.3) Telling the people you live with
Your regular appointments (with doctors or other health professionals)
and the possibility that you will need to take medications on a daily basis
may make it difficult to prevent the people you live with from becoming
aware of your HIV status. And if they know, they may worry unnecessarily
about the risk of infection. Providing them with information about HIV can
help to reassure them (see the list of support services found at the end of
this booklet).
HIV TRANSMISSION IN THE HOUSEHOLD ENVIRONMENT:
WHAT YOU SHOULD KNOW
Generally speaking, HIV is transmitted through unprotected sex, by
sharing drug injection equipment, or from mother to child during and after
childbirth. (See Section 3. Sexual Health.)
There is no risk of transmission through everyday contact.
No one has ever contracted HIV:
• By sharing household items (dishes, eating utensils);
• By using the same bathroom (toilet seat, wash basin);
• By sharing common spaces (office, living room).
4.4) Telling your sexual partners
4.2) Telling family members and close friends
Telling your sexual partners that you are HIV-positive can be especially
ag o n i z i n g . Unfortunately, people living with HIV have experienced
rejection on many occasions because of their status. It’s all too understandable that some people become hesitant to disclose the fact that
they’re HIV-positive. That said, it’s important to remember that in many
cases, it’s not really you who’s being rejected. Instead, people are often
reacting to the fear they feel due to a lack of knowledge about HIV.
The type of relationship that you have with family members and close
friends can guide you in determining whether or not you want to tell them
about your HIV status. If there are people in your immediate circle with
whom you do not tend to share this type of personal information, do really
want to tell them that you are HIV-positive?
As suggested previously, ask yourself why you might consider telling a
sexual partner that you are HIV-positive. A number of factors will likely
determine the decision you make. What type of relationship do you have
(casual, long-term)? What type of sex do you have? Some people living
with HIV take the view that there is little reason to disclose their status if
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their sexual practices involve no risk of transmission or if the risk is
negligible or very low. On the other hand, if you are of the view that
decision-making in a sexual relationship ought to be shared, it may be
very important for you to inform your partner. You may also want to
disclose your status, as some men do, for legal reasons. (See Section 4.5
What the law says.)
4.5) What the law says
Location and timing may also influence your decision about whether to
tell sexual partners that you are HIV-positive. Bars, saunas, and sex clubs
are clearly not the most ideal places to disclose your status. That said, it’s
useful to consider whether you might run into the same person at the
same place at some point in the future and be obliged to tell him about
your status. He might not appreciate the fact that you didn’t tell him the
first time.
HERE IS WHAT THE LAW SAYS:
Under Canadian law, a person living with HIV may be found guilty of a
crime for not disclosing his or her HIV-positive status prior to engaging in
certain activities. Charges have been laid against people living with HIV in
numerous cases, particularly cases involving sexual contact.
A person has a legal duty to disclose his or her HIV-positive status
to sexual partners before having sexual relations that pose a
significant risk of HIV transmission. This includes anal or vaginal sex
without a condom.
Which other activities require disclosure of HIV status is not fully clear.
Some of your sexual partners may have unrealistic expectations about
sex and HIV. For example, they might make the assumption that all gay
men who are HIV-positive systematically disclose their status to each and
every partner. Once they know that you are HIV-positive, they might also
begin to question the safety of condoms and lubricant regardless of the
scientific evidence. Is there any way to anticipate people’s reactions?
Truth be told, when you meet someone new, it’s difficult to foresee how
he will react or the degree to which he will show respect for the details
of your private life.
This is one reason why some people living with HIV prefer to wait and to
get to know a sexual partner a little bit better before talking about their
status. Other people like a more direct and casual approach and prefer to
mention their status from the get-go to avoid wasting time with a person
who cannot deal with this information or is not open to pursuing a
relationship with someone who is HIV-positive.
Talking about HIV status with a sexual partner
• Is it for life?
• Or one night?
• Is this a location in which I feel comfortable having
this discussion?
• What kind of sex are we going to have?
• Will our sexual practices be high risk?
It’s your decision whether or not to tell a sexual partner about your
HIV status. Even if you decide to keep this information to yourself, you can
still practice safer sex to avoid transmitting the virus, getting reinfected,
or contracting another STI. The following section will provide you with a
brief overview of legal issues in Canada related to the disclosure of
HIV status to sexual partners.
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What about practices that pose a lower risk?
There is only a duty to disclose when there is a significant risk of
transmitting HIV. However, the law is unclear about whether a person
living with HIV has a duty to disclose his or her status when engaging in
sexual practices that pose a negligible or low risk of HIV transmission
(See Section 3.1 How HIV is transmitted). It could be argued that the risk
of transmission is low enough in the case of some activities that it should
not be considered a significant risk and therefore that the person has no
legal duty to disclose. But this has not yet been confirmed by a court of
law in Canada.
There is no legal duty to disclose HIV-positive status to partners before
engaging in activities that carry no risk of HIV transmission (e.g., kissing,
masturbation, jerking off your partner, etc.).
For vaginal or anal sex with a condom, disclosure is not mandatory.
The Supreme Court of Canada has said that “the careful use of condoms
might be found to so reduce the risk of harm that it could no longer be
considered significant.” However, in a judgement rendered in July 2008,
a judge stated that if a person has a detectable viral load, that person
has a legal obligation to disclose his or her status to a sexual partner even
if a condom is used.
How to avoid criminal charges?
• Clearly disclose your HIV-positive status before engaging in any
activity that risks transmitting HIV, and in particular before
e n g aging in unprotected anal or vaginal sex or sharing
drug-injection equipment.
• Avoid sex that is considered “high risk” for HIV transmission,
especially unprotected anal or vaginal sex.
• Avoid sharing needles or other drug-injection equipment.
Source: Canadian HIV/AIDS Legal Network, Criminalization of HIV exposure: current Canadian law,
2008. Info sheet, 4 pages.
N.B.: The law evolves as new court cases come forward., For up-to-date information,
visit the Web site of the Canadian HIV/AIDS Legal Network (www.aidslaw.ca).
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4.8) Some situations to consider
4.6) Telling your spouse or long-term partner
If you are in a long-term relationship when you receive your diagnosis,
you will no doubt ask yourself whether you should tell your partner.
Sharing this information will probably generate a certain amount of
tension and concern. Your partner may become worried about his own
health and want to get tested for HIV. He might also suggest that you
reassess your sexual practices. On the other hand, he may also become
a source of help and support during this difficult period.
The prospect of telling your partner can put you in a delicate situation,
regardless of how he reacts. Consult the list of support services found at
the end of this booklet if you need some assistance. Help is available for
you and your partner.
4.7) Telling former sexual partners
If you think that you want to tell a former partner about your HIV status,
ask yourself the same questions that you would ask with regard to a
current partner. What type of sex did you have? What type of relationship
did you have? Do you think he would want to know about your status? Do
you want him to know?
In addition to these considerations, telling a former partner about your HIV
status can raise fears and concerns about “who’s responsible?” Is he the
one who transmitted the virus to you? Did you transmit it to him?
If you are unsure about how to deal with these questions, talk with the
professionals at your health clinic. They will be able to give you some
guidance on how to make the choices that are best for you. You can also
arrange to have them contact a former partner and recommend that he
get tested in a way that maintains your anonymity.
You may be able to relate to some or many of the following
scenarios. Talking to other people living with HIV or to a
professional can often make it easier to think about how to
handle situations like these. The list of support services included
at the end of this booklet can help you to find the sources of
support that are right for you.
You are going through a difficult time. You have just learned that
you are HIV-positive. You feel depressed and life seems gloomy.
You are concerned about your health. Your regular sex partner
knows about your diagnosis. He himself has been HIV-positive for
10 years. Now that you are HIV-positive too, he wants you to
start fucking him without condoms.
How do you react? What are your thoughts?
It has now been 12 months since you found out that you were
HIV-positive. Your boyfriend is HIV-negative. You have always
used condoms when having anal sex but tonight you don't have
any. Your boyfriend is really horny, and he tells you that it will be
alright “just this once” because the chances that he'll get
infected are very slim.
How do you respond?
You have always been close to your sister and you are used to
confiding in her, but she has grown more distant since she found
out that you are HIV-positive. On the rare occasions that you now
see each other, she is always alone and no longer brings along
your two nephews.
Do you bring this up with her? If so, how do you go
about it?
You are at the sauna and a sexy guy takes you into a dark
labyrinth. You grab each other passionately. You really want him.
You say nothing to each other. He lubricates his cock and gets
ready to fuck you. You tell him that you are HIV-positive and ask
him to put on a condom. He gives you a surprised look and walks
away without saying another word.
How do you react?
You are in a bar. You have just met this interesting guy. You find
him gorgeous, funny, and you’re very attracted to him. He invites
you home for a nightcap... In you mind, you are already hoping
that this will be more than just a one-night stand.
Do talk to him about your HIV status? If yes, what are your
reasons for doing so?
You have just learned that your viral load is undetectable. You’re
really happy. You feel like you’re alive again! You meet a young
guy in the street and he takes you to his place. You feel attractive
and you’re ready for some hot sex... Before you know it, he has
straddled you and your cock has gone almost completely up
his ass.
What do you do?
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5.1) What will happen to my health now?
From this point on, a new reality has entered your life—the fact that
you are living with HIV.
A whole range of questions have no doubt come to mind:
• To what extent can I be healthy if I am living with HIV?
• What impact will HIV have on my quality of life?
• What will be the impact on my social life, my emotions,
and my sex life?
• Will I have to change my lifestyle?
Some of the changes that may occur in your life as a result of living with
HIV are discussed in the sections that follow. In particular, we will look at
different dimensions of your overall health: physical, mental, sexual, and
spiritual. Each of these is an integral part of who you are. Neglecting any
one of them will very likely have an impact on the others.
5.2) Physical health
5)
General Health:
Taking Care of
Yourself
This section deals with the different dimensions of a
person’s health—physical, mental, sexual, and spiritual—
that contribute to overall well-being.
In preceding sections, we discussed some of the physiological aspects of
HIV infection. In an upcoming section, Treatment for HIV, we will look at
medications. Physical health, of course, involves more than simply CD4
counts or the side effects of medications.
A number of factors have an influence on your internal organs, your
immune system and how HIV infection progresses in your body. You can
exercise a lot of control over many of these factors on a day-to-day basis
and in a number of fairly simple ways. Among other things, you can
determine what you eat, how much exercise you get, and the number
of hours you set aside for sleep.
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5.2.1) Exercise
5.2.3) Diet
Exercise is an important and necessary way to keep the various
components and systems of your body in working order. Studies
have shown that there is a correlation between physical activity and
the strength of the immune system.
There is an undeniable connection between what you eat, your
energy level, and your physical and psychological well-being.
The food you eat provides the fuel that enables your body to
function properly. Food also fortifies your immune system. For these
reasons, it’s important to ensure that you have a healthy,
balanced diet.
If you have not been physically active or participated in sports in the
past, start gradually to give your body time to adjust. For example,
you might want to begin with a daily walk to the office or after work.
Start out with about 20 minutes, and then pick up the pace. If
walking doesn’t appeal to you, try swimming, cycling, jogging,
or skiing.
Try signing up for a group activity if you find it difficult to get
motivated. Exercise is often more rewarding and more fun if you do
it with other people. There are plenty of clubs for people who like to
walk or to play tennis or badminton. Need ideas? Go to a recreation
centre in your neighbourhood and consult their program, leaf
through your favourite gay magazines or look online. You’re sure to
find an activity that’s right for you.
5.2.2) Sleep
Sleep is essential to restore and regenerate your body’s cells, and
also greatly benefits your immune system.
Physical activity, eating habits, and stress have an especially
important influence on the quality of a person’s sleep. The number
of hours you sleep will, in turn, have an impact on your metabolism,
your mood, and your energy level. Getting enough rest is vital if you
want to maintain your overall physical and mental balance.
If you have trouble sleeping, a relaxing activity such as reading,
meditation, or listening to music can help you to fall asleep more
readily. If something is bothering you and you can’t stop thinking
about it, get up and write it down on a piece of paper. This simple
trick can often put a stop to those troublesome thoughts that keep
rolling around in your mind, allowing you to relax and fall asleep.
If you regularly suffer from insomnia, talk about it with your doctor.
He or she will be able to suggest possible solutions.
A proper diet can also reduce the risk of developing certain health
problems (such as hypertension or osteoporosis), and may help to
prevent certain diseases (for example, diabetes, heart disease and
cancer). Balance is the key. Eat lots of fresh fruits and vegetables
and make sure to get enough carbohydrates (bread, rice, and
grains), protein (eggs, meat, legumes, and nuts), and unsaturated
fats (such as olive or nut oil). Drink plenty of water, herbal tea, and
fruit juice (you may want to avoid certain brands of juice that have
very high sugar content).
You can find more detailed information in the food guides for
people living with HIV that are usually available in clinics that
specialize in providing healthcare to people who are HIV-positive.
Your doctor will also be able to answer some of your questions or
refer you to a nutritionist.
5.2.4) Drugs, alcohol, and tobacco
Regardless of whether or not a person is HIV-positive, drugs,
alcohol, and tobacco should be used in moderation.
If you do use drugs or alcohol, it’s important to consider what
impact the use of these substances has on your life in general and
whether drug or alcohol use increases the possibility that you might
take risks when having sex.
How can I find a balance between the pleasure
I get from using certain substances and the
importance I give to taking care of myself?
Personal reflection on these matters will often lead a person to opt
for moderation.
Tobacco is harmful to the health of all smokers, but smoking is even more
harmful for people who are HIV- p o s i t i v e . Studies have shown
that HIV-positive smokers are at a greater risk of developing
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27
bacterial pneumonia. HIV infection and the side effects of the medications
used to treat HIV already increase the risk of heart disease, and smoking
can elevate this risk.
It’s not easy to quit smoking, but there are many ways to get help
and support. Talking to your doctor or contacting a centre that specializes
in helping people to quit smoking can increase your chances of success.
See the list of support services found at the end of this booklet for some
useful references.
5.3) Mental health
5.3.2) Avoid depression by staying active
Feeling depressed can often make you feel like doing nothing.
Unfortunately, these feelings can mutually reinforce each other.
Getting involved in activities that you enjoy can help you avoid
falling into a vicious circle of depression and inactivity. Staying
active will allow you to focus on experiences that are meaningful
and positive and keep you from being drawn into a spiral of
depressed feelings. Whenever you begin to feel a sense of apathy,
take action quickly to break the cycle.
Feelings of depression
You have fewer
meaningful and positive
experiences
Anyone can have emotional and psychological problems, but a number
of studies have shown that HIV-positive people have a greater risk of
experiencing mental health difficulties. Social stigma and discrimination
are among the key causes.
The following suggestions can help you maintain the mental balance
needed to avoid depression or anxiety.
5.3.1) Confide in someone
Research has shown that people who talk to friends, loved ones, or
acquaintances live longer and tend to have fewer physical and
emotional problems. Confiding in someone is beneficial
and comforting. That said, it’s best to exercise care in choosing the
people you confide in. Some people’s reactions may be the
opposite of what you are expecting (See Section 4. Disclosing Your
HIV Status).
You may also want to join a group or discussion forum where you
can talk with other people who have gone through experiences
similar to yours. Getting support from a psychologist, social worker
or a staff person at a community organization is another option. Talk
to your doctor or consult the list of support services found at the
end of this booklet.
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You do fewer
activities
Based on your tastes and personality, there may be any number of
activities that you’ll have fun doing. Choose an activity that you find
enjoyable, be it working out at the gym, having a drink with friends,
inviting the family over for dinner, visiting a place of worship,
playing sports or doing volunteer work.
Nothing appeals to you at the moment? Think of activities that you
have enjoyed in the past, try to fit them in into your schedule, and
encourage yourself to take action. Your heart may not be in it for
now, but...
5.3.3) Take the time to relax
Both the body and the soul need rest. It’s important to give yourself
a break from time to time so that you can clear your mind and let
go of the pressures and concerns of daily life. There are lots of ways
to relax: take a hot bath, go for a long walk, listen to music...
There are also a number of specialized techniques (breathing
exercises, meditation, yoga, qi gong, massages, aromatherapy, and
reflexology to name a few) that can help you to relax and get rid of
accumulated stress. If you’re interested in learning more about any
of these techniques, go to a bookstore or do a search on the
Internet. Community organizations sometimes offer free services
like massage or tai chi lessons for people living with HIV.
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In short, exercising, getting enough sleep, eating properly, limiting drug
and alcohol use, avoiding cigarettes, keeping the lines of communication
open, doing activities that you find enjoyable, and taking the time to relax
are all important aspects of maintaining good overall health. This may
seem like a long list, but you’re likely to experience both immediate and
long-term benefits if you take things at your own pace...
5.4) Sexual and emotional health
Sex feels good and is good for you! This is reason enough for wanting to
have an active and fulfilling sex life. Sex also has undeniable health
benefits: it helps you to relax and sleep better, it’s good exercise, it helps
to reduce pain, it improves blood circulation, and it lowers cholesterol
levels.
Of course, you now have an infection to deal with that can be transmitted
through high-risk sex practices. Living with HIV will require that you take
the necessary precautions to avoid transmitting HIV to others, that you
protect yourself from other STIs and that you take steps to maintain your
overall health.
According to the World Health Organization, “Sexual health is a state of
physical, emotional, mental and social well-being in relation to sexuality;
it is not merely the absence of disease, dysfunction or infirmity. Sexual
health requires a positive and respectful approach to sexuality and sexual
relationships, as well as the possibility of having pleasurable and safe
sexual experiences, free of coercion, discrimination, and violence.”
(WHO, 2008)
Sexual health encompasses both sexual relations and emotional
well-being, and is an important aspect of a person’s overall health. It’s
part of who you are as a human being and you need to take care of it just
as much as any other aspect of your physical and psychological
well-being.
Looking after your sexual health does not mean forcing yourself to limit
the number of sexual partners you have or, conversely, putting pressure
on yourself to have more sex. Instead, it involves listening to your needs
and taking the time to explore, touch, and enjoy your body. Discovering
your erogenous zones (the parts of your body that give you the most
pleasure) is an important aspect of sexual health and is something you
can do by yourself, with someone else, or with more than one person.
Sexual health involves sharing pleasure with sexual partners and living
these moments to their fullest.
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If you are avoiding sex because you are afraid of transmitting HIV or
because you feel you are no longer desirable, consult a professional or
talk to your doctor. Community organizations such as RÉZO (formerly
Action Séro Zéro) and Maison Plein Cœur also offer support and services
that can help you.
Health professionals and community organizations can also help if, by
contrast, you are troubled by the feeling that you have too many sexual
partners and this is having a detrimental impact on your life, or if you are
concerned that you may have developed an addictive relationship to sex
(these concerns could date back to your adolescence or could have emerged since getting your HIV diagnosis).
Getting tested for STIs on a regular basis is another important aspect of
looking after your sexual health. You may be surprised to learn that 50%
of men who contract gonorrhea or chlamydia have no visible symptoms.
Don’t assume you will be alerted to having an STI by the appearance of
symptoms—get tested!
5.5) Spiritual health
Spiritual health has to do with a person’s innermost experiences, referred
to by some people as the “soul.” Each of us has our own unique way of
defining and experiencing spiritual well-being. Setting aside moments to
enjoy a bit of solitude and do some introspection can be an important way
to learn about life and broaden your awareness.
Spirituality can take various forms: attending services at a temple or
church, going on a retreat, meditating, reading books about philosophy
or religion, practising yoga, etc.
People with rich spiritual lives often note that they gain a measure of
strength, courage, and hope that helps them make it through life’s
difficult moments.
The important thing is to follow your inspiration, although it’s advisable to
avoid sects or religious groups that seek to exercise moral, social, or
monetary control over their followers and that recruit new members by
taking advantage of people who are emotionally vulnerable.
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A number of medications are now available that work to slow down the
replication of HIV in the body and the progression of HIV to AIDS.
No treatment yet exists that can completely eradicate the virus from the
body, nor are there vaccines that can cure HIV infection (a “therapeutic”
vaccine) or prevent HIV transmission (a “preventative” vaccine).
6.1) How is HIV treated?
A combination of medications called antiretrovirals (“ARVs”) is used to
treat HIV infection. HIV treatment is often referred to as “triple therapy”
because in most cases, a person takes a combination of three different
medications.
ARVs act on various stages of viral replication, suppressing the ability of
the virus to reproduce (make copies) of itself. This, in turn, prevents the
virus from breaking down the immune system.
If you adhere rigorously to your treatment on an ongoing basis, viral
multiplication in the blood will be almost completely suppressed, with
many benefits for your health.
6.2) At what point should you
begin treatment?
6)
When to start treatment is a decision that you and your doctor will make
together. Various factors will need to be considered, including changes to
viral load and CD4 count as well as your willingness to go on treatment
and your level of motivation. You will need to discuss these issues with
your doctor when the time comes
HIV Treatment
This section deals with the role that drugs used to treat HIV
infection play in maintaining and improving quality of life;
the side effects of these drugs; and the importance of
treatment adherence.
6.3) What is treatment adherence?
Treatment adherence has to do with taking all of the medications that you
are prescribed at the right time and in the right manner. Adherence is
essential if drug therapy is to be effective. Taking HIV treatment without
proper adherence can result in the virus becoming drug-resistant,
rendering medications ineffective.
6.4) What is drug resistance?
As the name implies, drug resistance occurs when HIV develops the
ability to resist the drugs used to treat it and no longer “responds” to
these medications. This occurs when the virus is exposed low doses of
medication. A number of factors can contribute to the development
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of drug resistance (for example, taking drugs on an irregular basis).
Your doctor and pharmacist will give you the information you need to help
you stay adherent and maximize the effectiveness of your treatment over
the long-term.
If drug resistance develops, you will no longer be able to take the
medications to which the virus has become resistant, meaning there will
be fewer drug combinations available to you that will be effective in
suppressing the virus in your body. Healthcare professionals place a lot of
emphasis on adherence for this reason.
6.5) What are the side effects?
6.6) How do you know if you’re ready to
go on treatment?
In addition to talking with your doctor, thinking about the following
questions can help you to decide if this is a step you are ready
to take:
• Do I know enough about the benefits and potential
consequences of going on treatment?
• What kinds of changes are likely to occur in my life? In what
ways might I need to change my lifestyle? Will I be able to
handle these changes?
Scientists have amassed a great deal of knowledge about HIV and its
internal mechanisms and this has allowed researchers to develop
medications that target HIV more effectively and with fewer side effects.
• Given that the first weeks are likely to be difficult, am I in a
position set aside other priorities in order to focus on my health?
How can I ensure that I’ll have the time I need to adjust and
adapt (for example, could I ask for a few days off at work)
Not too long ago, many of the medications used to treat HIV had major
side effects such as nausea, diarrhea, and complications of the kidneys
and liver.
• Is there someone who will be able to help me if I have
difficulty remembering when to take my medications? Are there
simple techniques I can learn to help myself remember?
A new generation of medications has since been developed. There are
still side effects, but in most cases they are less pronounced and easier
to control.
For many of the treatments now available, the number of pills that need
to be taken has been reduced to a few tablets a day, which makes staying
adherent to treatment much easier.
• Will I be intimidated or embarrassed about taking my
medications in front of certain people (for example, a new
boyfriend, colleagues at work, friends or family)?
Your doctor and the other professionals on your healthcare team will
be able to help you find answers to these and other questions you
may have.
Some antiretrovirals (ARVs) are can cause “lipodystrophy,” a metabolic
disorder that affects the regulation and distribution of fat in the body.
A person with lipodystrophy can develop a deposit of fat on the back of
the neck (sometimes referred to as a “buffalo hump”), a thicker waistline,
sunken cheeks, and a loss of fat on the thighs and buttocks.
Advances in drug development have now made it easier to identify the
ARVs that cause lipodystrophy. Your doctor can use this information to
prescribe the therapy that is best adapted to your metabolism and has the
fewest side effects.
Following the suggestions provided in Section 5. (General Health: Taking
Care of Yourself) can help to minimize the side effects of taking HIV
medications. Remember to eat well and exercise regularly.
When you begin treatment, the first weeks may be difficult. The side
effects usually decrease after that. In all likelihood, you’ll feel much
better and more energetic than you have felt in a long time!
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35
List of Support Services
Bibliography
For psychological support, help in relation to disclosing your status,
and general information:
Action Séro Zéro. Drugs, alcohol, and gay men, Montreal, 2007,
40 pages. rezosante.org (formerly sero-zero.qc.ca)
RÉZO (formerly Action Séro Zéro)
514-521-7778 | rezosante.org
AIDS Community Care Montreal (ACCM) / Sida Bénévoles Montréal
514-527-0928 | accmontreal.org
Action Séro Zéro. Enquête exploratoire sur les habitudes de
consommation d’alcool et de drogues chez un groupe d’hommes ayant
des relations sexuelles avec d’autres hommes (HARSAH) de Montréal et
propositions de pistes d’intervention, Montréal, 2007–2008, 53 pages.
Research report. rezosante.org.
Maison Plein Cœur
514-597-0554 | maisonpleincoeur.org
Action Séro Zéro. Le barebacking: être informé pour mieux en parler
entre nous. 2007, 2 pages. French brochure for men who have sex with
men. rezosante.org.
To find a community organization in your region:
Coalition des organismes communautaires
québécois de lutte contre le sida (COCQ-Sida)
514-844-2477 | cocqsida.com
For information on HIV and on HIV treatments:
Quebec HIV/AIDS Portal
514-523-4636 | 1-877-767-8245
pvsq.org (currently in French only)
Action Séro Zéro. Mon livre de lit: pour une sexualité plaisir en santé,
Vol. 1, Montreal, 2004, 96 pages. rezosante.org.
Agence de la santé et des services sociaux de Montréal.
Avis concernant la transmission du VIH par les personnes infectées
lorsque la charge virale est indétectable: la prudence est de mise.
Notice issued February 21, 2008 to healthcare professionals and other
stakeholders in the fight against HIV.
Public Health Agency of Canada. HIV/AIDS - Epi Updates, Ottawa,
Canada, 2007, 140 pages.
Bernard, EJ for NAM. HIV superinfection: more evidence, 2003.
nam.org.uk.
Canadian AIDS Treatment Information Exchange (CATIE)
1-800-263-1638 | catie.ca
Carter, M., Long-Term Stress Suppresses Immune System, Being Alive
Today, March 2005, page. 10. Newsletter published by the non-profit
organization Being Alive San Diego. beingalivela.org.
To find a CLSC or STI testing clinic
Dial 811 anywhere in Quebec to reach Info-Santé.
Chohan, B, et al. Evidence for Frequent Reinfection with Human
Immunodeficiency Virus Type 1 of a Different Subtype, Journal of
Virology, Vol. 79, No. 16, 2005, pages 701–708.
For legal information:
Canadian HIV/AIDS Legal Network
416-595-1666 | aidslaw.ca
Cossette, M, Delaney, M, Legault, HF. Pour le plaisir de manger:
informations, trucs et recettes pour les personnes vivant avec le VIH,
La Maison du Parc, 2003, 115 pages.
For information on Post-Exposure Prophylaxis (PEP):
Dial 811 anywhere in Quebec to reach Info-Santé.
Info-Santé will then direct you to the closest hospital
or clinic where PEP is available.
Direction de santé publique de Montréal, Institut national de santé
publique du Québec, Public Health Agency of Canada. Survey conducted
by G Lambert et al. Argus 2005: Summary of survey on HIV, viral
hepatitis, STIs, and associated risk behaviours among Montreal men
who have sex with men (MSM) June 2006, 4 pages. argusquebec.ca.
To quit smoking:
Canadian Cancer Society
cancer.ca
Interviews conducted with health professionals and community workers:
Riyas FADEL, Project Coordinator, COCQ-Sida (July 23, 2008); Éliocha
Cournoyer, Outreach Nurse, CSSS Jeanne-Mance (July 25, 2008);
Joseph Cox, Physician, Direction de santé publique de Montréal (July
18, 2008); Jacqueline Boudreau, Social Worker, CSSS Jeanne-Mance
(July 29, 2008); Jean Lawrence Roy, Nurse, Doctoral candidate,
Université de Montréal (July 31, 2008); Jean-Marc Trépanier, Clinical
Nurse, Clinique médicale du Quartier Latin (August 1, 2008); Daniel
Lanouette, HIV Educator, ACCM (August 5, 2008); Danielle Longpré,
Physician, Clinique médicale l’Actuel (August 19, 2008);
(See “Publications on reducing your risk of cancer”)
Centre d’abandon du tabagisme du CHUM
(for Montreal and surrounding areas)
514-890-8000, extension15983
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Marie-Claude Roy, Clinical Nurse, Clinique médicale l’Actuel (August 22,
2008); Pierre Côté, Physician, Clinique médicale du Quartier Latin
(August 25, 2008), Martin Blais, Professor, UQAM (September 11, 2008);
Sylvain Beaudry, Project Agent, Maison Plein Cœur
(September 11, 2008).
Interviews conducted September 18–24, 2008 with five men who have
sex with men who have been HIV-positive for at least five years (or have
been closely affected by the disease).
Serovich, JM, Mosack, KE. Reasons for HIV Disclosure or Nondisclosure
to Casual Sexual Partners. February 2003. Article published on
pubmedcentral.nih.gouv.
Smith, DM, et al. Incidence of HIV Superinfection Following Primary
Infection, Journal of American Medical Association, Vol. 292, No. 10,
2004, pages 1177–1178. Letter.
Canadian AIDS Society. Disclosure of HIV Status After Cuerrier:
Resources for Community Based AIDS Organizations. 2004.
Flores-Aranda, J, et al. Sexuality and the Experience of People Living
with HIV in 8 Regions of Quebec. Presentation of data from the MAYA
study at the 2005 Vancouver conference of the Canadian Association for
HIV Research (CAHR)/Association canadienne de recherche sur le VIH.
21 slides.
Canadian AIDS Society. HIV Transmission Guidelines for Assessing Risk,
2004, 72 pages. cdnaids.ca.
HOLT, R., et al. The Role of Disclosure in Coping with HIV Infection,
AIDS CARE, Vol. 10, No. 1, 1998, p. 49-60.
Terrence Higgins Trust. Devrais-je le dire? London, United Kingdom,
2006, 24 pages. tht.org.uk.
Miguez-Burbano, MJ, et al. Increased Risk of Pneumocystis Carinii and
Community-Acquired Pneumonia with Tobacco Use in HIV Disease,
International Journal of Infectious Diseases, July 2005, pages 208–217.
Terrence Higgins Trust. Mental Health and HIV, 2006, 6 pages. Fact
sheet. tht.org.uk.
Ministère de la santé et des services sociaux du Québec. Direction des
communications. La thérapie antirétrovirale pour les adultes infectés par
le VIH: guide pour les professionnels de la santé du Québec. 2008,
148 pages.
NAM. Adherence, 4th Edition, 2007, 44 pages. nam.org.uk.
NAM. HIV & Sex, 3rd Edition, 2007, 72 pages. nam.org.uk.
NAM. Viral Load & CD4, 7th Edition, 2007, 36 pages. nam.org.uk.
Terrence Higgins Trust. Gay men, sex and drugs, London, United
Kingdom, 2007, 48 pages. tht.org.uk.
Terrence Higgins Trust. PEP: Post-Exposure Prophylaxis, London, United
Kingdom, 2004, 6 pages. tht.org.uk.
Terrence Higgins Trust. Your Treatment, London, United Kingdom, 2007,
56 pages. tht.org.uk.
Terrence Higgins Trust. Your Decision, London, United Kingdom, 2007,
32 pages. tht.org.uk.
Terrence Higgins Trust. Your feelings: a guide to emotional well-being for
people with HIV, London, United Kingdom, 2007, 60 pages. tht.org.uk.
UNAIDS and WHO. Antiretroviral therapy and sexual transmission of HIV,
2008. Official statement following publication of the article published by
Switzerland’s Federal AIDS Commission relating to AIDS-related
problems. unaids.org.
Terrence Higgins Trust. Your sexual health: a guide for gay men with HIV,
1st Edition, London, United Kingdom, 2008, 35 pages. tht.org.uk.
Otis, J, Godin, G, and the MAYA Study group. Study data
Trépanier, JM. Exposition accidentelle non professionnelle à des liquides
biologiques. Presentation in the framework of the Programme national
de mentorat sur le VIH/sida, 2005. 32 slides.
MAYA–2004 to 2008.
Pilcher, Christopher D, et al. Amplified Transmission of HIV-1:
Comparison of HIV-1 Concentrations in Semen and Blood During Acute
and Chronic Infection, Aids–Official Journal of the International AIDS
Society, August 20, 2007, Vol. 21, No. 13.
Canadian Aids Treatment Information Exchange. PEP: Post-Exposure
Prophylaxis, (Treatment after Exposure to HIV) 2001, 2 pages Fact sheet.
catie.ca
Terrence Higgins Trust. Your shape: a guide to lipodystrophy for people
with HIV, London, United Kingdom, 2007, 12 pages. tht.org.uk.
Vernazza, P, et al. Les personnes séropositives ne souffrant d’aucune
autre MTS et suivant un traitement antirétroviral efficace ne
transmettent pas le VIH par voie sexuelle, Bulletin des médecins
suisses, Vol. 89, No. 5, 2008, pages 165–169.
Canadian Aids Treatment Information Exchange. HIV Viral Load Testing.
2007, 2 pages. Fact sheet. catie.ca.
Canadian Aids Treatment Information Exchange. A Practical Guide to HIV
Drug Side Effects, Toronto, Ontario, 2006, 51 pages. catie.ca.
Canadian Aids Treatment Information Exchange. A Practical Guide to
HAART (Highly Active Antiretroviral Therapy), Toronto, Ontario, 2006,
50 pages. catie.ca.
Canadian HIV/AIDS Legal Network. Criminalization of HIV exposure:
current Canadian law, 2008. Info sheet, 4 pages.
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Notes
Notes