iv poz mag.qxd

Transcription

iv poz mag.qxd

issue 56.qxd:liv poz mag.qxd
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Page 1
053FIGHTING WORDS
inside
333
A new condo development in Vancouver’s Downtown Eastside raises the question
of priorities.
063TRAVEL RESTRICTIONS
An update on countries that ban the entry of people living with HIV/AIDS.
083DISCRIMINATION
A humiliating airport incident becomes an opportunity to raise awareness about HIV.
123MICROBICIDES
There’s some hope on the horizon for newer options.
143HIV/AIDS LEADERSHIP
An interview with Dr. Julio Montaner, the head of the BC Centre for Excellence
for HIV/AIDS.
163HIV CARE REGISTRY
BCPWA is developing a registry of physicians with expertise in HIV.
09q AIDS CONFERENCE
features
q
An overview of the 2008 International AIDS Conference, which took place from
August 3rd to 8th in Mexico City.
20q TREATMENT AS PREVENTION
Swiss experts announced that PWAs with undetectable viral loads were “sexually
uninfectious.” Other worldwide authorities called the statement premature. Who’s right?
173AGING AND HIV
The population of people with HIV is getting older, which raises a slew of new and
unexplored concerns.
233LET’S GET CLINICAL
News and enrolling trial updates from the Canadian HIV Trials Network.
243ANTIRETROVIRALS
A report on the BC Centre for Excellence’s June antiretroviral update.
treatment
information
333
263NUTRITION
How to keep your food free of bacteria and protect yourself from food-borne illness.
283SIDE EFFECTS
A new study reports some immune-related side effects from the facial filler Bio-Alcamid.
303COMPLEMENTARY THERAPIES
Turmeric, ginger, and garlic don’t just add flavour, they have healing qualities.
323MENTAL HEALTH
How HIV and post-traumatic stress disorder can impact one another.
343STRAIGHT FROM THE SOURCE
The first Canadian division of AIDS has been created at the University of British Columbia.
363SIMPLY POSITIVE
Our easy-to-read pages on HIV treatment and care.
living 5 is published by the British Columbia Persons With AIDS Society. This publication may report on
experimental and alternative therapies, but the Society does not recommend any particular therapy.
Opinions expressed are those of the individual authors and not necessarily those of the Society.
SeptemberqOctober 2008
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think 5
opinion &editorial
The results of
our AGM
The British Columbia Persons With AIDS Society seeks to empower persons living with HIV
disease and AIDS through mutual support
and collective action. The Society has over
4400 HIV+ members.
living5 editorial board
Wayne Campbell – chair, Michael Connidis,
Philip Dawson, Sam Friedman, Rob Gair,
Derek Thaczuk, Glyn Townson
by Glyn Townson
Managing editor Jeff Rotin
he membership of BCPWA met
for our Annual General Meeting
on Saturday, August 23rd, to
elect five members to the BCPWA Board
of Directors.
The newly-elected board members are:
3 Ken Buchanan (vice chair, serving
until 2010)
3 Philip Dawson (treasurer, serving
until 2010)
3 Ryan Kyle (serving until 2010)
3 Keith Morris (secretary, serving
until 2010)
3 Malsah (serving until 2010)
3 Lorne Berkowitz (serving until 2009)
The following board members are
continuing the second year of a two-year
term, and will serve until 2009:
3 John Bishop
3 Damien Callicott
3 Sandy Lambert
3 Richard Theriault
3 Glyn Townson (chair)
BCPWA thanks all these members for
their support and wishes them good luck
during their term on the Board.
Unfortunately, the special resolution
proposed at the AGM failed by a small
margin. The voting members present felt
that the resolution to create a mail-in
balloting system that would give members
outside the Lower Mainland a chance
to vote on BCPWA’s business was not
adequately developed, and as such they
voted against it. This initiative is not
dead; the Membership Engagement
Committee will be tasked to review the
comments brought up at this year’s
T
Design / production Britt Permien
Copyediting Alexandra Wilson
Contributing writers
Jennifer Chung, Sarah Fielden,
Dr. Marianne Harris, R. Paul Kerston,
Alix Mathias, Shemina Patni, Ron Rosenes,
Neil Self, Shaleena Theophilus,
Jennifer Tsui, Tonya Wood
Photography Britt Permien
Cover photograph
International AIDS Society / Mondaphoto
Director of communications & education
Adam Reibin
Director of treatment information & advocacy
Adriaan de Vries
Treatment information coordinator
Zoran Stjepanovic
Director of positive prevention
Elgin Lim
Subscriptions / distribution
Edward Klyne, Ryan Kyle, Joe LeBlanc
Funding for living 5 is provided by the
BC Gaming Policy & Enforcement Branch
and by subscription and donations.
living5 magazine
1107 Seymour St., 2nd Floor
Vancouver BC V6B 5S8
TEL 604.893.2206
FAX 604.893.2251
EMAIL [email protected]
BCPWA ONLINE www.bcpwa.org
© 2008 living5
Permission to reproduce:
All living5 articles are copyrighted.
Non-commercial reproduction is welcomed.
For permission to reprint articles, either in
part or in whole, please email [email protected]
2
living5
AGM and retool the resolution for our
members’ consideration at next year’s
AGM, so that all BCPWA members can
have a voice.
BCPWA encourages its members to
share their voices in the upcoming federal
election on October 14th. New regulations
require that you must prove your identity
and address in order to vote. Ensure that
you’re on the voter’s list. If you have any
questions, or if you don’t receive a voters
card in the mail or your address has changed
since the last election, call Elections Canada
at 1.800.463.6868.
We must correct our country’s continued
failure to meet Lester B Pearson’s 1970
poverty reduction strategy to commit 0.7
percent of Canada’s gross domestic product
to foreign aid. Ask your local candidates
to promise to address this situation in
the government’s first budget.
Closer to home, ask your candidates to
commit to maintaining and strengthening
the long-term funding of the AIDS
Community Action Program (ACAP)
funding to ensure that community-based
AIDS organizations can continue to address
the issues facing PWAs across our country.
Make your vote count. 5
Glyn Townson is the
chair of BCPWA.
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A BCPWA success story
BCPWA’s treatment information work is
reaching far and wide. In mid-June,
Miriam Maxcy, an individual advocate at
BCPWA, was walking the streets of
McLeod Ganj, a small mountainous
town in northern India and home to the
Dalai Lama, when she noticed BCPWA’s
own easy-to-read fact sheets.
The fact sheets were posted in the
window of Kunphen, a centre for substance dependence, HIV/AIDS, and
human resources development that
works with HIV-positive Tibetan
refugees. Maxcy spoke with the executive
director and was informed that the fact
sheets were incredibly helpful tools
because the pictures told the story well
enough for everyone to get the message—
even if they didn’t speak or read English.
And that’s precisely their purpose.
The “Simply Positive” series of easyto-read fact sheets on HIV treatment and
care were developed by BCPWA’s Treatment Information Program, in an effort
to ensure that HIV-related information is
accessible to everyone, regardless of reading ability.
Kaletra pediatric tablet
in Canada
Abbott Canada recently introduced Kaletra (lopinavir/ritonavir) tablets for pediatric patients. The new dosage contains
100 mg of lopinavir and 25 mg of ritonavir per tablet. These tablets are for children weighing over 15 kg who are able to
reliably swallow intact tablets. It offers
similar advantages as the original
strength tablets, including no dietary
restrictions (it can be taken with or without food), no refrigeration required.
Page 3
Life expectancy with HIV increases dramatically
ico City was told that 345 patients in 21
centres in the US and Europe will take
part in the largest-ever trial of its kind.
The vaccine has been developed by
Bionor Immuno, a biotechnology company based in Norway. Results from the
trial are due by the end of 2009.
A break from standard HIV therapy
would potentially alleviate the adverse
side effects associated with the drugs,
which can include problems with the
heart and liver, diarrhea, nausea, and fat
loss. It may also help delay the
emergence of drug-resistant viruses, as
well as providing substantial savings for
healthcare services.
Source: BBC News
A 20-year-old HIV-positive person starting antiretroviral (ARV) therapy today
can expect to live, on average, to the age
of 69, according to new calculations published in The Lancet. The study authors
say this is a life expectancy increase of 37
percent over projections for 20-year-olds
starting ARVs during the early years of
combination treatment.
To determine life expectancy among
HIV-positive patients, an international
roster of researchers joined forces and
reviewed the medical records of more
than 43,000 people living with the virus
in the US, Canada, and several European
countries.
The researchers predicted that a 20year-old person starting ARV treatment
between 1996 and 1999, the early years
of combination ARV therapy, could be
expected to live an additional 36 years,
to the age of 56. This increased significantly, however, as time passed. A 20year-old who started treatment between
2003 and 2005 was expected to live an
additional 49 years, to the age of 69.
HIV-positive people who didn’t start
ARV treatment until their CD4s dropped
to 100 were expected to live 10 fewer
years than people who started therapy
when their CD4s were above 200.
Source: aidsmeds.com
Abbott to submit heat-stable
Norvir tablet for registration
Abbott has announced it will submit registration applications for a novel tablet
formulation of its protease inhibitor
Norvir (ritonavir) and request priority
review by US and European Union
authorities before the end of the year.
This new, heat-stable formulation will
not require refrigeration, which will make
it more convenient, particularly in developing countries where the majority of
people with HIV live.
School gets $100 million for
microbicide research
The East Virginia Medical School’s Contraceptive Research and Development
(CONRAD) program in Arlington was
awarded USD $100 million, the largest
grant in the school’s history, by the US
Agency for International Development to
create a product that prevents the transmission of the virus that causes AIDS
HIV vaccine could allow
“drug breaks”
Scientists are testing a vaccine designed
to give people living with HIV a
prolonged break from their regular medication without side effects. The 2008
International AIDS Conference in Mex-
continued on next page
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The grant will help CONRAD further
its two-decade study of microbicide
creams, topical gels, and oral pills that
would block not only HIV but also other
sexually transmitted infections. The
CONRAD researchers are also trying to
develop preventative products that work
over long periods of time as opposed to
gels that are applied before sex.
Source: poz.com
Belief in conspiracy theories
means less HIV testing in
South Africa
South Africans who believe in a conspiracy theory that HIV was introduced
by white people as a way of controlling
the black population are significantly less
likely to have had an HIV test, according
to a study published in the September
1st edition of the Journal of Acquired
Immune Deficiency Syndromes.
Investigators designed a study involving 503 men and 438 women who were
recruited from sexual health clinics in three
townships. They completed a questionnaire
Page 4
about their HIV testing history and attitudes and beliefs towards and about HIV.
The investigator’s first set of statistical
analysis showed that individuals who had
not tested for HIV had lower levels of knowledge about HIV and also had more stigmatizing views about the virus. The only
belief about HIV that was associated with
lower levels of testing was the belief in a conspiracy theory that HIV was created by white
people to control the black population.
Source: aidsmap.org
Suicidal thoughts common in
people with HIV
Nearly a third of people with HIV from five
London clinics reported having had recent
thoughts of suicide, according to a study
published in the August 20 issue of AIDS.
To determine how frequently their
HIV-positive patients experience suicidal
thoughts and feelings (ideation), Lorraine
Sherr, PhD, of the Royal Free and College Medical School in London, and her
colleagues enrolled 778 HIV-positive
patients from five London health clinics.
Roughly half the patients were foreignborn, 67 percent identified as white, and
65 percent were gay men.
Sherr and her colleagues asked the study
volunteers to complete an extensive survey
about their health and psychological wellbeing. Thirty-one percent reported suicidal
ideation in the past seven days. Of those,
about 5 percent said the suicidal
thoughts were constant, and 11 percent
said they were frequent. Heterosexual
men were almost 50 percent more likely to
report suicidal ideation than heterosexual
women or gay men.
Source: poz.com
2007 HIV/AIDS stats for BC
The BC Centre for Disease Control has
released its annual AIDS and HIV epidemiological report for the province, this
one for the 2007 calendar year. To view
the report, visit www.bccdc.org/downloads/
pdf/std/reports/HIV-AIDS%20Update
%20Report_2007.pdf. 5
photo by Mike Verburgt
At the August AGM, BCPWA members elected
a new Board of Directors (see page 2). The
2008/2009 BCPWA board from left to right:
Ryan Kyle, Malsah, Damian Callicott, Philip
Dawson, Richard Theriault, Glyn Townson,
Keith Morris, Ken Buchanan, John Bishop,
Loren Berkovitz, Sandy Lambert.
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FIGHTING WORDS
Bucks versus basics
New condo development in Vancouver raises the question
of priorities and discrimination by R. Paul Kerston
IV doesn’t discriminate. It affects men, women, and
children of all ages, races, and socio-economic status.
That said, lower socio-economic status is linked to a
higher risk of becoming HIV-positive. For those living with HIV,
the lack of stable and affordable housing impacts many areas of
daily life, from taking medications to co-infection, and beyond.
People need housing before they can face other basic needs.
HIV-positive people taking antiretrovirals need to be adherent.
However, adherence is difficult when basic things such as storing
medication and access become problematic—as they do for those
without adequate housing. People searching for shelter and food
may unwittingly sacrifice medical treatment in their search for these
basic needs. That’s why BCPWA monitors and advocates for adequate social housing. Nowhere is the need for housing more obvious
than in Vancouver’s Downtown Eastside (DTES). And that’s why a
new condo development in the DTES has advocates up in arms.
In late June, the City of Vancouver’s Development Permit
Board approved Concord Pacific’s proposed condo plan at 58
West Hastings Street. Despite acknowledging that 200 letters were
received—all negative —and despite the fact that all 40 people
attending the Board hearing (including a street pastor, nearby
condo owners, and residents) spoke against the development, the
Board seemed to feel that putting this out-of-context monstrosity
for high rollers within the midst of the DTES was more important
than housing local residents at risk of peril and even death.
Maybe city planners thought the municipal-provincial development of 12 social and supportive housing buildings, plus the
2007-2008 provincial purchase of 16 hotel single room occupancy
(SRO) units—a lousy alternative to proper housing, but a start—
was enough for the community. Interestingly, the government’s
figures indicate that of the 925 hotel units they purchased, only
626 (not quite two-thirds) are within the DTES.
Yet we know that there are roughly one to two new infections
per year for every 100 people in the DTES, and that about
30 percent of that population is currently infected. Statistics
also indicate that between 1995 and 2001, one-third of the
people who died from HIV-related causes never accessed antiretroviral treatments.
H
Agencies are moving into the DTES to expand access to
services, but without governments addressing basic human
needs, starting with stable and affordable housing, agency work
could be largely for naught. People look for housing before
medication. They require food and shelter before pills.
It would appear that the
almighty dollar’s power to
build condominiums speaks
louder than the need of people
seeking basic shelter.
Maslow’s hierarchy of needs states that basic physiological
needs—including food, water, and sleep/housing—must be met
before issues of safety, love, belonging, and esteem can be
addressed. In the DTES, these basic physiological needs are
often met in the most temporary and haphazard ways, which
means that the latter needs are often met through sexual or
self-medicating behaviours that increase the risk of HIV
infection. Moreover, people may seek to secure housing via
sex work, also increasing the risk of HIV infection.
If that’s the case, and with Vancouver’s 2008 homeless count
of at least 1,547 persons, why isn’t there a greater commitment
to provide housing in the DTES for those most at risk?
It would appear that the almighty dollar’s power to build
condominiums speaks louder than the need of people seeking
basic shelter. Gosh, that smacks of discrimination. BCPWA,
largely through its Community Representation and Engagement
Committee, is fighting discrimination like this.
HIV doesn’t discriminate. Why does
government? 5
R. Paul Kerston is BCPWA’s treatment
outreach coordinator and community
representation and engagement
(CRE) coordinator.
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Refused entry
An update on HIV/AIDS-related travel restrictions
by Ron Rosenes
eople living with HIV who want to travel for pleasure,
emigrate, or are forced to flee their home country as
refugees have a champion in the International AIDS
Society (IAS), which is taking a leadership role in advocating
for change among the 9 countries that ban HIV-positive people
from crossing their borders. These countries include the US,
China, and Saudi Arabia (see sidebar).
The IAS serves as the secretariat for the International Task
Team on HIV-related Travel Restrictions, convened by the Joint
United Nations Programme on HIV/AIDS (UNAIDS). The
Task Team is comprised of representatives from governments,
United Nations agencies, and civil society organizations including GNP+, ICW, the Canadian HIV Legal Network, UN,
WHO, and Labour and Human Rights Watch. The Task Team
will provide recommendations to UNAIDS and the Global
Fund to Fight AIDS, TB, and Malaria to remove HIV-related
travel restrictions at country and regional levels, in both the
short term and long term.
Several events at last month’s International AIDS Conference in Mexico City added to advocacy efforts and issued a call
to all countries that restrict the short-term entry of PWAs
and/or require prospective visitors to declare their HIV status
to lift these discriminatory policies. The IAS is also urging
countries to review their policies relating to HIV and restrictions on immigration, refugees, people wishing to adopt HIVpositive children, and student visas in light of sound public
health evidence and human rights principles.
P
Visaprocesschangesatthe2006AIDSConference
A great step forward occurred in 2006 when changes were made
to the visa process for HIV-positive people coming to Canada to
attend the last International AIDS Conference in Toronto. The
Canadian visa form was successfully changed from asking about
“any chronic condition, including HIV” to inquiring specifically
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about active TB, a highly contagious airborne pathogen that was
the main concern of health authorities (along with a second
question about potential burden to health and social services).
This important precedent is now being used by IAS-led advocates
to achieve change in the laws of other countries.
Many of the countries that have travel restrictions in place
did so at a time of high crisis and limited understanding of the
communicability of HIV at the time. Twenty-five years later,
most would agree travel ban laws don’t reduce HIV transmission. Such laws ultimately deny our collective responsibility for
HIV and create a false sense of security among citizens that hinders sound prevention efforts, including raising awareness of
their own vulnerability.
IAS argues that HIV-specific entry, residence, and stay
restrictions imposed by the US government are counterproductive to sound public health policy, because they encourage people
to lie about their status. This could further drive the epidemic
underground. Because of this, the International AIDS Conference can’t be held in the US.
The risk of going off meds to enter a country
Studies have shown that when these restrictions are imposed,
people living with HIV will interrupt their treatment regimens
while travelling to countries that monitor HIV status; as a
result, they risk developing a resistant virus due to non-adherence. Scientific evidence following the introduction of highly
active antiretroviral therapy (HAART) shows a significant reduction of viral load and infectivity of HIV-positive people on treatment. The scale-up of access to universal treatment coupled with
the falling cost in low- and middle-income countries dispels the
myth that mobile PWAs would drive up the cost of health and
social systems abroad.
As Violetta Ross, a PWA from Bolivia said at the United
Nations General Assembly Special Session (UNGASS) earlier
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this year in New York: “HIV-related travel restrictions create
and perpetuate the myth that the risk of AIDS is outside our
borders, violate fundamental human dignity and human rights,
fuel stigma and discrimination against those of us living with
HIV; deny the greater involvement of people living with HIV in
the response to the epidemic, and deny an honest discussion
on the linkages of mobility, migration and HIV.…HIV-related
travel restrictions are discriminatory….even migratory birds
have laws and treaties that protect them while moving across
borders, but not human beings living with HIV.”
The recent meeting of the Global Fund held in China
points to some progress being made there. China’s current
visa application form, introduced in September 2007, requires
disclosure of HIV status as a condition for entrance into the
country. For the Global Fund meeting in November 2007, the
Chinese Ministry of Health implemented a special waiver to
ensure no delegate would be required to disclose their HIV
status on visa forms or upon entry to China.
Following a series of meetings, on November 8, 2007, the
Chinese Ministry of Health announced its commitment to
changing its immigration laws, scrapping travel restrictions that
limit entry of people living with HIV. The proposed changes to
Chinese law, which will no longer require declaration of HIV
status, should be submitted for decision in the first half of
2009. The Global Fund has now adopted the IAS policy regarding the countries where it will hold future meetings.
Trying to change the laws in the US
Progress in the US has been harder to come by. Putting aside
the history of travel restrictions, which, sadly, were signed from
policy into law in 1993 by President Clinton, some change is
afoot. It will however require Congressional legislation and
signature of the President, either in the form of stand-alone
legislation or as an amendment to a larger bill.
Under the current law, eligibility for any type of waiver
requires individuals to disclose their HIV status. When a
“streamlined” process was announced in November 2007, it
only made the existing law more stringent, and still required
PWAs to declare their status before entering the U.S. The IAS
has urged the US government to table the rules around this
so-called streamlined process and to hold a public review of the
existing legislation.
The Center for Strategic and International Studies, in its
March 2007 report, Moving Beyond the U.S. Government Policy of
Inadmissibility of HIV-Infected Non-citizens, examined challenges
and options for current US law, and proposed that US policy
should be consistent with current scientific knowledge, public
health best practice, and aligned with humanitarian principles.
US Congressional Representative Barbara Lee introduced
the “HIV Non-discrimination in Travel and Immigration Act”
in August 2007. This bill seeks to amend the 1993 legislation by
striking the provision that renders PWAs inadmissible to the
Countries that ban PWAs
Countries that ban HIV-positive persons from entrance,
residence, and stay are Brunei, China, Oman, Qatar, South
Korea, Sudan, United Arab Emirates, the US, and Yemen.
Some 58 additional countries have some other form of
residence or immigration barriers based on HIV status. For
a complete listing of these countries, go to www.hivtravel.info.
US. It would return authority to the Secretary of Health and
Human Services to decide the status of HIV as a communicable
disease of public health significance. It would mandate a public
health review of all policies regarding the continued listing of
HIV as grounds for inadmissibility into the US. A report from
the process would be made available for public comment, and
findings submitted to Congress on whether to maintain the
ban by regulation or remove it based on public health analysis.
While Representative Lee’s proposal still falls far short of
overturning the discriminatory policy, it may pave the way to
have the law repealed.
Saudi Arabia’s new HIV Bill of Rights
On to Saudi Arabia, which protects Saudi citizens, but visitors
and migrants beware! Under a newly proposed “HIV Bill of
Rights,” the Saudi government proposes screening visa
applications if they are from countries “proven to have an
AIDS outbreak” to “prove the absence of AIDS virus in
such persons.”
Additionally, the Saudi Ministry of Health would “examine
those arriving in country for the purposes of residence to make
sure s/he is not infected with the AIDS virus.”
I attended the meeting in Mexico to learn more about future
advocacy plans on HIV-related travel restrictions and look forward to sharing them with you. My flight to Mexico was direct,
non-stop from Toronto—in case you were wondering. 5
Ron Rosenes is co-chair of the
Canadian Action Treatment Council,
co-chair of the Community Network
Advisory Committee of the Ontario
HIV Treatment Network, and a
board member of AIDS Action Now.
News update
On Wednesday July 16, 2008, the US Senate passed the
PEPFAR (President’s Emergency Plan for AIDS Relief) bill
and the section on the repeal of HIV travel and immigration
restrictions passed along with it. This is one step in a longer
process that will hopefully lead to change.
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Flight or fight
—or educate
A humiliating airport incident
turns into an opportunity to raise
awareness about HIV by Jennifer Tsui
been over 25 years since the first case of HIV/AIDS
was reported, yet ignorance about it—right in our own
province—is still shockingly commonplace, as Positive Living
North (PLN) discovered last spring. The organization’s reaction,
however, was anything but commonplace. And the final outcome
was heartening.
On March 28, nine members of PLN, an AIDS support group
in Prince George, were boarding a WestJet flight to attend BCPWA’s
Positive Gathering conference in Vancouver when they were stopped
by a security guard. The guard, a member of a private security
company, raised concerns about the members’ “disease” and the
possible danger they posed to the flight crew and other guests.
The flight was delayed until one of the PLN members spoke to
the pilot who subsequently dismissed the guard’s concerns and
continued with regular flight procedures.
Not only were the members of the group traumatized by such
treatment, the incident shocked the AIDS community and
sparked international media attention.
“My first reaction when I heard what had happened was
disbelief—I couldn’t believe that in 2008, we were still experiencing
this,” says Catherine Baylis, executive director of PLN.
Given the outrageous nature of the incident, PLN could have
justifiably reacted in numerous ways, from demanding compensation
to taking legal action; but the organization was adamant that its
response be positive and constructive.
“We said to ourselves: this happened, this is inappropriate, this
is unacceptable—what’s the best way to approach it?” says Baylis.
“PLN is so grounded in its beliefs about education that we knew
that’s what we wanted to do. We knew anger wouldn’t move
things forward.”
That mentality led to a full day of sensitivity training with
all the security managers and supervisors from virtually every
airport in BC.
The training, which was essentially HIV 101, covered basic information like how—and how not—HIV is transmitted. Participants
were provided with resources and materials they could take away to
educate staff in their respective airports. In addition, members of
the delayed group were present to share their experiences.
The response they received from the security personnel
was overwhelming. The personnel are now determined to move
forward with their learning and prevent similar incidents from
happening in the future.
It’s
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“When something like
this happens, we can choose
to build bridges instead of
building walls. How can
we shift attitudes and
understanding if we choose
the latter?” – Catherine
Baylis, executive director of
Positive Living North
“It was totally amazing, I couldn’t ask for anything more from
an education session,” says Baylis, adding it was so compelling
that people on both sides were moved to tears. “People left the
training with more information than when they arrived, and with
an absolute desire to do something with it.”
While other groups may have taken more aggressive action
after such an embarrassing incident, PLN chose instead to raise
awareness. And hopefully those enlightened security personnel will
share their knowledge with family and friends.
“I have a profound belief that education can change the
world, and I got to see that change in action,” says Baylis. “When
something like this happens, we can choose to build bridges
instead of building walls. How can we shift attitudes and understanding if we choose the latter? Building bridges
and education is what our work is all about.”5
Jennifer Tsui is a
Vancouver-based freelance writer.
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Cover Story
Universal action now
A report on the XVII International AIDS Conference,
August 3 – 8, Mexico City
by Glyn Townson
© International AIDS Society/Mondaphoto
XVII International AIDS conference, the first to be
held in Latin America, took place at the Centro
Banamex Convention Centre in Mexico City with over 25,000
in attendance. Overall, the city was welcoming and friendly, if
somewhat congested.
The opening ceremonies took place on Sunday at the Auditorio Nacional, a distance from the conference centre, with the
The
Mexican President, Felipe Calderón Hinojosa, and other foreign
dignitaries in attendance: Festus Mogae, former President of
Botswana; Maria Teresa Fernández de la Vega, First Vice-President
of Spain; Denzil Douglas, Prime Minister of St. Kitts and
Nevis. President Calderón gave an official welcome—a far cry
from AIDS 2006 in Toronto, where we couldn’t even get our
prime minister to make an appearance.
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Cover Story
The opening ceremonies included colourful entertainment and
music, and welcoming remarks from the conference co-chairs,
Dr Pedro Cahn and Dr Luis Soto-Ramirez. Dr Peter Piot, the
executive director of the Joint United Nations Programme
on HIV/AIDS, gave the keynote address, and Mony Pen, a
Cambodian living with HIV, also gave a moving speech.
It was obvious that the Mexican government had made special
efforts over the past several years to make AIDS 2008 in Mexico
City a success. By focusing on HIV and making it a priority issue,
it was possible to build a political case to give operational meaning
to universal health coverage. While other countries, even Canada,
let health services slide, Mexico has committed an additional one
percent of its GDP to medical services over the next seven years.
There are still capacity issues, and to date 22 million people have
access to coverage—approximately 22 percent of the population—
with a goal to reach full access by 2015.
The government has worked on changing laws allowing for
expanded healthcare—rights entrenched in the country’s constitution—and legislation banning homophobia, including the
launch of a country-wide anti-homophobia campaign. They
have also identified the problem of violence against women
and girls. Most evident of the government’s commitment is
that Jorge Saavedra López, the head of Centro Nacional para la
Prevención y el Control del VIH/SIDA, Mexico’s national
HIV/AIDS program, is himself HIV-positive, openly gay, and
legally married to his partner.
Prevention strategies must be realistic
The theme of the conference was “universal access to treatment,
medications, and prevention now.” The barriers are ignorance,
human rights violations, and poverty. At long last, there was a
full recognition of the importance of a human rights based
approach to HIV/AIDS, especially among vulnerable populations.
Prevention must go hand-in-hand with treatment.
The conference from start to finish was full of emotion and
passion. The basic message, repeated over and over, was that
current knowledge and research have proven that the treatments
work, even in resource-poor conditions. The current global
prevention strategies of abstinence and being faithful are clearly
not practical. Future efforts in prevention must be researchbased and specific to the populations being addressed.
Although many countries still don’t acknowledge men
having sex with men (MSM) as a local problem, recent studies
have shown that in all cases MSM are over-represented in the
numbers of new infections. The harsh reality is that for every
person starting antiretroviral therapy, three more become
infected, making prevention efforts tantamount to the fight
against HIV.
The message was loud and clear that we can’t treat our way
out of this pandemic. Approximately three million people are
now on antiretroviral therapy, with about 20 million currently
requiring therapy.
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More recognition of—and funding for—
high-risk groups
Proven strategies for harm reduction and prevention methods
where highlighted throughout the conference. In all cases, the
successful programs had several basic principles in common:
greater involvement of persons living with HIV; addressing local
problems and situations with local solutions; and education in
the context of the lived experience of those in risk of contracting
or spreading HIV.
“The AIDS dragon does
not ravage the world alone.
Its partners are the
unconscionable inequalities
of health care, poverty, and
education, which are things we
can do something about…We
must work tirelessly…until
the day for all the world’s
children comes when
the dragon is slain and all
the children’s dreams
can dance.” – Bill Clinton
While there has been little funding targeted directly at highrisk groups such as sex trade workers, intravenous drug users,
and MSM, novel approaches around the world have been making
some progress. But clearly more resources must be made available—without moral and faith-based restrictions—if we’re going
to get a real grip on prevention and make a tangible dent in
the numbers of new infections around the world.
An Argentinean sex trade worker, who was part of the
Thursday plenary, talked about her struggle getting recognition
from UNAIDS, which deemed the profession second class and
recommended retraining. She passionately cried out, “I don’t
want to learn how to sew! I don’t want to learn how to cook!
I know what I’m doing!” Her presentation also focused on
Canada’s spending priorities, with enforcement getting the
lion’s share at over 70 percent, while harm reduction was a
mere 2 percent.
The point of her plenary was to show that sex trade workers
are part of the solution, not part of the problem. By stigmatizing
and criminalizing their work, they’re put at great risk for violence
and have no protection or recourse when they’re victimized.
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Cover Story
Demonstrations about homelessness, drug
costs, and women’s rights
Activists were present throughout the conference, including the
opening ceremonies, though they had been warned that they
could face $1,000 fines, removal from the event, and deportation.
They still managed to unfurl a banner at the opening ceremonies
to protest the lack of housing and services for the homeless living
with HIV. There were daily protests on homelessness; some interrupting plenary and key speakers, including Bill Clinton. There
was a strategy area in the Global Village for activists to meet and
plan demonstrations throughout the conference.
An on-site demonstration of coffins, skeletal masks, and
black capes brought attention to the stalled negotiations
between the government and Abbott Laboratories regarding
second-line therapies for those whom the current drug
regimens are no longer working. (Interesting how there was no
official Abbott presence at AIDS 2008—a reminder of the
booth takeover at the International AIDS conference in
Toronto in 2006.)
The current standoff remains that Abbott has refused to cut
the Mexican government a deal on Kaletra—it offered a miserly
five percent discount, amounting to a cost of $450 per month
per patient, while people in other Latin American areas pay as
little as $45 a month for the same treatment, according to one
of the activists. Many of the activists in the demonstration
were themselves ill, and are waiting desperately to get access to
the second-line therapies. Some things never seem to change.
There was also a major anti-homophobia march in the historical district of Mexico City on the Saturday preceding the
conference, and a well-attended women’s march and rally from
the Juarez complex to the Zócolo the next day, which was
addressed by singer Annie Lennox.
The success of combining HIV, TB, and
malaria services
All the daily plenary sessions were exceptional. President Bill
Clinton was one of the keynote speakers and addressed the
problems of delivering quality services to those in resourcepoor countries. The burden of HIV is born mostly by women.
He highlighted the successes of combining tuberculosis and
malaria services with existing HIV clinics, providing a one-stop
shop for patients to get the care they need without having to
travel to different places and different providers. Today, 1.4
million people are receiving antiretroviral therapy through the
Clinton Foundation. (There are currently about three million
people around the world on antiretroviral therapy).
The Global Village was the largest one to date at an international AIDS conference. It was a hive of activity the entire
week, with brilliant entertainment from around the world—
including some of our own local groups, YouthCO and
Healing Our Spirit, who put on a popular forum theatre
performance. A colourful international marketplace with handSeptemberqOctober 2008
crafted wares, large centre stage, various meeting areas for
networking, and art installations added to the ambience. Youth
involvement was at its highest to date, a trend which will hopefully continue to future conferences.
Full human rights for the most
vulnerable populations
At the closing session, Dr. Julio Montaner assumed his role as
the new president of the International AIDS Society (IAS),
taking over from Dr Pedro Cahn. He welcomed the presidentelect, Elly Katabira, who will be the first African president
of the IAS. She is an associate professor at the Faculty of
Medicine at Makerere University in Uganda.
Dr. Montaner’s opening speech challenged Prime Minister Stephen Harper and all the G8 countries to step up to
the plate and follow the example of the US with its
renewed President’s Emergency Plan for AIDS Relief (PEPFAR) funding, which was recently announced by President
George W. Bush. Dr. Montaner also congratulated the US
for its announcement to lift the travel ban for those living
with HIV.
Dr. Montaner ended his speech by saying that there can be
no end to the pandemic unless we secure full protection of
human rights for those most vulnerable to HIV/AIDS. The
rights of sex trade workers, injection drug users, MSM, aboriginals, and women and girls must be protected through legal and
policy reform in every country around the world. Dr. Montaner
noted that we still have a long way to go, and he called on all
political and religious leaders to make this a reality.
“We know what has to be done,” he said. “We must strive
for universal action now! Anything less would be a crime.”
On the whole, AIDS 2008 felt as if it had tied the loose
strings together and revitalized the community movement to
tackle barriers facing those infected and affected by HIV/AIDS.
Although, as always, there is a daunting amount of work to be
done, we know what directions must be focused on: a combination of therapy, prevention—and universal action now.
All eyes will be on Vienna in 2010 for the XVIII International
AIDS Conference. The conference will coincide with the deadline that world leaders set for the goal of providing universal
access to HIV prevention, treatment, care, and support. 5
Glyn Townson is the chair of BCPWA.
Watch the sessions
The opening ceremony and all plenary sessions can be viewed
online at www.aids2008.org
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Microbicides:
the next generation
There is some hope on the horizon for newer options
by Shaleena Theophilus
ver the past few years, the field of microbicide
research has advanced considerably, with a few
setbacks. There is some hope on the horizon with
what’s being called second-generation microbicides.
A microbicide is a substance that can reduce the transmission of HIV and other sexually transmitted infections when
applied in the vagina or rectum. What makes a microbicide
unique is that it’s user-initiated. This provides options for
people who are unable or unwilling, for a variety of reasons,
to ask their partners to use a condom. Currently we don’t have
any proven microbicides on the market, however products
are under development.
If and when they are available, they’ll probably be in the
form of gels, foams, creams, or suppositories. These first generation microbicides will likely be contraceptive, since it’s much
harder to develop one that neutralizes viruses and bacteria
without affecting sperm. This would benefit women who would
like a product that both protects them from diseases and
prevents pregnancy.
Scientists are also working on products that will be noncontraceptive. This is a suitable alternative for women who
choose not to use contraceptives for religious or cultural reasons,
as well as for women who want to conceive a child while still
protecting themselves from infection. This second generation
of microbicides will be able to be applied several hours before
intercourse, and will come in vaginal rings or sponges, which
slowly release the product over time. Studies combining microbicides, diaphragms, and cervical caps are also underway.
O
Different classifications of microbicides
Microbicide products under development fall into five classifications. The first classification is blocking agents, which provide a barrier to prevent infection. The second type, called
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surfactants, would kill or disable the virus by breaking down its
surface membrane or coat. These would resemble spermicides,
which work by breaking up the outer coat of the sperm, thus
making the vagina inhospitable to HIV.
The third class of microbicides are the vaginal defence
enhancers. The vagina normally has a very acidic pH level, but
sperm counteract this acidity, making it possible for HIV to
survive. By maintaining the vaginal pH at a level that destroys
viruses, the vagina would inhibit the survival of HIV, thereby
reducing the risk of HIV transmission.
Another category of microbicides prevents the virus from
entering white blood cells. Two varieties of these entry inhibitors
are being researched: attachment inhibitors, which prevent the
virus from attaching to white blood cells, and fusion inhibitors,
which prevent the virus from entering the cells.
The fifth group of microbicides involves reformulating the
antiretroviral drugs developed to treat people living with HIV.
Researchers are now experimenting to determine if drugs that
have been reformulated for use as topical gels or creams could
stop localized HIV replication in cells in the vagina, before it
enters the bloodstream.
The first microbicides will likely be only 40 to 60 percent
effective. However, the London School of Hygiene and Tropical
Medicine calculated that if a product that’s 60 percent effective
is offered to 73 lower income countries, and is used by 20 percent
of people reached by healthcare during 50 percent of sex acts
when a condom isn’t used, 2.5 million new HIV infections over
three years can be averted.
When a microbicide is available on the market, some will
use it for anal intercourse, since HIV is more easily transmitted
to a receptive partner during unprotected anal intercourse than
during unprotected vaginal intercourse. Therefore, it’s important
to study the safety of vaginal microbicides for rectal use, as well
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Page 13
as to develop products specifically for anal intercourse. The
physical structure of the rectum is much different than the
vagina and provides additional challenges to creating an effective
product. Phase 1 studies are currently underway in the US.
Microbicides that are undergoing trials
All microbicides must undergo Phase 1 and Phase 2 safety
trials. If the product is found safe in these studies, they then
advance to larger scale Phase 3 trials, or what is also referred
to as a Phase 2b trial.
What makes a microbicide unique
is that it’s user-initiated—
providing options for people
who are unable or unwilling to ask
their partners to use a condom.
As of July 2008, there were 12 microbicide candidates in
clinical trials. Among them:
Cellulose sulfate: Also known as Ushercell, this product is a
cotton-based compound. The initial tests were promising, and
the product went in to Phase 3 studies in South Africa, Benin,
Uganda, and India. However, in January 2007, the Data Safety
and Monitoring Boards halted the trials. At that time, the
interim analysis showed that the product was not effective in
preventing HIV infection. Data from some trial sites suggested
that the product might have increased a woman’s chance of
acquiring HIV. The data is being analyzed to try to uncover the
reason for these results.
Carraguard: This microbicide candidate is an odourless, clear
gel made out of carrageenan. Carrageenan is a common thickener
made from seaweed, which has been used in foods for years.
Phase 3 studies of this product were conducted from 2004 to
2007 in South Africa. Although the product was both safe to
use and acceptable by women, it wasn’t effective in reducing the
risk of acquiring HIV. However, this trial was an important
landmark: having enrolled over 6,000 women, it was the first
large-scale microbicide trial to continue until its completion.
indicated that the 2 percent dose didn’t show a significant
protective effect over the placebo. However, the 0.5 percent
dosage arm of the study will continue and yield results in 2009.
BufferGel: BufferGel is a vaginal defense enhancer. It’s an
acid buffer that maintains the vaginal acidity, even in the
presence of sperm. It also creates a physical barrier that stops
or slows the virus from entering the vaginal and cervical walls.
Currently, it’s being tested in Phase 2/2b trials, where it’s being
compared with the 0.5 percent dosage of PRO 2000. These
trials are taking place in South Africa, Malawi, Zimbabwe,
Zambia, and the US.
Tenofovir gel: Tenofovir is an antiretroviral drug that has
traditionally been used to treat people living with HIV. Over
the past few years, it’s also been researched as a potential prevention method. Initial studies on the safety of tenofovir gel
showed that it’s safe for sexually active HIV-negative women to
use daily for an extended period of time. Building on these
results, Phase 2b trials in South Africa are being conducted.
Future studies of the tenofovir gel are also planned, including the VOICE study, which will examine its effectiveness if
used every day, instead of just at the time of intercourse. Given
that the product is longer acting, it can be inserted well before
intercourse, thereby providing more options for people. Enrollment is expected to begin in 2009, which will review the effects
of the tenofovir as a microbicide in pregnant women. The
VOICE study will also evaluate pre-exposure prophylaxis, a prevention approach involving the daily use of oral antiretrovirals.
Dapivirine—which is being used in vaginal rings as opposed
to the gel formulation—and UC-781 are two other antiretroviralbased candidate microbicides currently in Phase 1 studies.
Finally, the invisible condom, created at the Université Laval
in Québec, is an entry/fusion inhibitor. The key ingredient is
sodium laurel sulphate, a compound used in soaps and toothpaste to fight viruses and bacteria.
As more candidates are being researched, there is still much
hope for microbicides and the potential they hold for helping
stem the transmission of HIV. 5
Shaleena Theophilus is a program consultant at
the Canadian AIDS Society and coordinates the
Microbicides Advocacy Network Group (MAG-Net).
Other microbicide candidates in the pipeline
There are several microbicide candidates in the product
pipeline. The furthest along in clinical research include: PRO
2000, BufferGel, and tenofovir gel. There are also a few planned
for additional studies, including the invisible condom.
PRO2000: This product is an entry and fusion inhibitor
that binds to the virus and prevents it from infecting a healthy
cell. It is currently in Phase 3 trials in South Africa, Tanzania,
Uganda, and Zambia. Researchers were testing gels, one containing a 0.5 percent dose of the product, another containing a
2 percent dose. However, in February 2008, an interim analysis
For more information
For more information, visit the following websites:
q Canadian AIDS Society, www.cdnaids.ca
q Global Campaign for Microbicides, www.global-campaign.org
q Alliance for Microbicide Development, www.microbicide.org
q International Rectal Microbicide Advocates,
www.rectalmicrobicides.org
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Leader of
the pack
Dr. Julio Montaner
talks about the leadership role
of the BC Centre for Excellence
Dr. Julio Montaner is the director of the BC Centre for Excellence in
HIV/AIDS. At the end of the International AIDS Conference in Mexico
last August, he also became president of the International AIDS Society.
Living 5 Magazine: What are your top priorities for the
Centre?
Julio Montaner: In the last couple of years, we have put a
tremendous amount of effort trying to optimize access to antiretroviral therapy in British Columbia. First and foremost, it
prevents the progression of the disease, prolongs life, and
improves quality of life, and an important secondary role is to
decrease infectiousness as a result of treating viral load. I want
to emphasize that treatment is not meant in this context as a
replacement for traditional preventive strategies such as safer
sex or harm reduction. Being on treatment doesn’t mean that
one cannot infect, but rather being successfully treated renders
you less likely to transmit. So if all the precautions are in place,
at the end of the day the equation is a lot more favourable.
LP: What do you feel are the key challenges that the
Centre currently faces?
JM: I’m limiting my discussion to the expansion of HAART so
it’s not too broad. The number one thing we must recognize is
that when it comes to expanding antiretroviral therapy coverage
among those in medical need, it’s no longer the fact that the
pills aren’t available or the treatment is complex or toxic. We
have overcome those issues to some extent. Today, it has a lot
more to do with who are the individuals that are failing to access
treatment in a timely fashion, or who don’t know they’re infected. Unfortunately, we still see a significant number of people
who receive their first HIV test after they develop an AIDS-related
complication. That’s why we’ve made the “seek” part of the “Seek
and Treat” proposal an important priority. We want to ensure
that case finding is a priority, that we enhance HIV testing.
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The next challenge pertains to the variety of circumstances
that lead people to neglect antiretroviral therapy as a priority.
Social, cultural, and lifestyle issues play a very important role,
whether it’s a single mother with no babysitting resources who
fails to get to a medical visit, or a homeless person, or a person
who has no food security, or a person who is challenged with
other co-morbidities such as mental illness or addiction. Any one
of those represent very big challenges when it comes to the implementation of effective, high coverage for antiretroviral therapy.
At the end of the day, a successful campaign to advance HIV
diagnosis, appropriate engagement of HIV care, and eventual
successful engagement of antiretroviral therapy among those
in medical need, will require substantial strengthening of the
support that we’re able to provide. That really is beyond the
immediate ability or mandate of the Centre. So it’s more of a
multi-agency challenge where we have identified the importance
of rolling out antiretroviral therapy in a more effective way.
This is not something we can hope to do unless there’s a
concerted effort on the part of the municipal and provincial
government. I’m very impressed by the amount of encouragement and support that we’ve gotten from the Minister of
Health and the Premier himself. In reality we can only bring
the so-called medical interface to this initiative. The larger
social dimension is well beyond our scope.
LP: So what you’re saying is it’s for other agencies to pick
up on this and move forward with it.
JM: Exactly. The reason we have developed this research initiative
is because we believe that if we were able to demonstrate that the
additional preventive value of antiretroviral therapy is “x”, then
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Page 15
we can take that to third-party agencies, whether it’s the rest
of Canada or the developing world, and help them to devise
programs and policies.
Rolling out antiretroviral therapy anywhere in the world
becomes difficult to sustain unless it’s also contributing to the
control of the growth of the epidemic. Once you look at it
from that perspective, it gives you a much better opportunity
to engage international donors because they now understand
that this is not just about saving a life—you can save a life with
mosquito nets, you can save a life with clean and safe drinking
water—this contributes to curbing of the epidemic. That’s the
biggest challenge we face.
LP: How certain are you that the “Seek and Treat” strategy
will continue to be funded after its initial trial period?
JM: We’re not talking about doing a trial per se—we’re not testing
antiretroviral therapy. The whole gist of what we’re proposing is
that we have been failing to do what we said we intended to do,
which is to offer treatment effectively to individuals who need
treatment. So from that perspective there is no real research in
terms of the treatment aspect of things. The research part of it
has to do with once you do what you were supposed to be doing,
what would be the impact on the larger societal scale of doing so.
Whether we prevent one additional case or 100 doesn’t really
matter—I mean, it’s important, but it’s not directly relevant to the
decision of whether or not we continue to treat the people we
need to treat. Because those people need the treatment regardless.
So the research questions around the implementation of
the Seek and Treat proposal have to do with where are the
appropriate or best or most effective mechanisms to engage
people in testing, treatment, and care on a sustained basis. If
we were able to show that one strategy is better than another, I
think it would be very reasonable to suspect that the knowledge
we derive from that will become the standard of care.
With regards to the treatment, it’s business as usual. The
province of BC has made a commitment all along that it will
fund antiretroviral therapy for individuals within the province
who meet the criteria for treatment. I have absolutely no
doubt that the provincial government intends to fulfill their
promise on a long-term basis. I want to strongly emphasize
that the “treat” part of this proposal is not experimental, the
experiment here is to measure the societal impacts of doing a
better job of treating people that we decided need treatment.
So in that context, this is a no-brainer!
LP: Given that there’s an increased budget for the
enhanced Drug Treatment Program, what guarantees
are there that the money won’t be taken from money
that’s going to community-based responses?
JM: First, expanded therapy at this time has no budget. It’s a
theoretical concept that we have put forward. We have modelled
it mathematically and currently the government is studying our
proposal to try to understand what it would take to make it
happen. The Centre’s position has been and continues to be
“When it comes to expanding
antiretroviral therapy coverage,
it has a lot more to do with
who are the individuals
that are failing to access
treatment in a timely
fashion, or who don’t
know they’re infected.”
that for the expanded HAART proposal to be successful, it can
only get there by strengthening the current systems that we have
in place. That includes everything that is currently successfully
in place operating at a proportionally higher level so that it can
accommodate the increased complexity and challenges associated
with expanding coverage.
We have not worked out a budget fully because it would be
easy for us to tell you that, if we treat x number of people with
x number of dollars, if we were to treat double the number of
people, we will need double the number of dollars. And laboratory tests will cost double.
The challenge is to try to understand what additional
resources are necessary to successfully engage people on appropriate testing practices, appropriate engagement of care, and
sustained engagement on HAART over and beyond what is
currently available. And to be honest with you, we have no
idea because simply we have failed to do it so far
I am assured in our discussions with the Ministry representative
that they understand that there is an uncertainty regarding
what exactly it would take to put these programs in place.
All along we have strongly indicated that the successful implementation of this program will require more, rather than less,
support at the community level because we will be engaging
individuals who are in more vulnerable situations. It’s important
that their needs be accommodated.
LP: How will your appointment as president of IAS impact
your work at the Centre?
JM: I’ve been on the governing council of the IAS for nearly a
decade. So I’ve been able to do meaningful work at that level
without people being affected by my distractions from time to
time. So, in the role of president of the IAS, my time will be increasingly taxed as it has been for quite some time, but we have
a country of younger colleagues prepared to help out. At the
end of the day, my role in the IAS hopefully will not just benefit the IAS and the world, but will also benefit the Centre. It
will add an international dimension to what we’re doing,
strengthening our leadership role in Canada and internationally.
It can act as a facilitator for our national and local government
to continue to support some of the novel work we’re doing. 5
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Hot docs
BCPWA is developing a provincial registry of physicians who have
expertise in HIV by Neil Self
inding a family doctor in British Columbia is a challenge.
Finding a doctor who has experience in HIV care is even
more challenging. HIV positive people need access to the
healthcare system and they need to establish a strong doctor-patient
relationship. That’s why BCPWA is developing the HIV Care Physician Registry, a province-wide registry of physicians who self-identify
as experienced in HIV care and are currently accepting new patients.
According to the 2006 Census, BC has a population of over 4
million and just under 6,000 general practitioners or family physicians in the province—which works out to about 696 British
Columbians for every family physician. To make matters worse, of
the 6,000 general practitioners, only 400 are currently accepting
new patients. The BC Centre for Excellence in HIV/AIDS (BCCfE) has about 700 physicians—including family physicians and
specialists—registered with their programs and services; 60 of them
have registered with the BCPWA HIV Care Physician Registry as
accepting new patients. While that’s encouraging, bear in mind
that, in addition to the current 13,000 HIV positive people in BC,
there are, on average, about 400 new HIV infections every year.
Geography and context are also important factors in accessing qualified doctors. There’s a more significant lack of HIVexperienced doctors outside Metro Vancouver. Stigma, cultural
competence, and discrimination are barriers to accessing a family doctor in many rural communities.
Cultural competence means being educated, competent,
and comfortable discussing issues related to the sexual culture of gay
and bisexual men and men who have sex with men (MSM). This
particular issue is being addressed with the Engaging Physicians project, based out of the Living Positive Resource Centre in Kelowna.
F
BCPWA
Advocacy
gets
results!
In smaller communities, where disclosure of HIV status via
association is a real concern, many doctors and their patients don’t
want their clinic to be identified as the local AIDS clinic. The HIV
Care Physician Registry is addressing this concern by not publicly
listing the doctors and by housing the registry at BCPWA.
There are still too many doctors who won’t see HIV-positive
people for a variety of personal and religious reasons—an unacceptable reality that we’re hoping to address with education
and the promotion of the HIV Care Physician Registry.
With assistance from the BC-CfE and the provincial
HIV/AIDS public health nurses, we have currently recruited
and registered 60 physicians for the registry. But 41 of the 60
doctors are in Metro Vancouver; there are clear deficiencies in
the north and in other geographic pockets in the province. In
order to overcome these challenges, BCPWA will need to work
with physicians, nurses, AIDS service organizations, and PWAs
to continue to expand the registry, to ensure that person living
with HIV in BC has access to a qualified physician. 5
Recommend doctors for the registry
If you can recommend a doctor for the HIV Care Registry, visit
the registry page on the BCPWA website at
www.bcpwa.org/empower_yourself/physician or call
604.646.5366, or toll-free at 1.800.994.2437 ext. 366
Neil Self is an advocate in BCPWA’s
Treatment and Information Advocacy Department
and an MSW student at the University of British Columbia.
The BCPWA Society’s Advocacy Program continues to work hard to
secure funds and benefits for our members.
The income secured for June 2008 and July 2008 is:
$28,155 in debt forgiveness.
t $2,800 in housing, health benefits, dental and
t
long-term disability benefits.
$120 in monthly nutritional supplement benefits.
t $2,700 in ongoing monthly nutritional supplement
t
benefit for children
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*nformation
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Page 17
treatment
TREATMENT INFORMATION
PROGRAM MANDATE &
DISCLAIMER
In accordance with our mandate
to provide support activities and
facilities for members for the
purpose of self-help and self-care,
the BCPWA Society operates a
Treatment Information Program
to make available to members
up-to-date research and information on treatments, therapies,
tests, clinical trials, and medical
models associated with AIDS
and HIV-related conditions. The
intent of this project is to make
available to members information
they can access as they choose
to become knowledgeable partners
with their physicians and medical
care team in making decisions to
promote their health.
The Treatment Information
Program endeavours to provide
all research and information to
members without judgment or
prejudice. The program does not
recommend, advocate, or endorse
the use of any particular treatment
or therapy provided as information.
The Board, staff, and volunteers
of the BCPWA Society do not
accept the risk of, or the responsibliity for, damages, costs, or
consequences of any kind which
may arise or result from the
use of information disseminated
through this program. Persons
using the information provided
do so by their own decisions
and hold the Society’s Board,
staff, and volunteers harmless.
Accepting information from this
program is deemed to be
accepting the terms of
this disclaimer.
An issue
that’s
coming
of age
The population of people with HIV is getting
older, which raises a slew of new and
unexplored concerns
by Adriaan de Vries
ately, there’s been a lot of talk
about aging while living with
HIV. Not long ago, the very idea
was considered an oxymoron, and thus
not worthy of discussion. However,
the population of PWAs has changed
dramatically in the past 12 years—and
continues to change. In 2005, only 6
percent of Canadians who tested positive
for HIV were 50 years of age or older. In
L
living5
2008, 19 percent of newly diagnosed
people were 50 or older. Statisticians
predict that within 10 years, 20 percent
of all Canadians living with HIV will be
50 or over.
Why should we pay attention? What
makes age important enough to warrant
special attention from the medical community
as well as people living with HIV? For
starters, studies have found that untreated
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older HIV-positive individuals are twice as likely to die than
their untreated younger counterparts.
A number of issues factor into these age-related differences.
First is the issue of diagnosis. People over the age of 50 have
very different and often unrecognized barriers to being diagnosed for HIV disease. They have significant barriers to accessing
prevention information and education, which is largely targeted
to younger age groups—those considered more sexually active,
more involved with recreational drugs, and more involved in
youth culture activities such as tattooing.
We tend to approach older people differently. Doctors are
less likely to ask older patients about high-risk behaviours or to
suspect the possibility of HIV in their patients. They don’t
review their sexual histories and risk behaviours as frequently,
and thus are less likely to talk about safer sex practices or get
tested for HIV. Older people also tend to be less comfortable
discussing their sexual lives and asking for an HIV test.
To further complicate matters, many symptoms and conditions related to aging are common to those related to being
HIV-positive. Pulmonary and heart problems are common to
both, especially to those with a history of smoking and other
lifestyle factors. Stamina and immune function are often
decreased in the elderly. People’s faces become thinner, and
they develop hypertension. If a doctor doesn’t test for HIV
antibodies, these symptoms may be attributed to age. As a
result, HIV isn’t diagnosed, monitored, or treated, even though
it may be necessary to do so.
An important factor in treatment is knowing whether symptoms
are HIV- or age-related. Choosing the wrong treatment means the
treatment could cause unknown, possibly negative results. Older
patients also have a greater likelihood of experiencing toxicity with
HAART medications. CD4 and viral load test responses can be
different: older people develop less CD4 cells than younger people
as a normal part of aging. When on HAART, older people increase
their CD4 count more slowly than their younger counterparts and
reduce their viral load less quickly.
To complicate matters,
many symptoms and
conditions related to aging
are common to those
related to being HIV-positive.
Not a lot is known about aging with HIV, simply because
we have never had to be concerned about people living
longer than 25 years with HIV. Furthermore, many HIVpositive people over 50 need both HAART and medications
for conditions related to aging. The interactions of those
combinations are not yet well understood. Research is just
beginning in this area.
In future issues of living 5, we’ll explore specific HIV and
aging issues, such as cardiovascular health, cancers, bone and
liver health, hypertension, and mental health concerns such as
depression and dementia. 5
Adriaan de Vries is the director of BCPWA’s
Treatment Information and Advocacy Department
and has been involved with HIV issues since 1983.
We need people like you. BCPWA has volunteer opportunities in the following areas:
HIV+ Women Volunteers Needed>knowledge of HIV, medications, tests, health treatment issues.
Interested in obtaining speaking and/or workshop development skills?
Second Hairstylist>Volunteer hairstylist needed to provide
professional haircutting and styling at our own in-house salon
Lounge Host >Serve coffee, tea, juices and pastries to members
Polli & Esther’s Closet Assistant >Help in a free clothing store
that provides clothing and small household items to members
Special events >AccolAIDS Awards Gala and AIDS WALK for LIFE
Writers > living5 magazine, Communications
volunteer
@ BCPWA
Benefits of becoming a volunteer:
◆ Make a difference in the Society and someone’s life
◆ Gain work experience and upgrade job skills
◆ Find out more about HIV disease
If you are interested in becoming a volunteer and/or to obtain a
volunteer application form, please email [email protected],
call 604.893.2298 or visit www.bcpwa.org.
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Feature Story
Undetectable vs.
uninfectious
Swiss experts announced that PWAs with undetectable
viral loads were “sexually uninfectious.” Other worldwide authorities called the statement premature.
Who’s right?
by Derek Thaczuk
was the Swiss shot that was heard around the
world. In January 2008, Swiss HIV experts
stated that HIV-positive individuals could be
considered “sexually non-infectious,” as long as
they were on effective antiretroviral treatment and
free of other sexually transmitted infections. The
statement—authored by four of Switzerland’s
foremost HIV experts and published in the Bulletin des médicins suisses—proclaimed that “an HIVinfected person on antiretroviral therapy with
completely suppressed viraemia [i.e., with an
undetectable viral load] is not sexually infectious,
i.e. cannot transmit HIV through sexual contact.”
With this confident, unprecedented claim, the
Swiss experts threw an abrupt curve at previous
prevention messages—all of which had stressed
just the opposite: that undetectable viral load did
not equal the absence of transmission risk. This
caution had stemmed from several reasons, first
and foremost, the consequences of being wrong:
one new infection due to undue optimism equals
one more person with HIV.
Secondly, viral load levels can differ between the
blood and other body fluids. While lower viral
RNA in blood usually also means lower RNA in
sexual fluids, the amounts are not equal: HIV
in semen, vaginal fluids, and rectal tissue can be
measurable even if undetectable in the blood
plasma. Even “undetectable” merely means that
viral RNA is present in smaller amounts than
current tests can detect; it doesn’t mean it’s
completely absent.
Finally, any number of other factors could
potentially affect a person’s likelihood of infectiousness, notably, having other sexually transmitted infections is known to increase the risk of
passing HIV to sexual partners. (A fact that was
acknowledged in the Swiss report.)
It
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Feature Story
What, then, led the Swiss commission to make such a
bold leap?
What were they thinking? Evidence for
Antiretroviral treatment does greatly reduce HIV transmission
risk in two other settings: childbirth and breastfeeding. When an
HIV-positive mother’s viral load is reduced by antiretroviral
therapy, transmission risk during delivery and birth is greatly
lowered as well. Treatment for HIV-positive mothers around the
time of delivery (now routine practice) has drastically reduced
rates of HIV transmission to newborns. Studies have also
repeatedly found that breastfeeding children of HIV-positive
mothers are much less likely to become infected when the
mother is on highly active antiretroviral therapy (HAART).
What about transmission between sexual partners? Relatively
few studies have investigated the question, largely since controlled
studies would be ethically impossible. (Clearly, you can’t instruct
mixed-status couples to have unprotected sex, just to see how
many negative partners get infected. Trials of preventive vaccines
face a similar challenge.)
However, a small but growing number of uncontrolled observational studies have associated lower viral load with lower sexual
transmission risk. A study published in 2000 analyzed 415 serodiscordant heterosexual couples—those with one HIV-positive and one
HIV-negative partner—in Uganda. The highest rates of HIV transmission—23 new infections per 100 person-years—occurred when the
HIV-positive partner’s viral load was above 50,000 copies/mL. At
lower viral loads, between 400 and 3,499 copies/mL, infections were
just a tenth as frequent, at 2.2 cases per 100 person years. Most
strikingly, no new HIV infections were seen in couples where
the HIV-positive partner’s viral load was below 1,500 copies/mL.
At least three other studies of serodiscordant heterosexual
couples reached similar conclusions, finding no infections in
the partners of HIV-positive people on HAART with
undetectable viral loads. These included a prospective Spanish
study of 393 couples between 1991 and 2003, a prospective
Brazilian study of 92 couples, and a retrospective Spanish study
of 62 couples who were trying to conceive children through
unprotected intercourse.
The Swiss analysis also referred to studies of HIV in semen
and vaginal fluids, noting that viral load in both semen and
vaginal fluids generally decreases during HAART treatment, and
that viral load in the female genital tract is generally lower than
that in blood plasma. They also argued that, even when HIV
RNA can be found in semen, it does not necessarily indicate that
infectious virus is also present—an argument somewhat like saying
that a gun “might not” be loaded.
The Swiss team concluded that “all epidemiological and
biological data indicate that there is no relevant risk of transmission during ART which is completely adhered to” on the
basis of all the above evidence—a conclusion that many
others challenged.
Evidence against
Naturally, the Swiss statement came with certain caveats. The
need for HAART adherence, sustained undetectability of viral
load (for at least six months), and lack of other sexually transmitted
infections were clearly called for. But several other counterarguments were raised in the ensuing criticism. Most importantly,
other world experts have stressed that the report’s conclusion
is based on interpretation and opinion, not conclusive evidence.
The argument for non-infectiousness hinges on the trust
that undetectable viral load in the blood means no infectious
virus in the semen or other sexual tissues. Studies have in fact
found that effective antiretroviral treatment most often leads to
an undetectable HIV viral load in blood, semen, and vaginal
fluids—but not necessarily at the same time. It’s entirely possible
to have significant viral load in sexual fluids while the viral
load is undetectable as measured by blood. Several studies have
found significant virus in semen after the six-month
“undetectable” period recommended by the Swiss.
The Swiss team concluded
that “all epidemiological and
biological data indicate that
there is no relevant risk of
transmission during ART which
is completely adhered to.”
Even if undetectable plasma viral load would be a completely
reliable measure of infectiousness, there is still the matter of
blips—short-lived increases in viral load to detectable levels that
are sometimes seen in people on successful HAART. Since these
blips can appear unpredictably, there is no guarantee that a person’s viral load is undetectable at any given time, even if it was
undetectable at the time of last measurement. The same argument
could apply to sexually transmitted infections (STIs): if you’ve
been sexually active, how certain can you be that you have not
picked up an STI since your last negative test?
Finally, one of the statement’s biggest shortfalls was its failure
to address gay men and anal sex. As more than one community
advocate has put it, “one hole is not the same as the next.” More
scientifically, there are significant differences between the tissues
of the vaginal tract and the rectum. Since the studies cited in the
Swiss statement were conducted in heterosexual couples, their
interpretations cannot be applied to gay men. (Some studies in
gay men, such as the San Francisco Men’s Study, have shown
declining HIV incidence since the introduction of HAART, but
this is a very far cry from conclusive evidence.)
As yet, there is no assurance that an undetectable viral load
equals lack of sexual infectiousness for gay men. And there is certainly no indication of what an undetectable viral load might
mean for injection drug users.
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Crucially, many critics stress that terms like “uninfectious”
and “zero risk” are misleading, and the report itself admits that
such terms need careful interpretation. The authors admit that
the medical and biological data do not permit “strict scientific
proof” that infection during effective HAART is strictly impossible.
They liken the claim to the argument that “HIV cannot be transmitted by kissing”—not indisputably proven, but compelling
enough to be taken as fact.
This is where agencies and AIDS groups around the world beg
to differ. Granted, safer sex guidelines, including the Canadian
AIDS Society’s, contain a “minimal” or “theoretical” risk category.
This category is reserved for activities like kissing, where actual
cases of transmission have never been observed, and the theoretical
chance is astronomically slim—if not unequivocally “zero.” Most
experts argue that it’s a question of the burden of proof. Kissing
can reasonably be assumed to be safe unless and until the unlikely
event that someone proves otherwise. Unprotected sex during
treatment, on the other hand, should be considered unsafe until
a great deal more evidence consistently shows otherwise.
Treatment as prevention: a population point
of view
The Swiss statement was, in fact, not the first take on the question of treatment as prevention, even if it was the most dramatic.
One of the leading researchers to put the treatment as prevention
issue on the map was the BC Centre for Excellence in HIV/AIDS’s
own Dr. Julio Montaner. In a commentary recently published in the
Canadian Medical Association Journal, Dr. Montaner and colleagues
argue that, since HAART has been shown to reduce the rates of HIV
transmission, expanding treatment to the HIV-positive population
could serve as a prevention tool to curb the rates of new infections.
Opponents of this view point out that what works at a population level doesn’t necessarily make good individual advice.
This distinction has been much discussed in the context
of preventive vaccines, which are unlikely to be completely
protective. Think of a vaccine that you knew to be, let’s say, 90
percent protective against HIV. On a world scale, that might
result in hundreds of thousands of averted infections. But if
you were HIV-negative, would you personally rely on it to
protect you the next time you had sex?
Somewhat surprisingly, Switzerland has one of the world’s
most punitive legal environments toward sexual transmission of
HIV. In Canada and many other countries, HIV-positive people
are generally safe from criminal charges as long as they clearly
disclose their status to sexual partners before sex takes place.
Not so in Switzerland, where charges can still be laid against an
HIV-positive person for having unprotected sex, even with full
disclosure and consent. It has been suggested that the Swiss
statement was meant to work against these frightening legalities.
(The authors themselves state that one of their objectives was
to “alleviate fears of people living with or without HIV, and
thus to allow…people living with HIV in Switzerland to live as
‘normal’ as possible a sexual life.”)
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Whether this strategy will have any success—in Switzerland
or elsewhere—remains to be seen. To our knowledge thus far,
no arguments based on viral load and infectiousness have been
brought forward in a legal case concerning HIV transmission.
At present, there is no indication whether any of the arguments
used in the Swiss statement would carry legal weight in a
Canadian, Swiss, or any other court.
The need for clear messages
The complexities and confusions of the Swiss debate have
made one thing clear: while information shouldn’t be dumbed
down for public consumption, it does need to be as clear and
consistent as possible. Most people don’t have the time or
resources to follow the fine print: they need to know whether
“this is safe” or “this isn’t.”
Changing information has led to other confusing flip-f lops
in prevention messages in the past, and likely will again. In the
meantime, we have a shared responsibility to inform people as
clearly as we can.
The “uninfectious” debate will likely remain heated and
highly polarized for some time to come. On the one hand, a
message of such magnitude needs to be endorsed by more than
the considered opinion of one expert group—it needs rocksolid evidence that can be widely agreed upon.
On the other hand, with vaccines and microbicides still a
distant and uncertain hope, alternatives to a lifetime of condoms are sorely needed—not just for couples who want to raise
children, but the millions of sexually active people living with
or at risk for HIV.
One point that has gotten a bit lost in all the scientific
debate is that people with and at risk for HIV are starving for
the kind of good news that the Swiss statement represented.
Imagine a world in which HIV-positive people could have unprotected sex—freely, safely, and without fear of infecting their partners
or suffering legal consequences. We need more than reasons
why that isn’t a reality—we need to make it a reality. 5
The world weighs in
The Swiss statement has been almost universally criticized by
other experts worldwide. Two informative analyses are:
q The Australasian Statement on HIV Antiretroviral Therapy
and Infectiousness, www.ashm.org.au/news/334/11/
q The Canadian AIDS Treatment Information Exchange (CATIE)’s
“Swiss guidelines take a troubling turn”, www.catie.ca.
(Search the site for “Swiss”, under “CATIE news.”)
Derek Thaczuk has worked in information and
support services within the HIV community for over
a decade and is now a freelance writer and editor.
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Let’s
get
clinical!
Taking a shot at the flu
W
by Jennifer Chung
ith a flu pandemic expected to occur in the next
five to 10 years, being ready to provide timely care—
especially to those with compromised immune
systems—is essential. Canadian researchers have risen to the
challenge by rolling out a study examining vaccine strategies in
HIV-infected people [CTN 237].
“The burden of influenza disease among patients living with
HIV, including those who have been previously vaccinated, is
actually quite high in Canada and elsewhere,” says study principal investigator Dr. Curtis Cooper of the Ottawa Hospital.
“For this population, the illness is more severe, the duration is
longer, it results in more hospitalization, and there’s a slight
increase in mortality.”
Over the coming months, and in advance of flu season, participants will be randomized to one of three groups. Group
one will receive a single injection of Fluviral, group two will
receive an injection of Fluviral followed 30 days later by a second booster, and group three will receive a double dose of Fluviral followed 30 days later by a second double dose of Fluviral.
Researchers believe that if the booster dose of influenza vaccine results in improved seroprotection and eases disease burden, it will be valuable in treatment guidelines for flu
vaccination in people living with HIV.
“It’s been a long-standing recommendation that all HIVinfected persons receive a flu shot every year. It turns out we
aren’t quite sure that it’s effective,” says Dr. Brian Conway,
director of the Downtown Infectious Diseases Clinic, the BC
site that will be recruiting participants for this study.
Conway explains that in some individuals such as
women, older people, and those with lower CD4 counts, a
different strategy may be needed to maximize the benefit of
f lu shots. “This study will allow us to compare different
approaches to the yearly f lu shot and demonstrate which is
best for our patients.”
Dr. Cooper says that early planning might enable future
trials to be conducted quickly through the network of trained
sites developed from this one study.
“It’s vital that if we’re in the middle of a pandemic, we’re
able to recruit patients rapidly to evaluate new vaccines,
he says. “Much of the data collected will allow us to
understand why people do or don’t participate in inf luenza
vaccine studies.”
Dr. Cooper explains that findings from this study could also
help others with compromised immune systems. “We’re eager to
see if results from this study might be applicable to other populations including those on steroids as well as people living with
autoimmune disease, organ transplantation, and cancer.”
CTN 237 is aiming to recruit 285 people at 10 sites in
Canada. The study is expected to roll out in early fall. 5
Jennifer Chung is the information and
communications coordinator at the
Canadian HIV Trials Network in Vancouver.
Trials enrolling in BC
CTN 239—
CTN 233—
CTN 222—
Phase II study of AGS-004 an immunotherapeutic
agent in combination with ART followed by
ART interruption
BC sites: St. Paul’s Hospital, Vancouver
Pharmacokinetics of antiretroviral therapy (ARV)
in HIV-positive women
BC sites: Downtown Infectious Diseases Clinic
(DIDC), Vancouver; St. Paul’s Hospital, Vancouver;
Children’s and Women’s Hospital, Vancouver
Canadian Co-infection Cohort
BC sites: DIDC, Vancouver;
St. Paul’s Hospital, Vancouver
CTN 214—
CTN 194—
Effect of a One-Year Course of HAART
in Acute/Early HIV
BC sites: DIDC, Vancouver; Cool Aid Community
Health Centre, Victoria
Peg-Interferon and Citalopram in Co-infection (PICCO)
BC sites: St. Paul’s Hospital, Vancouver,
DIDC, Vancouver
To find out more about these and other CTN trials,
visit the Canadian HIV Trials Network database
at www.hivnet.ubc.ca or call 1.800.661.4664.
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Antiretrovirals
Antiretroviral update
The BC Centre for Excellence’s June presentation
by R. Paul Kerston
he BC Centre for Excellence in HIV/AIDS (BC-CfE)
held their semi-annual antiretroviral update in early June.
There were a number of highlights.
BC-CfE’s director, Dr. Julio Montaner, presented 48-week
results from the CASTLE study showing that once-daily
atazanavir (Reyataz) boosted with ritonavir (Norvir) appears
as good as twice-daily soft gel capsules of ritonavir-boosted
lopinavir (Kaletra) in suppressing HIV, with very minor differences in CD4 increases between them. The study looked at 883
treatment-naïve patients having viral loads greater than or equal
to 5,000, and dosing included emtricitabine (FTC, Emtriva)
and tenofovir/emtricitabine (Truvada) once daily.
Dr. Montaner suspects that maraviroc (Celsentri)—in a new
class of drugs called CCR5 co-receptor antagonists—while
approved for treatment-experienced patients in Canada, might
be used for first-line therapies in future. Unfortunately, maraviroc
can easily become ineffective for a number of reasons.
Notably, Dr. Montaner mentioned there were only seven
cases of protease inhibitor (PI) class resistance in all of BC
during 2007, showing how effective antiretroviral treatments
can be with good adherence.
He also mentioned that new blips in low-end viral load
results—which might truly be less than 40 copy results but
sometimes read higher with the new test—shouldn’t be ignored
and the test should be retaken, just to be safe.
Dr. Montaner urged physicians whose patients present with
opportunistic infections (OIs) to immediately treat with antiretrovirals, regardless of current CD4 cell counts. Raising CD4
T
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levels through successful viral treatment helps ensure against
OIs. The recommendation is also based on results from Study
ACTG A5164, presented at Conference on Retroviruses and
Opportunistic Infections (CROI) this year.
New BC-CfE treatment guidelines should be available in
September 2008, with the newer Atripla (a three-in-one, once-aday combination of emtricitabine, tenofovir, and efavirenz)
plus Kivexa or Truvada as a preferred first-line regimen, and
atazanavir/ritonavir, Kaletra, or boosted saquinavir (Fortovase),
in other first-line recommended combinations. Advanced treatment options will probably favour efavirenz (Sustiva) over Kaletra
for those with equal to or greater than 200 CD4 cell counts.
Women and side effects of Truvada
Dr. David Burdge, from the Oak Tree Clinic, presented on HIV
infection in women. He noted he’s seen more women than
men experiencing side effects with Truvada, which can include
nausea, vomiting, and rashes, usually within the first week.
Women who are able to adhere to treatment do as well as men
on this drug, however. He suggests that lamivudine (3TC) with
tenofovir produces fewer side effects, generally, and he added
that tenofovir appears good for women’s overall bone health.
Dr. Burdge thinks DEXA bone density scans will soon become
a part of BC-CfE guidelines at baseline, meaning they would be
part of an initial screening upon HIV diagnosis.
Junine Toy, a clinical pharmacist at St. Paul’s Hospital,
talked about how the pharmacy noticed that protease
inhibitors (PIs) and even tenofovir-based regimens may produce
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gas. She gave strategies for controlling gas and other relatively
minor but annoying side effects such as diarrhea: avoiding
ritonavir, nelfinavir, and Kaletra; abstaining from caffeine,
alcohol, sorbitol, and high-sugar beverages; going easy on
greasy or spicy foods, plus dairy products; and using both
prescription and non-prescription medications, including
psyllium, calcium, loperamide (Imodium) and lactase. She gave
similar advice for flatulence, cramps, nausea, and vomiting.
She also offered ideas for controlling the central nervous system
effects of efavirenz, and she urged against doing treatment
interruptions with efavirenz because of its long half-life.
Toy also mentioned that atazanavir has been associated with
increases in blood levels of bilirubin, a product of the breakdown of aging red blood cells, and found in the liver before
typical excretion. In excess levels, this indicates jaundice. She
said that minor increases in bilirubin can be tolerated.
Baseline assessments for hepatitis B
Dr. Zig Erb, from the Department of Gastroenterology at
Vancouver General Hospital, gave a presentation on baseline
assessments plus treatments for hepatitis B (HBV). He also
stressed doing resistance testing for HBV drugs at baseline and
whenever changes are anticipated.
Repeatedly, Dr. Erb stressed that HBV RNA is the best
assessment of HBV infection, and said that if the RNA
test is positive, treatment should begin. He stressed that HIVnegative persons with HBV RNA positive results (as well as
HIV-positive persons not on HIV treatment) should always be
treated for HBV. He suggests using two classes of HBV medications, including either lamivudine or emtricitabine plus a class
2 HBV drug, if the person is HIV-positive; if HIV-negative, then
he said to consider using pegylated interferon (Pegasys) and not
lamivudine or emtricitabine. Finally, Dr. Erb pointed out that
interferon, for six months, is paid by MSP.
Dr. Richard Crawford, from the Division of Dermatology at
St. Paul’s Hospital and an affiliate of the Immunodeficiency
Clinic at the BC-CfE, talked about various skin disorders
affecting HIV-positive persons, including molluscum,
eosinophilic folliculitis, and rashes. He also suggested some
treatment options, including the new PI darunavir (Prezista), in
addition to nevirapine, which have some risk for the potentially
fatal Stevens-Johnson syndrome. Dr. Crawford suggests that
treatment with topical corticosteroids is effective, but stressed
that the potency of the drug selected is more important in
determining effectiveness than the drug’s concentration in
the medication.
(The old test only measured up to 100,000 and down to 50.)
This test requires a greater volume of blood than previously
needed and some results are coming back as “insufficient
volume: no result.” Dr. Harrigan said he would advocate for
greater volume in those blood draws, and he urged patients to
do the same.
Dr. Harrigan also spoke about the new CCR5 tropism assay
he is developing. This test is needed to determine susceptibility
to maraviroc, but testing is currently only done in a San Francisco laboratory. Limitations of this assay include the need for
5 ml of blood that has been freshly processed (not frozen) and
the viral load must be at least 1,000 copies.
Therapeutic drug monitoring
Dr. Marianne Harris, the clinical research advisor for the AIDS
Research Program at St. Paul’s Hospital/University of British
Columbia, addressed how therapeutic drug monitoring (TDM)
isn’t standard of care and can only be used with PI medications
and non-nucleoside reverse transcriptase inhibitors (NNRTIs),
not with nucleoside reverse transcriptase inhibitors (NRTIs).
TDM requires a patient’s informed consent and currently
must be performed at St. Paul’s Hospital. TDM can establish
whether drug levels in the blood are too low or too high or
within therapeutic range, but Dr. Harris stressed that it isn’t yet
an exact science because the timing of the peaks and troughs
relative to the blood draw aren’t fully known yet, thus results
may not be accurate. It’s still experimental. Physicians may
request TDMs through Dr. Montaner or Dr. Harris.
Additionally, Dr. Harris mentioned that there are 14 cases
in medical literature concerning kidney stones associated
with atazanavir, which don’t appear to be related to drug
concentration levels.
Finally, Dr. Montaner presented several slides showing how considering HIV as a chronic inflammatory disease explains not only the
CD4 cell loss but also the causes of HIV-related (but non-AIDS)
events such as heart, liver and kidney problems, plus cancers. 5
Watch the presentation on video
To watch the entire antiretroviral update on video,
visit the BC-CfE’s website at
http://cfenet.ubc.ca/video.php?id=23&sid=33&cat=57.
New viral load assay
Dr. Richard Harrigan, the director of Research Laboratories at
the BC-CfE, spoke about the new viral load assay that measures
HIV RNA. Developed by Roche, the new test, called the TaqMan, measures up to 1,000,000 copies and down to 40 copies.
R. Paul Kerston is BCPWA’s treatment
outreach coordinator and community
representation and engagement
(CRE) coordinator.
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Nutrition
Better safe than sorry
Know how to keep your food free of bacteria and protect yourself
from food-borne illness
by Sarah Fielden and Shemina Patni
arlier this year, tomatoes were pulled from grocery store
shelves and removed from the menus of restaurants
across North America. The culprit: Escherichia coli
(E-coli), bacteria that live in humans and the bodies of
other animals but can be toxic if consumed in high levels
in contaminated food. E-coli and other bacteria such as
Campylobacter, Salmonella, and Listeria can f lourish in
foods produced and consumed in unsafe conditions.
These, in turn, produce food-borne illnesses that can be
accompanied by symptoms that range from mild (nausea)
to severe (meningitis).
And yes, you should care: HIV-positive people are more
susceptible to food-borne illness than other people with
stronger immune systems.
In the food service industry, certain steps in producing
and distributing foods have been identified as critical control
points for ensuring that food remains safe from farm to
plate. Safety plans are put into place according to guidelines
and models such as HACCP (Hazard Analysis and Critical
Control Points). These steps are comparable to the safety
process that you should follow when purchasing food and
preparing it at home.
The following suggestions will help to keep you safe from
food-borne illness at each step.
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Purchasing
q Buy only pasteurized dairy products, ciders, and juices.
q Avoid dented cans, broken seals, and other signs of damage.
q Avoid bruised produce—it has begun decomposing prematurely
at those spots.
q Check the expiry date of items before you buy them.
q Make sure you rotate foods such as eggs in your fridge so
that you eat the less fresh items first (as long as they are
still good).
q Minimize the time from store to fridge for refrigerated and
frozen items—buy them last and bring them directly home.
q Avoid raw foods—such as sushi, some desserts made with raw
eggs—that are sold in the grocery store and at restaurants.
Thawing
q Thaw foods in your fridge or, if necessary, under cold running
water, rather than on your kitchen counter. Bacteria thrive in
warm moist environments.
q Thaw items on plates in your fridge, so raw juices don’t contaminate other foods; this is called cross-contamination.
Preparation
q Make sure surfaces, cutting boards, utensils, and serving dishes
are clean. Dishes should ideally be cleaned in water that is
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HIV-positive people
are more susceptible to
food-borne illness than
other people with stronger
immune systems.
180F/82C (steaming) temperature. Surfaces should be bacteria
free (you can use a solution of 1 teaspoon of bleach to 1L of
water as a cheap alternative to expensive cleaners).
q Wash fruits and vegetables with running water, rubbing them
or scrubbing them to get rid of surface bacteria.
q Use different cutting boards for meats, dairy, and produce; try
different colours. Plastic cutting boards are easiest to keep clean.
q Wash your hands before preparing food and often throughout,
especially when handling raw meats.
q Use clean washcloths and sponges and replace them regularly.
q If in doubt about a food’s quality, throw it out.
q Cook all meats, poultry, eggs, and fish to the well-done stage.
There should be no pink in meats, egg yolks should be firm,
and juices of chicken should run clear. A thermometer should
reach 180°F (82°C) for chicken and 160°F (71°C) for burgers.
Most cookbooks will tell you proper cooking temperatures
and techniques.
q Avoid cross-contamination by keeping raw and cooked foods
separate during preparation.
q Leave microwaved items to sit out of the microwave for a few
minutes in order to finish cooking.
Holding and storage
q Keep hot foods hot (over 140°F/60°C) and cold items cold
(under 40°F/4°C).
q Don’t leave foods sitting at room temperatures for more than
two hours if they’re not shelf stable, that is, foods that can be
stored on the shelf like dry grains.
q Don’t leave raw meats in the fridge for more than 2 days.
q Store food items in sealed containers in and outside of the refrigerator.
q Don’t keep leftover foods for more than two days after they’ve
been prepared.
q Reheat leftovers only once to a steaming temperature over
165°F (74°C). 5
Further reading
For more information about food-borne infection and precautions,
read “Spoiled rotten,” living 5, September/October 2005.
Sarah
Fielden is a
member of
Vancouver
Dietitians in
AIDS Care and
is completing
her PhD at the University of BC
in Interdisciplinary Studies at
the Centre for Population
Health Promotion Research.
living5
27
Shemina
Patni is a
registered
dietitian and
works for
Morrison
Healthcare
Food Services as a patient
food services manager at
the Children’s and Women’s
Health Centre of B.C.
10/3/08
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Side Effects
The two
faces of
Bio-Alcamid
New study reports some
immune-related side effects
from the facial filler
by Zoran Stjepanovic
here has been some news recently about people having
immune-related side effects many months after having
been injected with facial filler polyalkylimide gel, or
Bio-Alcamid. This raised some eyebrows at BCPWA because
we’ve been advocating for medical insurance coverage of this
injection for people living with HIV.
Facial lipoatrophy, or facial wasting, is a direct side effect of
HIV medications or HIV itself. This debilitating and disfiguring
condition can have a detrimental effect on a person’s self-esteem,
causing the person to become isolated and even more stigmatized. As a result, many individuals develop clinical depression
and they may have difficulty functioning in daily life.
Bio-Alcamid’s treatment for facial lipoatrophy was approved
by Health Canada in 2006. It’s a filler implant that comes as a
transparent gel in sterile syringes, and is permanent—though it
can be removed if necessary. Known potential side effects may
include pain, swelling, bruising, or redness that can occur in
the first few days after being injected. These side effects usually
go away. There have not been any reports of the immune system
reacting to Bio-Alcamid.
However, recently a study was published in the Archives of
Dermatology reporting problems with Bio-Alcamid. Spanish
physicians from Barcelona assessed 25 people who had what
appeared to be side effects of Bio-Alcamid injections 12
months or more after treatment. The side effects ranged from
tender modules or bumps at the injection site in 24 of the 25
participants, and headaches and fever in six participants.
Twenty individuals had laboratory abnormalities that implied
immune inflammation. Note, however, that this was a very
small study and the study didn’t indicate whether participants
were HIV-positive.
Since these study results were released, Ascente Medical
Corporation has responded by stating that the rate of delayed
adverse events with Bio-Alcamid is extremely low and also
T
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living5
comparable to the average rate of occurrence among other facial
fillers, including hyaluronic acids (Restylane) and polylactic
acids (New Fill/Sculptra). They claim that between 2001 and 2006,
over 190,000 mLs of Bio-Alcamid were sold in Spain and
approximately 2mL to 5mL were used for each treatment—
meaning that somewhere between 32,200 and 80,200 patients
were treated. Based on the number of treatments, delayed adverse
events occurred in only 0.04 percent to 0.10 percent of patients.
It was a very small study and
the study didn’t indicate
whether participants
were HIV-positive.
The manufacturers also argue that Bio-Alcamid wasn’t compared to other facial fillers in terms of delayed adverse events,
and that a 2007 study also showed delayed adverse effects
related to hyaluronic acid and acrylic hydrogel dermal fillers; in
that study, investigators found an occurrence of delayed adverse
effects at 0.05 percent.
BCPWA has been advocating with the Ministry of Health to
get medical services coverage of this product for people with
HIV based on the argument that it’s reconstructive surgery,
and not a cosmetic procedure used to alleviate symptoms of
HIV disease. Expect to hear about these advocacy efforts in the
near future, as well as more detailed information on different
treatments used to treat facial lipoatrophy in future issues of
living 5 magazine.
Zoran Stjepanovic is BCPWA’s
treatment information coordinator.
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Complementary Therapies
Spice up your life
Turmeric, ginger, and garlic don’t just add flavour,
they have healing qualities by Alix Mathias
hat’s hot, tasty, and gets your blood pumping? Todd
Caldecott, clinical/medical herbalist, Ayurvedic
practitioner, and author of Ayurveda: The Divine
Science of Life, shares his wisdom on the use of herbs and spices
for healing. Caldecott volunteers at the Vancouver Friends
For Life Society, teaching group classes on how to apply the
ancient healing art of Ayurveda in your wellness journey.
W
Alix Mathias: What are your three favourite medicinal or healing herbs and spices?
Todd Caldecott: It’s very difficult for me to narrow it
down to just three, but I choose turmeric, garlic, and ginger.
AM: What are these spices traditionally used
for? What are their healing properties?
TC: Turmeric is a cooling, bitter-tasting, detoxifying remedy
that helps to promote bile flow in the liver, cleans the blood,
purifies the skin, and reduces inflammation. It’s used to treat
most types of liver disorders, particularly if there is congestion
or obstruction of bile flow. Turmeric speeds up and enhances
the filtering of blood, which benefits the skin so it is very helpful for conditions like eczema and acne. The yogis of India have
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living5
traditionally used it to strengthen and nourish the
ligaments and reduce inflammation in the joints.
Garlic is a heating, pungent-tasting, detoxifying herb that
helps to strengthen digestion and boost the immune system.
It’s believed to have vascular [i.e., the tubes that carry your
blood] benefits, normalizing blood lipids and improving blood
circulation. Garlic is seen as rejuvenative and restorative, and is
taken by people recovering from chronic illness, or post-partum,
to boost their vital energy. In this case, garlic is better cooked
in a meat broth, boiled in milk, or roasted to remove its pungent,
aggravating properties.
Ginger is another important herb, with a heating,
pungent f lavour that similarly strengthens digestion and
moves the blood. In Ayurveda, ginger is called dipanapachana, meaning that it stimulates the appetite while
providing a cooking activity, helping to transform foods
into nutrients in the gastrointestinal system. Ginger is
widely used to alleviate cramping and is particularly useful in
nausea. Ginger is mixed with honey to get rid of excess
mucus and congestion, and is also good to promote circulation. Taken on its own, or with herbs such as turmeric,
ginger is useful for joint pain.
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AM: How can those of us who didn’t grow
up with these herbs and spices learn how
to start making better use of them in our
daily lives?
TC: Garlic is the easiest to incorporate into your diet because it
tive effect in the liver, and can be combined with other herbs
to support the liver.
can be added to most any dish. It’s best eaten fresh, mixed with
a little fatty food such as avocado to minimize its pungent quality. On less appetizing subjects, a poultice of garlic is very good
to draw pus out of abscesses and treat infections, and when
crushed and mixed with oil can be used as a suppository for
parasites like pinworms. Raw garlic infused in honey is another
combination, and is a very good cold, flu, and cough remedy.
Turmeric should be used in small amounts; maybe 1/4
teaspoon per person per dish, otherwise it lends too bitter of
a flavour. It can be added to the water of grains like rice or
quinoa to give it a brilliant yellow colour. Turmeric can be
boiled in some organic milk as an effective remedy for coughs
and bronchitis. Mixed with a little salt and water, turmeric is
also a good gargle for sore throats. Turmeric has definite
antimicrobial properties, and can be applied topically and
taken internally for infection, and works very well for parasites
and fungal infections.
Tea made with fresh, boiled ginger is fantastic to drink in
the cold season and will help ward off colds and flus. Ginger
can be added to the water when boiling dry beans to ensure
they don’t cause flatulence.
although what is aphrodisiac to one person may not be for another. Among the commonly used spices, nutmeg is probably
the most reputable aphrodisiac. Cardamom is also believed to
have mild aphrodisiac properties, and can be combined with
nutmeg and other similar herbs such as cinnamon and ginger,
boiled in milk, and taken with a teaspoon of ghee and a little
sugar. Other common spice cabinet aphrodisiacs include
chocolate, vanilla, saffron, and rose. Garlic is another reputed
aphrodisiac, and is avoided by some meditators because it inflames the passions. Of course, it works best if both partners
consume it, otherwise the libidinous aroma of your partner
could just as easily be a turnoff! 5
AM: Where’s the best place to buy these
spices? Fresh, whole, or ground—what’s best?
TC: It’s best to find them in the whole form, either fresh or
recently dried. Fresh turmeric root—rhizome, actually—can
typically be found at Indian markets and sometimes at upscale
health food grocery stores, but it’s very seasonal. Fresh ginger
root can be found everywhere at most times of the year, and the
dried whole ginger root can be found at both Indian and Chinese grocery stores.
AM: Are there any contraindications? Is
there any reason someone who is HIVpositive or has hepatitis C shouldn’t use
these spices?
TC: For HIV, larger therapeutic quantities of garlic could
theoretically promote the premature clearance of protease
inhibitors such as ritonavir, by inducing one of the body’s
liver enzymes, but not on the same level as something like St
John’s wort. I would have no problem, however, suggesting its
use in larger amounts for short periods during active infection. There’s no data suggesting that either ginger or turmeric
has this action. For hepatitis C, turmeric is of special value, as
it helps to support phase II liver detoxification, which helps
to remove reactive intermediates produced by phase I reactions. As such, turmeric has a general protective and regeneraSeptemberqOctober 2008
AM: What do you consider the sexy spices?
TC: Several spices are believed to have aphrodisiac properties,
Golden milk recipe
When the weather starts to turn colder, warm yourself
with this delicious and healing brew. It will help
keep coughs and colds away and your liver will thank
you. But wear an apron because turmeric will stain
your clothes.
3 1/4-1/2 cup water – add more water if this gets
too dry
3 1/8 teaspoon turmeric – you can use as much as 1/2
tsp per cup for a stronger taste
3 3 green cardamom pods (optional)
Bring to a boil and simmer 5 to 7 minutes, then add:
3 1 cup milk – raw, organic if you can; goat milk is a
good alternative to cow milk if you have an allergy
3 2 tablespoons almond oil; cold-pressed is best
Bring the liquid to the boiling point then remove from
heat. Don’t allow it to boil. Add honey or maple syrup
as desired to taste.
Makes one serving.
Alix Mathias is a Kundalini Yoga teacher
and cheerleader for wellness.
She lives a super healthy life,
which includes chocolate, ice cream,
and coffee because joy is an
aspect of wellness.
living5
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Page 32
High anxiety
HIV and post-traumatic stress disorder can impact one another
by Tonya Wood
aunting loneliness, desolate isolation—both real and
imagined—and an aching emptiness that can seem endless: if you’re living with HIV, you can experience these
feelings at any time in your life. Compound those feelings with
post-traumatic stress disorder (PTSD) and you could be overwhelmed, confused, and not know where to turn for help.
Post-traumatic stress disorder is a new name for a very old
condition. In the early twentieth century, it was known as shell
shock or battle fatigue. Before that, it had no name.
A PTSD diagnosis can have a negative impact on the cause
and progression of HIV/AIDS in a number of ways. People
H
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living5
with PTSD tend to report more health problems as compared
to people without the disorder. They also tend to engage in
more health compromising behaviors, such as alcohol and drug
use, smoking, lower levels of physical activity, and poor diets.
PTSD is common among PWAs
Given the high rate of exposure to traumatic events among
people living with HIV/AIDS, it isn’t surprising that many may
also have a diagnosis of PTSD. Studies have found rates of
PTSD among PWAs to range anywhere from 22 to 64 percent—
higher than in the general population.
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How to tell if you have post-traumatic stress disorder
You may have post-traumatic stress disorder if:
q You experienced, witnessed, or were confronted with an
event or events that involved actual or threatened death,
serious injury, or a threat to your or another person’s
physical integrity, and
q Your response involved intense fear, helplessness, or horror
Persistent avoidance of stimuli, as indicated by three or
more of the following:
q Efforts to avoid thoughts, feelings or conversations
associated with the trauma
q Efforts to avoid activities, places, or people that arouse
those recollections of the trauma
Signs and symptoms fall under three groups:
q Inability to recall an important aspect of the trauma
q Persistently re-experiencing the traumatic event in one
q Markedly diminished interest or participation in
or more of the following ways:
significant activities
3 Recurrent and intrusive distressing recollections of
the event including images, thoughts, or perceptions
q Feeling of detachment or estrangement from others
3 Recurrent distressing dreams of the event
q Sense of a foreshortened future (e.g., don’t expect to
3 Acting or feeling as if the traumatic event were
recurring (e.g., a sense of reliving the experience,
illusions, hallucinations, and dissociative flashback
episodes, including those that occur upon awakening
or when intoxicated)
3 Intense psychological distress at exposure to
internal or external cues that symbolize or resemble
an aspect of the traumatic event
q Restricted range of affect (e.g., unable to feel joy)
have a career, marriage, children, or a normal life span)
Persistent symptoms of increased agitation:
q Difficulty falling or staying asleep
q Irritability or outburst of anger
q Difficulty concentrating
q Hyper-vigilance – constantly on the lookout
q Exaggerated startle response
3 Physiological reactivity upon exposure to internal or
external cues that symbolize or resemble an aspect
of the traumatic event
An HIV diagnosis itself can cause PTSD symptoms. You
may feel as if your life is threatened, and you may experience
fear and helplessness. The stigma of an HIV diagnosis may also
increase the severity of PTSD symptoms.
Studies have found rates
of PTSD among PWAs to
range anywhere from 22 to
64 percent—higher than in
the general population.
PTSD can also interfere with adherence to highly active
antiretroviral therapy (HAART). Studies have found that this
may be due to high levels of depression and distress.
Finally, PTSD may negatively affect immune function. Some
studies reveal that HIV-positive individuals who have been
exposed to a traumatic event show a more rapid decrease in
CD4/CD8 cell ratios.
There are a number of effective treatments for PTSD.
Medications for a primary diagnosis of PTSD vary with each
person, and can depend on whether you have co-existing
diagnoses. If you have a secondary diagnosis of depression, you
may require an antidepressant medication: selective serotonin
reuptake inhibitors (SSRIs) or serotonin-norepinephrine
reuptake Inhibiters (SNRIs) are commonly prescribed.
Some physicians may treat your anxiety disorder with
benzodiazepines—in other words, tranquilizers and sleeping
pills. However, if you also have a substance abuse disorder,
these medications could be problematic, since they’re
potentially addictive.
Importantly, all these medications may interact with your
HIV drugs. If you do seek a psychiatric consultation and the
therapist prescribes something for PTSD, make sure the
therapist is aware of which HIV medications you’re taking
and is familiar with the possible interactions. 5
Various treatment options
If you suspect that you have PTSD, contact your family doctor
for referral to a therapist who specializes in anxiety disorders.
Tonya Wood is a volunteer with BCPWA’s
Support Services Department.
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what’s new in research
The first Canadian
division of AIDS at UBC
T
by Dr. Marianne Harris
he University of British Columbia Department of
Medicine established a Division of AIDS (DAIDS) in
April 2007. Precedents for a similar DAIDS exist at other
major universities in North America, including Harvard Medical
School and the University of California at San Francisco General
Hospital. The UBC Division of AIDS, based at the BC Centre for
Excellence in HIV/AIDS (BCCfE), is the first of its kind in Canada.
The Division of AIDS at UBC will bring together faculty
and staff members with expertise in epidemiology, basic science, clinical science, HIV prevention, integrated primary and
specialty care, urban health, and international health.
The advantages of having a DAIDS in Vancouver are many.
First, it will enhance collaborations between the BCCfE and
the Department of Medicine at UBC. As well, the formal
acknowledgement of HIV/AIDS as an academic discipline will
allow new physicians and researchers to focus their careers
specifically on this area of study, which has previously been
encompassed as a subspecialty within the Division of
Infectious Disease. Finally, the DAIDS will attract and retain
staff with the wide range of expertise needed to further
enhance HIV/AIDS clinical care, scientific research, and
training in BC.
The effort to establish a DAIDS at UBC was spearheaded by
Dr. Julio Montaner, who serves as head of both the BCCfE
and the DAIDS. Dr. Montaner is well known locally for his
leadership in HIV patient care in BC. He’s also recognized
nationally and internationally for his important contributions
to innovative research in the global fight against HIV/AIDS.
The profile of the BCCfE and the UBC DAIDS will be further enhanced now that Dr. Montaner has taken over as the
president of the International AIDS Society (IAS) at the XVII
International AIDS Conference in Mexico City. Dr. Montaner’s
two-year term as IAS president will bring attention to the role
of Canada, and BC specifically, at the forefront of HIV/AIDS
care and research.
34
living5
BCCfE at the AIDS Conference
In other news from the AIDS conference, a number of leading
researchers from the BCCfE presented their results in Mexico City.
Dr. David Moore and colleagues looked at what happens to people
who interrupt their antiretroviral therapy for three months or
more without medical supervision. Of 1,558 people who started
treatment in BC between January 2000 and June 2006, 39 percent
(609) went off treatment for at least three months up to June 2007.
Although the reasons for treatment interruption weren’t
assessed in this study, they may have had to do with lifestyle
issues and access to medical care; women and IDUs were more
likely to go off treatment, as were younger people and those
with less advanced HIV disease. The good news is that most
people (all but 2) who interrupted treatment remained alive
and 74 percent eventually restarted antiretroviral therapy.
Another BCCfE study presented by Dr. Natalie Jahnke
looked at the complex relationship between HIV and hepatitis
C (HCV) infection. Of 1,007 people who started antiretroviral
therapy in the BCCfE Drug Treatment Program between
August 1996 and July 2000, 574 were HCV-negative and 433
were HCV-positive, and 209 died before June 30, 2007.
Injection drug users, people who were non-adherent with therapy,
and those who had lower CD4 cell counts and higher HIV viral
loads at the time of starting antiretrovirals had poorer rates of
survival. Not surprisingly, people who were coinfected with HCV
were more likely to die than those who were HCV negative; however, no difference was seen in terms of risk of death between
people who had HCV genotype 1 (which is generally associated
with poorer response to HCV therapy) and those
infected with HCV genotypes 2 and 3. 5
Dr. Marianne Harris is a family doctor
with the AIDS Research Program
at St. Paul’s Hospital in Vancouver.
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Page 35
Cast an
informed vote
on October 14!
In the lead-up to the federal election on October 14, it’s imperative that voters
determine where the parties stand on the issue of fighting HIV/AIDS in Canada.
The number of HIV-infected individuals continues to grow in our country
and, while great strides have been made to curb the spread of this disease with
innovative treatment programs and research, the Conservative government has
continued to ignore this serious public health threat and its effective treatment.
A government with appropriate policies can help prevent new cases of HIV
and improve the quality of life for those who are most vulnerable to HIV, as well
as for those already infected and affected by it.
The Conservative government’s record of fighting this disease and
supporting the ever-increasing population of those it affects is the worst of any
Canadian federal government since the epidemic began.
In 2004, $84 million was promised to—and budgeted for—the Federal
Initiative on HIV/AIDS in Canada, yet that promise was never met and
subsequent annual year budgets were slashed.
Consequently, over the past two years the community-based HIV/AIDS
movement in Canada has experienced a $20 million shortfall—now $11.8 million
annually, a 13 percent cut—in federal government funding from what had been
budgeted in 2004; that money was diverted to other programs.
Ongoing antiscientific opposition to proven effective harm reduction
initiatives like Vancouver’s InSite project condemns the most wretched among
us to ongoing addiction, poverty, and death.
Canada’s inaction in the global fight against HIV/AIDS in the last two
years is an international embarrassment.
We urge you to vote on October 14 and send a clear message about the
leadership needed to stop HIV in Canada by voting for those parties that
support an effective fight against HIV/AIDS.
Important Reminder:
When you vote, you MUST prove your identity and address with TWO pieces of
approved ID. You have three options (visit www.elections.ca for more details):
1) Provide one original piece of identification issued by a government or
government agency containing your photo, name, and address.
(driver’s licence, provincial ID)
2) Provide two original pieces of identification authorized by the Chief
Electoral Officer of Canada. Both pieces must contain your name, and one
must also contain your address. (SIN card, credit card statement, etc.)
3) You can be vouched for by an elector whose name appears on the list of
electors in the same polling division and who has an acceptable piece or
pieces of identification. Both will be required to make a sworn statement.
An elector cannot vouch for more than one person, and the person who has
been vouched for cannot vouch for another elector.
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where to find
Page 38
help
If you’re looking for help or information on HIV/AIDS, the following list is a starting point.
A Loving Spoonful
Dr Peter Centre
Positive Living North West
Suite 100 – 1300 Richards St,
Vancouver, BC V6B 3G6
604.682.6325
e [email protected]
www.alovingspoonful.org
1100 Comox St,
Vancouver, BC V6E 1K5
t 604.608.1874
f 604.608.4259
e [email protected]
www.drpetercentre.ca
Box 4368 Smithers, BC V0J 2N0
3862 F Broadway, Smithers BC
t 250.877.0042 or 1.886.877.0042
e [email protected]
AIDS Memorial Vancouver
Friends for Life Society
205 – 636 West Broadway,
Vancouver BC V5Z 1G2
604.216.7031 or 1.866.626.3700
e [email protected] www.aidsmemorial.ca
1459 Barclay St, Vancouver, BC V6G 1J6
t 604.682.5992
f 604.682.3592
e [email protected]
www.friendsforlife.ca
AIDS Society of Kamloops
Healing Our Spirit
P.O. Box 1064, 437 Lansdowne St,
Kamloops, BC V2C 6H2
t 250.372.7585 or 1.800.661.7541
e [email protected]
3144 Dollarton Highway,
North Vancouver, BC V7H 1B3
t 604.879.8884 or 1 866.745.8884
e [email protected]
www.healingourspirit.org
Positive Women’s Network
614 – 1033 Davie St, Vancouver, BC V6E 1M7
t 604.692.3000 or 1.866.692.3001
e [email protected] www.pwn.bc.ca
Purpose Society HIV/AIDS program
40 Begbie Street
New Westminster, BC V3M 3L9
t 604.526.2522
f 604.526.6546
Red Road HIV/AIDS Network Society
804 – 100 Park Royal South,
W. Vancouver, BC V7T 1A2
t 604.913.3332 or 1.800.336.9726
e [email protected] www.red-road.org
AIDS Vancouver
Living Positive Resource Centre
Okanagan
1107 Seymour St, Vancouver BC V6B 5S8
t 604.893.2201 e [email protected]
www.aidsvancouver.bc.ca
Vancouver Native Health Society
101–266 Lawrence Ave.,
Kelowna, BC V1Y 6L3
t 250.862.2437 or 1.800.616.2437
e [email protected]
www.livingpositive.ca
AIDS Vancouver Island (Victoria)
1601 Blanshard St, Victoria, BC V8W 2J5
t 250.384.2366 or 1.800.665.2437
e [email protected]
www.avi.org
AIDS Vancouver Island
(Cowichan Valley Mobile Needle Exchange)
t 250.701.3667
AIDS Vancouver Island (Campbell River)
t 250.830.0787 or 1.877.650.8787
AIDS Vancouver Island (Port Hardy)
t 250.949.0432
AIDS Vancouver Island (Nanaimo)
t 250.753.2437
AIDS Vancouver Island (Courtenay)
t 250.338.7400 or 1.877.311.7400
441 East Hastings St, Vancouver, BC V6G 1B4
t 604.254.9949
e [email protected]
Victoria AIDS Resource & Community Service Society
McLaren Housing Society
200 – 649 Helmcken St,
Vancouver, BC V6B 5R1
t 604.669.4090
f 604.669.4092
e [email protected]
www.mclarenhousing.com
1284 F Gladstone Ave, Victoria, BC V8T 1G6
t 250.388.6620
f 250.388.7011
e [email protected]
www.varcs.org/varcs./varcs.nsf
Okanagan Aboriginal AIDS Society
#330-1105 Pandora St., Victoria BC V8V 3P9
t 250.382.7927
f 250.382.3232
e [email protected] www.vpwas.com
Victoria Persons With AIDS Society
101 – 266 Lawrence Ave.,
Kelowna, BC V1Y 6L3
t 250.862.2481 or 1.800.616.2437
e [email protected]
www.oaas.ca
Wings Housing Society
12 – 1041 Comox St, Vancouver, BC V6E 1K1
t 604.899.5405
f 604.899.5410
e [email protected]
www.wingshousing.bc.ca
ANKORS (Nelson)
Outreach Prince Rupert
101 Baker St, Nelson, BC V1L 4H1
t 250.505.5506 or 1.800.421.AIDS
f 250.505.5507 e [email protected]
http://kics.bc.ca/~ankors/
300 3rd Ave. West
Prince Rupert, BC V8J 1L4
t 250.627.8823
f 250.624.7591
e [email protected]
ANKORS (Cranbrook)
205 – 14th Ave N Cranbrook,
BC V1C 3W3
250.426.3383 or 1.800.421.AIDS
f 250.426.3221 e [email protected]
http://kics.bc.ca/~ankors/
YouthCO AIDS Society
205 – 1104 Hornby St. ,
Vancouver BC V6Z 1V8
t 604.688.1441
1.877.968.8426
e [email protected]
www.youthco.org
Pacific AIDS Network
c/o AIDS Vancouver Island (Victoria)
1601 Blanchard St.,
Victoria V8W 2J5
t 250.881.5663
e [email protected]
Asian Society for the Intervention of AIDS (ASIA)
210 – 119 West Pender St,
Vancouver, BC V6B 1S5
t 604.669.5567
f 604.669.7756
e [email protected]
www.asia.bc.ca
f 250.920.4221
www.pan.ca
Positive Living North
1–1563 2nd Ave,
Prince George, BC V2L 3B8
t 250.562.1172 f 250.562.3317
e [email protected]
www.positivelivingnorth.ca
BC Persons With AIDS Society
1107 Seymour St, Vancouver BC V6B 5S8
604.893.2200 or 1.800.994.2437
e [email protected]
www.bcpwa.org
38
living5
For more comprehensive listings of
HIV/AIDS organizations and services please
visit BCPWA’s website at www.bcpwa.org
and click on “Links and Services” under the
“Empower Yourself” drop-down menu.
of
please
a.org
er the
nu.
10/3/08
12:33 PM
Page 39
Upcoming BCPWA Society Board Meetings:
Date
Time
Location
Reports to be presented
October 8, 2008
1:00
Board Room
Written Executive Director Report
Financial Statements—July / Director of Communications
October 22, 2008
1:00
Board Room
Standing Committees / Director of IT
November 5, 2008
1:00
Board Room
Executive Committee / Financial Statements—August
November 19, 2008 1:00
Board Room
Director of Support
December 3, 2008
1:00
Board Room
Standing Committees / Director of HR
December 17, 2008
1:00
Board Room
Financial Statements—September
Executive Committee / Director of Development
BCPWA Society is located at 1107 Seymour St., 2nd Floor, Vancouver.
For more information, contact: Alexandra Regier, office manager Direct: 604.893.2292
Email: [email protected]
BCPWA Standing Committees and Subcommittees
If you are a member of the BC Persons
With AIDS Society, you can get involved
and help make crucial decisions by joining
a committee. To become a voting member
on a committee, please attend three
consecutive meetings. For more information
on meeting dates and times, please see
the contact information on the right
column for the respective committee that
you are interested in.
Board & Volunteer Development
Contact: Marc Seguin
t 604.893.2298
e [email protected]
Community Representation &
Engagement
Contact: Paul Kerston
t 604.646.5309
e [email protected]
Education & Communications
Contact: Adam Reibin
t 604.893.2209
e [email protected]
Positive Gathering Committee
Contact: Stephen Macdonald
Prevention
Contact: Elgin Lim
t 604.893.2225
e [email protected]
Support Services
Contact: Jackie Haywood
t 604.893.2259
e [email protected]
Treatment Information & Advocacy
Contact: Adriaan de Vries
IT Committee
Contact: Ruth Marzetti
t 604.646.5328
e [email protected]
living5 Magazine
Contact: Jeff Rotin
t 604.893.2206
e [email protected]
Yes! I want to receive living5 magazine
Name _________________________________________________________
Address ____________________________ City _____________________
Province/State _____ Country________________ Postal/Zip Code________
Phone ___________________ E-mail _______________________________
I have enclosed my cheque of $______ for living5
❍ $25 within Canada
❍ $50 (Canadian $)International
please send ______ subscription(s)
1107 Seymour Street
❍ BC ASOs & Healthcare providers by donation: Minimum $6 per annual subscription
please send ______ subscription(s)
❍ Please send BCPWA Membership form (membership includes free subscription)
❍ Enclosed is my donation of $______ for living 5
* Annual subscription includes 6 issues
Cheque payable to BCPWA
w w w.
b c p wa .
o rg
living5
2nd Floor
Vancouver BC
Canada V6B 5S8
For more information visit
www.bcpwa.org
e-mail to [email protected]
or call 604.893.2206
39
10/3/08
12:33 PM
Page 40
Volunteering at BCPWA
Bronwyn Punch
Profile of a volunteer:
Volunteer history
I have been a massage therapist doing bodywork at the
Loon lake retreats, and teaching the occasional workshop.
Started at BCPWA
I started in September 2003 and have been at every
retreat since.
Why pick BCPWA?
I was looking for a volunteer position when I saw an ad sent to
the Massage Therapists Association. I thought it was just for
one retreat, but by the time I left the retreat I was really keen to
come back. Everyone was so welcoming and appreciative of what
I had to offer that I came away recharged.
“Bronwyn’s gifted massages
at the healing retreats relieve
city stress, demonstrate sincere caring, and spread
around a little of that Loon
Lake magic dust. She is reliable, kind, and welcoming
to all. She offers unique
healing energy beyond
the massage table—and a
great sense of humour.”
Rating BCPWA
I have been very impressed with everyone at BCPWA and the work
that they all do.
Favorite memory
There are so many. Playing Pictionary against Jackie ranks very high.
The hugs! The other volunteers. The retreat team. The galas.
Jackie Haywood,
Director of Support Services
Future vision of BCPWA?
I hope they continue to be such a wonderful supportive team who
make everyone feel welcome.
Polli & Esther’s Closet
Your peer-run, second time around store!
Great selection!
Bring your membership card
and pay us a visit at
1107 Seymour Street, 2nd Floor
Open Tuesday, Wednesdays & Thursdays,
11AM to 2PM for your shopping convenience
40
living5

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Transcription

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