It’s Different Now

Yes, it is different now.  It wasn’t until my final year of University that I was required to take a computer course; now one needs a computer to take a course.  I recall phone booths (yes, the kind from which Superman sprang forth to save the world) cost ten cents, and then twenty-five cents, then thirty-five cents, then I didn’t see as many telephone booths on the streets, though I did see virtually everyone on the street with their own telephone……Ooops, I mean, ‘cell phone’. It’s different now.  My years at University prior to the year of the computer course were spent in a building known as a ‘library’.  With the internet today, most space on the planet can become a ‘library’ by activating the ‘Power On’ button and typing (‘key boarding’ in today’s terms) an ‘IP’ address (which is not a street address!), then get all the information you could possibly imagine about any subject on Earth.  I remember computer ‘bulletin boards’, which are now ‘Ethernets’ and a billion times faster!!  Things are changing so fast!  Yes it’s very different now. 

With most everything today, it is different than it was.  But not so much in all things.  Take HIV for example.  We’ve witnessed the healthcare onslaught over time for women to be cognizant about the risk of breast cancer; we’ve seen ‘Nutrition Facts’ labels appear on foods to help us choose the products we’re consuming; we see constantly on television ads for medications to relieve one thing or another; doctors’ offices are awash with information about how to stay healthy and how to exercise.  Today it seems there is little difference from 32 years ago regarding HIV.  People in the city of Vancouver, BC however, are beginning to narrow this HIV knowledge schism.  Specifically, the STOP HIV/AIDS Project (http://www.cfenet.ubc.ca/stop-hiv-aids) involving the BC Centre for Excellence in HIV & AIDS, Vancouver Coastal Health, and Providence Health Care (an independent healthcare provider in the Vancouver Coastal Health region) have combined forces to accelerate finding ways to slow HIV transmission and normalize the HIV health issue.  HIV is different than it was at the start of the epidemic. 

Unfortunately, for many, the beliefs about HIV are not so different than 32 years ago.  Things are different today because we’ve learned what works, what doesn’t; what’s true, what isn’t; what’s right, what’s wrong.  Healthcare workers and activists in Vancouver have learned lots about this epidemic virus and are sharing it with the world.  With HIV things are becoming noticeably different than they were.  We know more about risks.  We know more about testing.  We know more about treatment.  And we know the prognosis for HIV infection is that it’s possible to live a long, healthy life, full of goals and aspirations set in future years.   We know these things because of research having been done and research that continues being done. 

One such piece of research is the Vancouver STOP Project (Seek and Treat for Optimal Prevention).  Now we need to stop for a moment here.  Think of the world we live in.  Think of the destruction, the wars, and the senseless violence that seems never to end.  With a title like ‘Seek and Treat’, military references come to mind.  Some have suggested this language makes the approach sound like an offensive against people living with HIV.  It is not.  It is, though, an offensive against HIV itself, not those living with the virus.  According to the Public Health Agency of Canada, 25% of those living with HIV don’t know they are living with the virus and may be unknowingly transmitting it to others. Let’s agree to look at STOP without attacking the semantics of the title.  Rather, let’s use what STOP has given us and reduce the HIV schism even further.  

The concept is simple:  encourage people to be tested for HIV.  This is not based on any preconceived notions of who might, or might not, be at risk for acquiring HIV.  Instead, making HIV testing a routine part of our personal health care as well as having hospitals and doctors offering HIV testing, with informed consent, to all their patients should be encouraged and routinized for all who enter the health care system.  Second, if a positive test result surfaces, then post-test counseling and the discussion about treatment can occur.  Note the word ‘discussion’. Next, taking HIV medications is a personal choice based on all possible information available to the individual.  The human right to decide whether or not to accept treatment is an individual’s alone.  Third, if all people who test positive for HIV are offered treatment (and many decide to be treated), individual viral loads will drop and the probability of forward HIV transmission will be significantly decreased.  Finally, as this process unfolds more people will have lower and, hopefully, an undetectable viral load which means fewer infections in the community over the long-term.  The idea is logical.  The implementation process is already under way, and the results are encouraging.  Another tool in the toolbox to reduce HIV in our own communities and in humankind overall - can we justify not giving it a try?  

It’s our turn; we need to realize ‘it’s different now’.  Like previous movements in history, change for the good of all works best when ‘you’ and ‘them’ becomes ‘me’ and ‘us’.  Routine testing, numerous medications from which to choose, and the prognosis of a long, healthy, goal-pursuing life are the differences from 32 years ago.  Today we can help make HIV non-stigmatizing for ‘me’ and ‘us’.  It’s different now, it’s our turn.

By: A person living with HIV and a believer in the concept of “test and treat” when it is implemented within the parameters of law and human rights.

Harm Reduction and Health Promotion; a Bathhouse Three way!

The AIDS Calgary HEAT Worker, in partnership with The Texas Lounge and Goliath’s Saunatel management and staff and the Alberta Health SAFEWORKS team,  work together to provide HIV/STI and hepatitis C testing and other health services, supports and referrals to Calgary and area Gay and MSM through an onsite outreach testing and health service in the bathhouse every Friday evening between 4:00 – 6:00 pm.

I have noted over the last couple of years an increasing number of men coming in for testing, connecting with workers with questions and checking in with workers at this location recognizing  the professionals providing the services are of value, respectful and culturally competent to provide clear non-judgmental services to Calgary and area Gay and MSM.  

This did not happen overnight, in fact it took a full year of building  trust and understandings between ourselves the workers and the men who were accessing Goliath’s to recognize that we were not the sex police and harpers of safer sex only messaging. In fact we are about informed choices and understanding of the risks associated with certain behaviours between Gay and MSM that place them at higher risk for HIV and other STIs.

A bath house is known as a “safe” place where men can meet other men for mutual pleasure, relaxation and conversation and provides Gay/MSM with a place to meet other likeminded men. As such the bath house makes for a perfect point of care site to offer HIV/STI testing services that are otherwise offered at the STI clinic or through a family physician.

Many have commented their appreciation for having the service available on site and wonder why it is not offered more often at the bath house. The reality is money and resources currently do not allow for the expansion of this program however we are doing our best to address this gap and need  through the addition of a regular Wednesday clinic on the main floor of the Sheldon Chumir Health Centre between 1:00 and 3:00 pm specifically for anyone with a history of addiction, homelessness, involved in sex work, street youth and Gay/MSM.

For those of you who may not already know this, the AlbertaHarm Reduction Conference will be hosted in Calgary at The Coast Calgary Plaza Hotel May 22-23. 2013.

AIDS Calgary, as one of the partner organizations for the Alberta Harm Reduction Conference has encouraged staff to submit abstracts on programs and services we offer that highlight our commitment to harm reduction and health promotion.

HEAT & SAFEWORKS will be presenting an abstract on this partnership entitled “Three Way in the Bathhouse”.

African Women on HIV/AIDS --- AWOHA!

The adage that African women are the conduits of change was at play during the dinner hosted by the Right to Know African Communities Program. The event saw over 25 African women come together to celebrate and to support the Right to Know project.

The dinner was a social event for Calgary’s African women from different countries to share their ideas and experiences with HIV and AIDS. This group of women, representing 13 African countries and ranged in age from 21 to 70, enjoyed a fun filled evening in a casual manner. These women discussed how their communities are responding to the HIV messages that AIDS Calgary is sending to them through the Right to know project.

The collective support of the project was expressed by most, if not all. A 70 year old grandmother and retired teacher from Zimbabwe challenged the women that, “It takes women to change social and cultural beliefs of our communities. If we do not learn enough about this disease and teach our families on how to protect themselves, the burden will ultimately fall squarely on us as wives, mothers and grandmothers to care for the members of our families that will be affected through lack of knowledge. In our African culture, women are the ones who take care of all the family members when they are healthy or when they fall sick”.

A young Sudanese woman pointed out the belief by most youth that the disease is for older people and also mentioned that youth think they are invincible.

Another member of the group recommended that doctors and nurses in health delivery system receive training on HIV because “most of them know very little about the disease.  We as Africans are often getting a raw deal when we visit health care centres. They always assume we are infected because we are from endemic countries. The Canadians are also at risk because they have communities where there are high rates of drug use. We should all be urged to go for testing. This is not a blame game. The disease does not care who you are or where you are from. Collective responsibility is called for here and we all should fight this disease together” she emphasized.

The group of women suggested another get together in summer. They wish to share more information on HIV and AIDS while doing beadwork and exploring  art work from their different countries.

Hepatitis: what you should know about the ABCs

Hepatitis has a staggering toll on the health of people around the world, and according to the World Health Organization (WHO), it is largely unknown, untreated, and undiagnosed. It is also 100% preventable. July 28 is this year’s World Hepatitis Day. The theme of the event is this is hepatitis. Know it. Confront it. No time is too early to start talking about it.

Hepatitis just means inflammation of the liver, in fancy-pants medical terminology; the ‘hepa’ part of the word means liver (it comes from the Greek root hepar), and ‘itis’ means inflamed. This can be caused by a variety of factors, including viruses, such as hepatitis A, B, and C.

Who cares!?
There are about 1.4 million cases of hepatitis A in the world, every year—that’s more than the entire population of Calgary. An estimated 500 million people are living with chronic hepatitis B or C worldwide. Even more shocking is the World Health Organization’s estimate that 2 billion people globally have ever been infected with hepatitis B. These viruses cause acute and chronic liver disease, and can lead to liver scarring, cancers, or even death.

What does my liver do anyhow?
The liver is the largest organ in the human body, and can weigh up to four pounds. That’s like four blocks of butter hanging out in the lower right part of your ribcage! The liver is like the factory of the body—it filters the blood, breaks down toxins (including alcohol), helps break down the food that you eat, and takes the nutrients from digestion and packages it into forms that can be used or stored for later. Scientists say that the liver performs over 500 individual functions, and you can’t live without it.

Okay, so how can I get viral hepatitis?

Hepatitis A is transmitted by fecal-oral routes—this just means that you have to eat or drink something that has been contaminated. It’s a gross thought—who wants to eat poop, right?—but it can be as simple as having somebody make your burger who hasn’t properly washed their hands after going to the bathroom. The virus can cause mild to severe illness, and can also cause liver failure. The good news is there’s a vaccine! Talk to your doctor about getting vaccinated, if you haven’t already gotten it. Although hepatitis A can make you sick, and it affects an estimated 1.4 million people a year, it doesn’t cause chronic liver disease like B and C.

Hepatitis B and C are both transmitted blood-to-blood. So in order for you to get it, somebody’s blood containing hepatitis B or C has to get into your bloodstream. Some of the most obvious ways are through sharing needles or having unprotected sex. It can also be transmitted through sharing personal hygiene items such as razors, toothbrushes or nail clippers. A relaxing day at the spa can be riskier than we think: manicures and pedicures done with improperly sterilized equipment are high risk for transmission. Hepatitis B and C can cause chronic liver disease, and the liver just can’t do its job—this can lead to cirrhosis (scarring of the liver) and liver cancers: this can be fatal. So the good part is that there’s a vaccine for hepatitis B. Unfortunately, hepatitis C doesn’t have a vaccine yet—but it is treatable!

So the toilet seat’s safe, right?
It sure is! You cannot get viral hepatitis from a public toilet seat. Neither can you get it from hugging, kissing, tears, sweat, or sharing a drinking glass, or eating off the same plate as an infected person. Getting a blood transfusion in Canada isn’t a high risk, as Canadian Blood Services began screening blood for viruses in 1989.

How do I know that I have it?
You need a blood test. You can’t tell if somebody has hepatitis just by looking at them. Some people can have hepatitis C for decades before their liver gets damaged enough to stop working properly. Talk to your doctor and get a blood test. 

Well, I’m vaccinated, and can’t possibly have hepatitis C!
Think so, eh? It might be true—but there are lots of people who get infected with hepatitis C and have NO IDEA about how they got it. You don’t need to be young to get it: in fact, the highest risk group in Canada for hepatitis C infection is the baby boomers! If you were born between 1945 and 1965, you’re much more likely to be infected than any other demographic in the country. Check out this short video from the Canadian Liver Foundation for an illustration for at-risk demographics: http://www.youtube.com/watch?feature=player_embedded&v=ap0GPgHT5jo

How to prevent and treat it

Get vaccinated for hepatitis A and B, and do things that help protect yourself from hepatitis C. Avoid unprotected sex or sharing needles, and try to avoid sharing personal hygiene supplies like toothbrushes and razors. Get tested! If you do have hepatitis A, B, or C, they’re treatable. Talk to your doctor. Treatment can be a long process, but it’s worth it for a healthy liver!

 

Sources

Canadian Liver Foundation. (2012). How the liver works. Retrieved from http://www.liver.ca/liver-health/how-liver-works.aspx

Public Health Agency of Canada.  http://www.phac-aspc.gc.ca/hepc/index-eng.php

World Hepatitis Appliance. World Hepatitis Day 2013. Retrieved from http://www.worldhepatitisalliance.org/WorldHepatitisDay/WHD2013.aspx

World Health Organization. Global Alert and Response (GAR): World Hepatitis Day 2012.  Retrieved from http://www.who.int/mediacentre/factsheets/fs164/en/

World Health Organization. (2012). Media centre: Hepatitis C Fact Sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs164/en/

'Functionally' cured of HIV

There seems to be a lot happening in the world of HIV and I wanted to take a minute to share this with you. My usual online navigation rarely brings me anything of interest, but the latest information on the baby who was cured from HIV was worth a double take.

 

Apparently in Mississippi a baby was born to an HIV positive mother who only found out about her status due to a rapid HIV test while she was in labor. The baby received a stronger than normal dose of HIV medications as the mother was not on any HIV meds throughout the pregnancy. Now the child is two years old and appears to be ‘functionally’ cured of HIV. Functionally cured? What does this even mean? If a person is functionally cured it means that the virus is suppressed, without the use of ongoing medications and treatments. Some of you may remember the story of the Berlin patient, TimothyRay Brown, who received a bone marrow transplant from a donor with genetic immunitiy to HIV(known as the Delta 32 mutation). As a result he is ‘cured’ from HIV and any segments of the virus still in his system are dead. Moving back to the story of the baby… There are a lot of questions still unanswered when it comes to this case.

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Does the fact that the baby was born prematurely have an effect on HIV and treatment?

What, if any correlation is there due to the fact the mother was not on medication?

Is this a viable cure for HIV in newborns?

How can this be translated into a potential cure for people already living with HIV for several years?

Isn’t this just the same as post-exposure prophylaxis (PEP)?

Were/was the parent(s) provided with proper informed consent when it came to administering a combination therapy to the newborn?

What services (medical and financial) are in place to monitor the health of the child and family?

Is this really the first time that a combination therapy has been administered to a newborn? What happened in the other attempts to suppress the virus of newborns?

Why did the child stop receiving medication?

What other factors have been influencing the decision making of the parent(s)? Poverty, stigma, lack of accessible health care, rural setting, etc.

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There are still several people who are skeptical when it comes to this ‘latest’ breakthrough. For some people, there is nothing new about this treatment and it does not appear that it will create a cure as quickly as we would like. Additionally, there are concerns about the portrayal of the mother in the media, as she has been blamed for not taking the steps to ensure that proper prenatal care was in place. Let’s not forget that the USA does not have the same standard of medical care that we have in Canada, and that there may be several factors which have not been released to the media. Before we are quick to blame the mother, it is important to look at the environment that an individual is living in. What is exciting is that HIV and the possibility of a cure are once again in the media’s spotlight. This can lead to changes in policy and opportunities for future education and discussion around HIV/AIDS. Sounds like this will be something to keep an eye out for in the world of HIV. Stay tuned to our Facebook page for all the latest news on HIV and updates on the ‘functionally cured’ baby.