The Rainbow Tube: Do We Get The Television We Deserve?

This article is a series of personal views covering a selection of TV programmes. There are of course several others which you may feel should be discussed and your own views may differ greatly from mine. Feel free to react.

It’s tempting to think that we’ve never had it so good regarding LGBT representation on TV and I’m sure lots of TV bosses are patting themselves on the back thinking how progressive and inclusive they are. But is it actually true? There may be more mainstream LGBT visibility on the television than ever before but is it a question of quantity trampling all over quality?

To my mind, we more or less reached parity with heterosexual TV programmes when ‘Queer as Folk’ was first shown on Channel 4 in Britain in 1999 and North America in 2000. Its creator, in association with Channel 4, Russell T Davis then sold the idea to Showtime entertainment and Cowlip productions, (Showcase in Canada); retaining editing rights along the way to keep it from being watered down. From 2000 to 2005, the American production turned out to be as good if not better than the original version. This was partly thanks to a large Canadian contribution. The interior scenes were filmed in Toronto and Canadian directors were able to direct more freely than any US directors could have done. This was despite the fact that the series was supposedly set in Pittsburgh, Pennsylvania.

The programme wasn’t originally titled ‘Queer as Fuck’ for nothing, because to every LGBT viewer’s delight, gay life was shown in all its glory, with sex and nudity giving it all the spice you needed short of pornography. Issues were addressed, not the least of which was HIV, and heterosexual North America was confronted with parts of gay life as they actually are and not as the ad-men would like us to see them.

Even in Europe, where viewers are more used to challenging scenes of sexuality and violence, ‘Queer as Folk’ had a huge impact and was widely praised. Eyebrows were raised but mainly by newspaper editors looking for ‘Disgusting, Filth’ headlines and in general, the British and later the American series were critically well received.

So what’s happened since then? Did ‘Queer as Folk’ actually set the standard from which all subsequent LGBT-themed TV is measured? The answer is probably yes but sadly little has lived up to that standard since; not even close. Strangely enough, the American ‘Queer as Folk’ was inclusive within the LGBT community almost to the point of cliché. There was the butch anti hero (still don’t quite understand why a straight man had to play that role but if he was playing gay, he played it very convincingly); the doting friend; the friendship group; two strong lesbian roles; a camp man with a heart of gold and inner strength; an everyman character; the obligatory fag hag (played brilliantly by Sharon Gless) and her brother, who was HIV positive. The UK version was shorter and a little more edgy but to their eternal credit, the directors of the American version took the best of the original and added yet more quality to it to make it truly ground-breaking.

The key to its success was the acting. There were no cheesy or corny roles and almost every character was believable and someone you have probably met in your gay travels. Had the acting been of any lower quality, the sex scenes and plot lines would have been seen as sensation for sensation’s sake. Instead, they were integral to the flow.

That should have set the benchmark for the future and twelve years later we should be revelling in excellent quality LGBT-driven TV shows, fighting for Emmy’s and other show biz gongs. So let’s take a look at other gay themed shows of the last twelve years and compare them to ‘Queer as Folk’. Have we progressed or was ‘Queer as Folk’ a flash in the pan?

You can’t talk about gay TV in the last ten years without mentioning the endlessly–repeated ‘Will and Grace’. A landmark show as far as North American TV is concerned and still popular in Europe, it was never regarded as ground-breaking; far too tame for that. That said, the same ingredients are in the ‘Will and Grace’ mix as in most other shows of its type: the camp gay man; his straight-acting counterpart; the fag hag (in this case, two!) and various other gay or gay friendly characters. It also had its hilarious moments but hardly smashes any taboos unless you count the fact that it appeared on mainstream American TV. Again, more often than not saved by the script and the humour but you can’t avoid the fact that Jack’s character was really a hideous cliché.

In 1993 and 1994, ‘Tales of the City’ and ‘More Tales of the City’ were shown on British TV and then on PBS and Showtime in North America as a miniseries. The idea was good, based on the hugely popular books by Armistead Maupin but for one reason or another it never really took off. Here again, a mix of characters both LGBT and straight but they didn’t translate well to the TV format, despite such actors as Laura Linney and Olympia Dukakis taking major roles. The problem was that the gay characters came over as wooden and one dimensional. The potential was there but the networks declined to go any further.

Since then, we’ve had overtly gay shows such as ‘Queer Eye for the Straight Guy’ on Bravo and ‘One Girl, Five Gays’ on Logo. The latter was a Canadian production that was picked up worldwide but whilst it got to the point as far as an LGBT audience was concerned and although it’s been running for four seasons; its target audience is really too small to ensure mainstream status. ‘Queer Eye’ on the other hand was aimed at straight men (or rather their girlfriends and wives) but once again hammered home the stereotype that gays and fashion or style go together. Carson Cressley provided the high octane camp and thus humour that appears in so many other shows. You get the feeling that producers see this sort of character as being a prerequisite for a straight audience. Women can identify and men aren’t threatened, all of which applies to Cam in ‘Modern Family’, ‘Bryan’ in The New Normal and Jack in ‘Will and Grace’. Compare this to the characterisation in ‘Queer as Folk’ and the credibility gap is enormous.

From 2006 to 2011, ‘Brothers and Sisters’ tried to bridge the ‘realness’ gap by showing its gay characters as ‘normal’ every day guys who you would assume were straight and most people would say that it worked to a large extent. However, the gay plot lines were always subservient to the ‘family’ theme of the show until they adopted a child and created a new ‘family’ within the bigger family thus preserving family values as the central theme. Relatively good and consistent acting plus Dallas/Dynasty types of soap plot lines kept the show interesting until it ran its natural course. However, many would claim that the gay roles were a little too shallow to be taken seriously and truly regarded as ground breaking.

The current show with strong LGBT representation is ‘Glee’ but despite the promising beginning and the immense popularity of this modern ‘Fame’ clone, the writing seems to be on the wall for ‘Glee’. They may be able to squeeze one more series out of it but viewer numbers have tailed off dramatically in the last year. Personally I feel that ‘Glee’ is a chance missed. It’s dominated by its creator Ryan Murphy (who also created ‘The New Normal’) and as such, it seems that the plot lines are becoming thinner by the week. ‘Glee’ has always been known for living in its own particular universe in terms of chronological anomalies and plot consistency. However, whereas in the beginning the viewer was prepared to suspend disbelief, as the Glee club launched into 30 piece orchestral arrangements in the school music room and characters met seemingly fatal accidents yet re-emerged unscathed, lately that has just seemed tired and irritating. The music was and is of good quality and that must have launched the whole Gleeks phenomenon but a necessary rejuvenation of the cast has not caught on with the public and old cast members returning seem somewhat ‘forced’. Even dragging in the Sarah Jessica Parkers of this world has seemed a frankly desperate tactic!

There was however, one LGBT theme that really hit home and became ‘Glee’s high point in the history of gay TV and that was when Kurt was being bullied by the school jock, who then turned out to be closeted and gay. Thanks to strong acting, those scenes made Glee iconic but they couldn’t keep them up. With a lack of realistic and meaningful issues, the frailties of Glee have become ever more apparent. The characters are a smorgasbord of politically correct representatives of society. The black, Asian, disabled, straight, misfit and of course, gay, lesbian and cross-dresser characters could have provided endless powerful storylines which could have genuinely made a difference if handled in the same way as the bullying issue. However, without good scripts, these characters become nothing more than cartoons or at best, caricatures.

Despite huge media exposure that has made them all starlets, you wonder where these people will go now. Broadway may be the best most of them can hope for and Leah Michele may never escape endless ribbing from the ‘Fashion Police’ crew for her red carpet pouting. I can’t personally see Chris Colfer (Kurt Hummel) playing anything else than versions of himself in the future. It’s sad but these were actors tailored to their roles and typecast to the last note; they may disappear without trace. The two actors who will always have an acting future are Jane Lynch (Sue Sylvester) and Kurt’s father Burt, played by Mike O’Malley. In their own different ways, these two bring depth to the show and manage to actually say something about society. It’s ironic that Jane Lynch is a lesbian role model in real life and acidly scathing of all things liberal in the show but she has become iconic as a result.

So to my mind, the Glee furore is almost over and now we can see that it actually wasn’t that ground-breaking after all. It repeated the ‘Fame’ formula and despite its best efforts, filled it with plastic and one dimensional stereotypes. Some people have accused Glee of being so stereotypical that it has actually increased stigma against LGBT people; there may be an element of truth in that; time will tell. Is there anything else currently running then, that could possibly compete with the brilliance and forward thinking of ‘Queer as Folk’?

An Emmy winner three years running; ‘Modern Family’ started in 2009 and superficially has many of the same ingredients of ‘Queer as Folk’ although it has to be said that it’s a comedy and not a drama series. It’s funny in parts and the gay roles are prominent. It’s an ensemble cast centred on three interrelated families which are in turns dysfunctional and meant to reflect foibles in society. The gay characters are probably meant to be slight caricatures (one extremely camp and the other less so) and when the scripts slacken off even a little, appear clichéd to the extreme. Again, the show is saved by good acting but if only the other two components of the extended family were LGBT the show would be more credible because they are intrinsically funnier and actually much ‘gayer’.

The new trend is the parent/child interaction in TV gay relationships. Mothers and their gay sons have long been fodder for comedy but when the gay couple has a child of their own, this is new. It’s repeated in ‘The New Normal’, which could be said to be ‘Glee’ grown up and left school (and has the same creator) and has also been seen in several gay themed films. The child is often world-wise and used to deliver the antidote to societal judgement through his or her asides in the script. However, adding the child bomb to bolster the argument for gay marriage and gay normality, only works if the parents are non-stereotypical and under no circumstances could Mitchell and Cameron from ‘Modern Family’ and ‘Bryan and David’ in The New Normal be seen as anything other than stereotypes. Well-meant maybe but realistic...I don’t think so. To subdue the more extreme audience reactions, there is always a strong heterosexual female presence to act as moral watchdog (the birth mother and grandmother in ‘The New Normal’ and the other close, female, family members in ‘Modern Family’). It’s a bit of a cop-out really and when you compare it to the gritty story lines of adopting a teenager and having a baby in a lesbian relationship that breaks up, as in ‘Queer as Folk’...well the timing should have been the other way round. ‘Queer as Folk’ should have been the progression from shows like ‘The New Normal’ and ‘Modern Family’, instead of the other way round.

Other series like ‘Happy Endings’, ‘Torchwood’, ‘True Blood’ and even unexpectedly, ‘Downton Abbey’ are attempting to improve LGBT visibility on screen by making the gay characters incidental to the main action. They may be gay, or lesbian or transvestite but that is clearly not the issue in the overall themes of the shows. It’s a case of; these people are gay and this is how they sometimes live but it’s no big deal. There is lots of British and Canadian input in these shows, in terms of direction and actors and thereby hangs a tale of how these issues can be modernised. US TV bosses are still reluctant to play the gay card unless it’s a stereotype that is clearly defined and can be judged accordingly. The British and Canadians are much more sophisticated and subtle and know how to win audiences over with realistic and often sympathetic portrayals. What do you first think of when you hear the title ‘True Blood’ for instance? Vampires; shape shifters; the deep South and above all, blood! The fact that there are lip-licking men who regularly strip off and that some of them are gay or at least bisexual; plus the odd lesbian vampire and a superbly acted transvestite in major roles, is a bonus but no big deal and the show appeals to a cross-section of society. ‘True Blood’ has also somewhat lost the plot in its last series, as convoluted story lines make watching it a puzzle. This suggests that it has reached the end of its natural life but its atmosphere, thrilling storylines and good acting mean that it’s a step forward in LGBT representation on the television.

‘Torchwood’ is also a bit of a ground-breaker in that it brings gay characters into science fiction in the same way that True Blood does for fantasy. It started off as a low budget BBC series but has translated well across the Atlantic despite American insistence on the toning down of some gay scenes. Many people may not be aware but it’s actually a Doctor Who spin-off and as such still has a touch of the polystyrene sets and unbelievable storylines that made Doctor Who so successful. The fact that the lead character is an out and out sexual man, who’s mostly gay, seems not to have created the uproar that you might have expected and Torchwood is well on the way to cult status. It also seems to have succeeded in showing gay characters, where films like ‘Star Trek’ and series like ‘Caprica’ have failed.

When an archetypal BBC costume drama like ‘Downton Abbey’ brings in gay plot lines, you know the world has turned on its axis but once again it’s well acted and subtly portrayed, revealing the attitudes of the times. Nobody could accuse ‘Downton Abbey’ of being great acting but its well-written soap plots have got audiences hooked across the world. Quietly introducing a credible gay element is symbolically important for LGBT representation in 2012 – not earth shattering but a good sign for the future.

In conclusion, to my mind nothing has emerged since ‘Queer as Folk’ to challenge its status as best gay-themed show ever. Modern shows tend to be formulaic and use far too many stereotypes (and I haven’t even mentioned ‘Ru Paul’s Drag Race’!). They veer away from gritty realism because they are desperate for viewing figures and rankings to ensure repeat series being made. Producers and writers think they are being innovative by introducing gay marriage and adoption issues but the characters behind them lack enough depth to make them credible and LGBT humour is constantly delivered by outworn stereotypes who promote camp bitchiness as our comedy niche. Soaps in the UK and the rest of Europe invariably have gay storylines and some work better than others but Joe public doesn’t bat an eyelid anymore and that indicates their success in bringing gay life into what’s seen as the normal mainstream view of society as a whole. However, television’s mega bucks are still made in North America and syndicated shows sold across the world are still mainly US-made. There, the ability (or will) to modernise the LGBT profile seems to be lacking. Who dares doesn’t win in that sort of atmosphere and even Hollywood hasn’t moved on from ‘Brokeback Mountain’ and ‘Milk’.

The best series ever from an LGBT viewpoint is now twelve years old and we haven’t moved very far since but in the States, it’s still all to do with money and pleasing Middle America or the political and religious right. The last US election saw politicians claiming that there was a homosexual plot to destroy society. Daring new TV series aren’t likely to make much headway in the near future in that sort of climate. Hopefully countries like Britain and Canada will continue to push the boundaries backed up by great work coming out of other European countries such as Spain and Germany. Maybe the future lies in web series like ‘Barcelona’ and ‘Where the Bears Are’ although at the moment, these fall victim to financial squeezes after promising starts.

YouTube, Vimeo and the like may also be able to play a role in the future, as viewers latch on to new ways of viewing film. As for HIV on the TV; it might as well be the Bubonic Plague for the amount of coverage it currently gets. Queer as Folk once again set the benchmark and included it as a fact of life but we shouldn’t hold our breath while waiting for Blaine, or Cam, or the blood soaked vampires to finally fall foul of the virus.

These days, there’s not much that makes me really angry. I guess the older you get, the more you’ve seen it all before and can let it go like water off a duck’s back. Oh sure I get irritated and positively grumpy at times, especially at perceived injustices, but I'm never really angry to the point of rumbling, blood boiling rage. Then a rather frail, 85 year old man said something that made the hairs on the back of my neck stand up and made me angrier than I have been in years.

He was born Joseph Aloysius Ratzinger and is now Benedictus XVI, the 265th Pope, head of the Catholic Church and spiritual leader for millions. He also happens to be at best misguided and at worst, a mean-spirited and hate-filled politician who has deliberately chosen Christmas to condemn individuals in a section of society, by denying their right to love each other.

Now I’m not a person of faith; any faith. In fact, I take pleasure in smiling sweetly at door-to door evangelists and informing them that I’m a devil worshipper. That said I’ve never felt that my atheism is any more valid than anyone else’s firm belief in a one and only deity. I went to Sunday school as a kid, granted under duress, but I liked the tunes and was confirmed as a member of the Church of England. But as soon as I could make a decision as to whether this was anything for me, I dropped it and got into hippy New Ageism and eventually Cynicism instead. I was shocked when my parents, who had forced me to go to church, confessed later that they didn’t believe either but at least I made my choices, having seen a bit of how it all works.

I’ve never personally understood how LGBT people can be believers in any faith either (hedonists don’t count). Since the eighties, I’ve always believed that if that was a God at work during the worst of the plague years, then it was a cruel and vengeful deity and I wanted nothing to do with it. Then again, many LGBT people are religious and hold deeply held beliefs and who am I to criticise? I suppose we can only speak for ourselves and in my case, there’s no room for religion in my life.

So, most religious leaders' speeches have left me cold. The papal rejection of condoms since the Fifties, which resulted in Third World famines, poverty and death due to over-population and later HIV, were shockingly unjust but that brought not much more from me than a shake of the head over the breakfast table. Notwithstanding, by 2012, I assumed that common sense and reason had taken a stronger role and even in large, traditional Catholic populations, condom use was seen to be the sensible thing to do. Abortion began to be accepted as a recognisable need for some women, even in Catholic countries, and pragmatism seemed to have taken hold. 

Unfortunately the Catholic hierarchy has also noticed the influence of the Church being eroded to the point where several sacred taboos have become acceptable. LGBT relationships in general and gay marriage in particular are increasingly being seen as a basic human right and spreading (however slowly) across the world. The Church sees this as a huge challenge to its moral authority and has begun significant moves to re-establish the status quo.

"Well now Ratzinger and his cronies have stepped over my own personal line and if I could, I would take him to the European Court of Human Rights and have him charged for discrimination and the spreading of religious hate."

We should not underestimate what the people in the upper ranks of church hierarchies are capable of. At that level, they are top politicians first and clerics second.This organisation has had hundreds of years to fine tune its tactics and make no mistake, the Vatican is a well-oiled political propaganda machine but hey, as long as they left us alone, right! Well now Ratzinger and his cronies have stepped over my own personal line and if I could, I would take him to the European Court of Human Rights and have him charged for discrimination and the spreading of religious hate.

A couple of weeks after the latest school tragedy where a very disturbed person took his mother’s guns and took his frustrations out on the innocent, the Pope has taken the opportunity to sow the seeds of hate in the minds of huge numbers of people across the world. Who knows what sort of unstable character may take his words as being visionary and wreak vengeance yet again in the name of the Lord! Extremists across the world, whether Islamic, revolutionary, Christian or any other group who feel they have divine permission, only need a trigger and hopefully the Pope has not provided one.

It does no good to scream and shout at these people; the Catholic church has had centuries of getting its own way, however understandable and the protestations of its target demographic will just confirm their opinions and their prejudices. You can rage against the machine but in this case, the machine has centuries of experience of suppressing dissidence (ask the victims of the Inquisition).

Let’s begin by contradicting what many people think in that this was the text of the Pope’s Christmas message from St Peter’s. It wasn’t, it was an annual address to the Vatican big-wigs, the Curia, in the Clementine Hall at the Vatican and in a way this was far more important than the message to the world’s Catholics because he was rallying the generals for the fight ahead. It’s building up quite nicely because a week ago he again took on gay marriage, in his annual ‘peace’ message:

 "...abortion, euthanasia and gay marriage bring 'irreparable' damage to world development, peace and the environment".

Last month, the Vatican launched the first salvos after three American states approved gay marriage as a result of a democratic vote. It’s not difficult to see the trend and the political machinations behind all this and in many ways, you can almost understand it. The church is clearly in panic; watching the world slowly but surely move towards acceptance of LGBT people as equals in society. Same sex marriage (or at least civil partnership) is legal in Spain and Portugal and France may not be far behind. In South and Central America, Argentina, Brazil, Colombia, Ecuador and Uruguay, Costa Rica and Mexico (in the capital) all recognise single sex partnerships or marriage. These are traditional Catholic countries and former bulwarks of the religion and it must be a thorn in the Catholic hierarchy’s side that this has seemingly happened under their noses. The rest of the world may well laugh and say ‘ha, too late!’ but the Pope is still spiritual leader of 1.8 billion people and should never be underestimated.

"We can expect far more nasty sound bites to emerge from the Vatican in the years to come."

The church’s fight-back may seem to be a little late and behind the times but you can be assured that now they have woken up to the threat, the huge Vatican propaganda machine, with unlimited financial resources, is now getting up to full steam. We can expect far more nasty sound bites to emerge from the Vatican in the years to come.

Some people are saying that the Pope didn’t actually specify LGBT people in his address but you’d have to be naive to miss the message. He claimed that people have abandoned their God-given identities to suit their sexual choices, thereby damaging the ‘very essence of humanity’ in the process. So, with just a few words, our humanity is being thrown into doubt and our very being and existence is being de-validated in his heterosexual world. As I said, Vatican script writers have whole libraries of experience to draw on; they know how to mask meaning behind masked meaning and still leave nobody in any doubt who their target is.

We’re well used to the ‘family values’ tag being used against us. The world has just watched another great propaganda machine, on the political right in the USA, base their election chances on exactly this; they failed. The Pope has always maintained that the family is the basis of society and the absolute rock on which the Catholic Church is built. Same sex marriage, abortion and euthanasia are anathemas to the idea of the family and actually destroy it, according to the Church. What they fail to realise is that the nuclear family has long been on the skids and society has moved on to a veritable cornucopia of accepted relationships and family structures.

Since the 1^st and 2^nd World Wars, people have begun to realise that the traditional family structure based on fidelity and child-bearing is very often not a practical option and other structures are more fitting to circumstances. The idea of procreation within a formal structure is not exactly pertinent for LGBT people but the acceptance of one-parent families, or unmarried heterosexual partners with children, has enabled LGBT people to also establish their own relationships as being ‘normal’. The increase in LGBT couples having children shows that many people were just waiting for the climate to change to fulfil their dreams and create same-sex relationships including children. It’s over ten years since the Netherlands was the first country to legalise same sex marriage and adoption; the world has not ended and at 29% surprisingly the largest religious group in this country is Catholic.

In a bid to sway opinion in France, where same sex marriage is a political hot potato at the moment, the Pope quoted the chief Rabbi of France, Gilles Bernheim as saying that the campaign for gay marriage and gay adoption is an assault on the traditional nuclear family:

"The manipulation of nature, which we deplore today where our environment is concerned, now becomes man's fundamental choice where he himself is concerned," he said.

Pope Benedict quoted Bernheim as deploring how a new thought process behind sexuality has emerged, whereby sex and gender are "no longer a given element of nature that man has to accept and personally make sense of: it is a social role that we choose for ourselves, while in the past it was chosen for us by society."

Pope Benedict said: "When freedom to be creative becomes the freedom to create oneself, then necessarily the Maker himself is denied and ultimately man too is stripped of his dignity as a creature of God."

He also said God had created man and woman as a specific "duality" and "an essential aspect of what being human is all about."

So in this case we are accused of denying our nature which was defined by our genders when we were born. The Church is now saying that we are rejecting what God gave us in favour of making selfish sexual choices. It’s so ridiculous it’s almost laughable but this is the Pope’s line. Using a chief Rabbi from the country where the next battle front will be fought is a double barrelled attack. The Pope is actually saying; ‘see, even the Jews think like we do.’ The fact that Judaism in general is far more tolerant of same sex relationships than most other world religions seems to have passed him by. LGBT people can get married and adopt children in Israel!

It’s ironic that despite all, he seems to expect LGBT people to decide they’re oriented toward the opposite sex, if they want to belong to the family of man and that’s not a complete denial of nature right?

This Pope is known as a hard-liner and was a tough and intractable Cardinal who worked his way up the Vatican ranks until the Papal throne was within grasp. He was feared in the Vatican’s honeycomb of corridors and people crossed Cardinal Ratzinger at their peril. It’s in his nature then to be uncompromising, fiercely conservative and determined to rule with a rod of iron. That however, is no excuse for singling out a group in society and throwing the full weight of discrimination, demonization and threats of hellfire at them.

T"he seasonal message is peace on Earth and goodwill to all men, unless you are LGBT"

In the same speech, he calls for world peace and resolving of conflicts in Syria, and elsewhere in the Middle East, as well as other conflicts across the world. Preaching love, compassion and peace as well as hate and discrimination in the same speech is a carefully thought out tactic. At Christmas, the Catholic world is concentrating on the birth of Christ and all that that has meant. The seasonal message is peace on Earth and goodwill to all men, unless you are LGBT. We may curl a cynical lip but there are still millions of people who hang on to the Pope’s every word, especially at such an emotive time of year.

The dichotomy of his message is reflected in the official Catholic line regarding LGBT people. Homosexuality is ‘intrinsically disordered’ yet non-heterosexuals should be treated with compassion and dignity. Shake our hands and stab us in the back, why don’t you! The history of Popes suggests that it was always thus!

The current Vatican approach doesn’t only deny us our own nature and essence of humanity because we don’t marry, breed like rabbits and stay together for life; it strips us of our ability and right to love. This Pope is saying that LGBT people cannot possibly love each other because that destroys the purpose God has already created for us. If you are a man, you should love a woman and vice versa; anything else is unnatural and against the will of God. If you deviate from that then your essence of humanity doesn’t exist anymore. Any love you might feel for the same sex is negated, doesn’t have validation and you will be excluded from the Kingdom of God. That makes us somehow less than human then, a sort of untermensch (and I choose my word carefully). If just a million of the 1.8 billion Catholics across the world believe this, this will set LGBT rights back a decade in many parts of the world.

That’s why I’m so angry with the Pope’s current singling out of LGBT people as being responsible for the breakdown of marriage and the family. Really Benny, heterosexuals have been doing a great job of breaking down the institutions of marriage and family for decades now – without LGBT input I might add. If he wants to focus on marriage and family then he should be looking at the reason why straight relationships break down so easily these days and why the divorce courts are full to over-flowing. He should be picking up the spiritual pieces for kids who are abandoned in the divorce courts, or are used for slave labour in Third world sweat houses, or who become victims of abuse in all its forms. Save them and you may save the Church as an influential institution for another century. Attacking LGBT people who just want to prolong and extend loving relationships is both hypocritical and short sighted. This Pope and his Curia are victims of centuries of super-glued dogma that means they can’t modernise, move with the times and adapt. We know what happened to the dinosaurs, don’t we!

Someone should make an example of Benedict XVI in the courts, if only to persuade him that he needs to think again, in 21^st century contexts. Nobody will. The European Court of Human Rights, in whose jurisdiction he sits, just wouldn’t dare because of the influence of millions of newly resurrected Catholics in Eastern Europe. That, by the way, is another worry facing the Vatican: Russia and many eastern European states are part of the Orthodox Church and are suddenly very relevant. The Vatican must be shivering in its boots at the idea of another renewed centuries-old, power struggle with the Byzantines of the Orthodox Church. Under Communism they could be ignored but freedom has suddenly created another huge religious faction to question the Vatican’s edicts. These people can be relatively intense in their belief, if only because, after years of repression, they can! Look to the East Pope Benedict; or to Islam, or Confucianism and Buddhism, or Hinduism because that’s where the philosophies and belief structures of the world will be formed in the future.

All this makes it even stranger that the Catholic Church is mounting such a vehement and stigmatising campaign against LGBT people. Granted, the ‘war’ for souls is also being fought again abortion and euthanasia but we seem to be disproportionally targeted. Actually, it’s a story as old as mankind itself: the people with power are predisposed to making sure that that power is both maintained and unquestioned. Gay marriage, abortion and euthanasia are all questions of choice; the Vatican wants to remove those choices by claiming as they have always done that God wants it that way. Well sorry guys but that sort of argument just doesn’t cut it anymore and we don’t buy it. Luckily, it seems that more and more people across the world aren’t buying it either and are granting basic civil and human rights to LGBT people.

There is so much still to be done and so many minds of all beliefs that need to be changed but the ball has started rolling and may not be able to be stopped, even with the might of the Vatican against it. We’re not asking for the Earth, and many of us aren’t particularly interested in the kingdom of Heaven but we are asking to be treated the same as everyone else, both legally and morally. Hopefully, the Pope’s latest diatribes will be seen as out of touch and unrealistic in the modern world and that eventually he will see that as well but I’m not holding my breath.

Just thought I’d jot down a few wishes and hopes for under the tree this year and by the way. Thanks for reminding me that the virus is for life and not just for Christmas. Such a nice ironic touch all those years ago that it also came unwrapped (and to think that they still call it ‘the gift’)! Ah well, what’s done is done and you were only delivering someone else’s wish list after all.

You know. I’m not one to ask for much but having just seen the Glee Christmas episode, I was so full of joie de vivre (I’m sure you’ll understand that that’s meant to be slightly ironic!) I wondered if my old, childhood hero and favourite grown-up daddy could pull a few strings up there in the space between heaven and earth and maybe have a word with a few of the other gods and goddesses in the pantheon and grant me a few small wishes? I realise that you’ll have to get the Dollar god on your side (I know, even among the worshipped, ‘new money’ must be annoying!) but I’ve been a really good boy this year, I have! Well maybe there was that time in June and maybe...oh yes and in July and September and...aw shucks! You’ve got Sauron’s all-seeing eye up there as well, so I won’t get away with anything will I? However, you do know my intentions have always been good: problem is...spirit willing, flesh weak sort of thing eh!

So, to the messed up, train of thought, kind of list:

Peace

I suppose I could wish for peace on earth and joy to everyone but I’m sure you’d ask me if my parents were high as kites when they conceived me; so could we maybe have a little more peace in our schools, so that kids born like me can get an education without being driven to misery or suicide? Maybe then there’ll be less tragic incidences of misplaced anger being taken out on the wrong people. We don’t want any more victims in places that should be safe. A few less gadgets for the bullies and less guns in their daddies’ Christmas boxes might do the trick...only a suggestion. 

Brandy?

Now I’d leave you a bunch of carrots, some hot milk and cookies under the tree but I suspect at your age, the milk and cookies will turn your stomach and the carrots will have Rudolph farting ‘till New Year, so how about a bottle of Brandy? In return, maybe the elves could cast a glance over the books of the 1^st world and tell our clueless politicians how we’re going to get out of a crisis that’s closing down our HIV support systems and supplying 3^rd world, HIV kids with outdated and harmful drugs.

Surviving the Recession

If you could also drop a few ideas on how to survive the recession into our stockings, including tips to increase our self confidence enough to get the jobs we want, along with an ample supply of energy; we might just be able to avoid being up shit creek without a paddle! We know it’s the banks that caused it all and we know they’ve got governments by the short and curlies but maybe you could arrange a little fire and brimstone to even things out a bit (or is that someone else’s department?) You do know you’re a major contributor to negative capitalism yourself don’t you? People’s debts rise sky high at Christmas; even though you provide work for millions in Chinese toy factories. Please have a word in the right ears; we need a fairer system.

Stop jailing people

A major request next and one which you may not agree with but I know you’re an even-handed man and if you’re still confused, ask your husbear Claus. Please stop people with HIV being thrown into jail because the world is not balanced or safe enough yet for them to disclose their status. Nobody ever asked for HIV; nobody ever asked for the hatred that it can engender in our peers and nobody ever asked to be celibate for the rest of their lives either. We know when it’s safe to make love to us and we know what to do to make it safe for other people to do the same. So if our viral load is practically undetectable and we’re taking precautions on top of that; please teach the lawmakers that their hysteria, that takes away people’s freedoms for daring to have sex, is unfounded, unjust and inhuman. I do appreciate that’s a biggie and not exactly a gift request but maybe you can wrap up some pragmatic whispers and drop them in their ears while they’re sleeping?

The homeless

Could you also arrange for someone to invite some homeless kids with HIV into their homes for Christmas? Okay, even in the best of all possible worlds, that probably won’t happen but maybe you can twist the church’s and the city council’s arms to open up their halls and provide a bit of tinsel, turkey and TLC?

Movie screenings 

Oh yes, would it also be possible to have a few screenings of ‘How to survive a plague’, played out in young LGBT people’s dreams. They might just get the message then and be a little more tolerant of their own, less fortunate kind and a bit more active in standing up for their rights! It really hurts to be called a troll by someone young enough to be your grandchild who still wants the world to be all pink and fluffy. In the words of Saint Ru: “If you can’t love yourself, how the Hell you gonna love someone else?” 

Keep the promise

An end to discrimination is probably out of reach but a word in leading politicians’ ears would be great if you could. Tell them that they should put their money where their election mouths were and at least keep their promises as far as LGBT issues go.

Gay marriage

Gay marriage...meh! I don’t really care what you do with that one but I guess people should at least have the right and it’s a Christmas gift in itself to see apoplectic church leaders and right wing politicians choking on their wishbones! 

The personals

Okay, now a few just for me. Can we have less media hype and hysteria please? Less whoopin’ and hollerin’ when a D-lister appears on the box and when Oprah and Ellen give stuff away, please make them aware that they are solely responsible for whipping up bare-assed greed in screaming Middle America. Enough already; put something in their mince pies to calm them down. Not only that but a little bromide in the coffees of all newspaper moguls might just make them tone down the headlines.

“Portly vicar fiddles with seventeen choirboys! Possible Aids infections! We demand justice for the nation!”

No, no, no more...that’s so 1987! Whatever happened to balanced reporting? The news is bad enough.

And another one; please could you invent a user-friendly, tattoo removal kit to show people the error of their ways? Have you ever seen tattoos on the over 50’s? 

And climate change – what’s up with that! Do you really want the polar factories to be flooded, especially now that the elves are unionized? Good move by the way, towards being an equal opportunity employer and shifting the operations to Shanghai!

By the way, something that really gets my goat and is also related to the media bosses mentioned in an early wish. In all the hysteria and witch hunting to track down paedophiles, could you please get the message across that ‘paedophile’ does not equal ‘gay or lesbian’? Joe public’s gay-hate switch is still immediately triggered when child abuse hits the headlines. As if we haven’t got enough stigmas to deal with! For that matter, young kids always deserve to be protected from sexual exposure and bullying, so more concrete, psychiatric help for those who can’t help themselves and then take away kids’ choices please!

Now I know that Christmas is a heap of baloney invented by the Christmas tree balls industry but the basic message is a no-brainer, so if you could grant just one of my wishes and make us all be just a little bit nicer to each other in 2013, I promise I’ll try to be a better boy next year. Oh and making my neuropathy so bad that I have no choice in the matter is not an option thank you very much!

Seasonal Greetings and I’ll try to believe,

Dave

P.S. I suppose a cure or vaccine for HIV is out of the question?

P.P.S.  According to that brilliant article in the Huffington Post, it looks as though your secret may be out. Someone told me you have a summer penthouse somewhere in Manhattan and profile yourself regularly on Grindr as ‘Polar bear with iceissues’ but it always seemed so unlikely! Well if it’s all true (and newspaper headlines are always true...right?) I promise I won’t out you to any kids or republicans I meet but hey...I’m just saying...nudge nudge...wishes are meant to be granted...okay!

P.P.P.S. If you have room on the sledge, could you slip me in Joe Manganiello, in nothing but a big red bow? If you’re cutting costs...forget about the bow.

“Pain is experienced by people and families not by nerve endings” Dame Cicely Saunders

A nightmare for some and a godsend for others; some people become addicted to opioids because opioids have become their recreational drug of choice, others because their pain symptoms are so severe that they have no choice. Either way, a problem has arisen which threatens social stability in whole communities, especially in North America and makes authorities unsure which way to turn.

You may see this as a far from my bed phenomenon but as I will explain later, many people living with HIV find themselves involved with opioids before they know it and have to live with the consequences of this sort of treatment simply because there is no better way of treating their pain.

First some statistics to highlight the scale of the problem:

• According to the US Institute of Addiction Medicine in 2007, 23 million people over the age of 12 needed treatment for substance abuse in the USA.
• Between 1992 and 2003, abuse of prescription drugs increased by 140%.
• Given that Americans represent 5% of the world’s population; 80% of the world’s supply of opioids and 99% of the global availability of hydrocodone is used within the US borders.
• Because opioids are legally available as prescription drugs, this availability has been matched by a 63% increase in opioid-related deaths between 1999 and 2004.
• Many studies have shown that abuse or misuse of these drugs averages out at between 20% and 58% of people who have been prescribed opioids for chronic pain.
• In 2005 it was established that almost 2 million Americans were opioid dependent but more alarmingly...
• Approximately 4.7 million teenagers and adults used opioids for non-medical purposes and...
• Over 32 million Americans reported having used them for non-medical purposes at least once in their lives. 

Shocked yet? Actually these statistics were assembled before the current explosion in opioid addiction and abuse that has recently begun to hit the headlines across the western world. The figures, five years later in 2012 will be far higher and the number of deaths and serious health problems resulting from both opioid prescription and the black market, will now be alarmingly high. It’s a problem that is almost unrecognised in its expanse and a social time bomb that we still seem unwilling to acknowledge.

Still, why should this be relevant to people living with HIV? The answer is that many people with HIV are also chronic pain patients; something that is often overlooked when reading about the negative aspects of being positive.

According to the Well Project, many people with the virus have to manage chronic pain symptoms for the following reasons:

• Peripheral neuropathy (between 25% and 40% of people with HIV) – nerve damage with over 100 causes, amongst which are the virus itself, diabetes, cancer treatment, toxic medications and even high alcohol consumption.
• Abdominal Pain (26%...) – as a side effect of some HIV drugs; parasitical infection or bacteria; problems and irritability in the intestines, including irritable bowel syndrome; inflammation of the pancreas caused by some HIV meds; too much fat in the blood; or drinking; bladder or urinary tract infections and in women, uterus, cervix and ovary conditions.
• Headaches and migraines (17%...) - from mild to severe brought about by a variety of causes including certain HIV drugs
• Joint, muscle and bone pain (5%...) – can also be from mild to severe and be HIV-related to forms of arthritis, rheumatism; bone disease and bone density problems. It can also occur when using drugs for high cholesterol and especially hepatitis.
• Herpes pain (5%...) – many people may see herpes as par for the course when you’re sexually active but a cold sore, or sore on your genitals represents its mildest form. If you’ve ever had shingles, you’ll know that the pain can be excruciating and as the herpes virus can frequently re-occur, it’s something that can plague your life if you have HIV.
• Skin problems and rashes – side effects of certain HIV medications or other drugs.
• Chest pain caused by lung infections such as TB, bacterial pneumonia, or PCP pneumonia.
• Mouth pain caused by ulcers or fungal infections.
• Pain due to cancer in all its forms.

"the good news is that the explosion in opioid use since then has not been paralleled in the HIV population" 

According to pain.com in 2005, 8% of HIV individuals were on long-term opioids for severe pain, which was more than double the non-HIV population. However, the good news is that the explosion in opioid use since then has not been paralleled in the HIV population. This is possibly because opioids are prescribed for valid reasons to HIV patients and there is less incidence of recreational opioid use which has worsened the problem in the general population.

Before everybody writes in to say that they’re fine and have never had a problem with the virus or the medication, please be reassured that you are some of the lucky ones. Of course only a certain percentage of people living with HIV will suffer chronic pain in one form or another but a significant proportion of those will eventually have no option but to start taking opioids as the only painkillers that will help. It’s not a choice; some pain is so severe that it just doesn’t react to over the counter medications, or medications meant for other diseases. Opioids, if used properly, are a very effective solution. The problem is that they are not always used properly as the statistics above clearly show.

Recreational use of opioids could also be said to be the result of psychological ‘pain’; fulfilling a need to escape from the harsh edges in life (it could also be simply the well-known search for a kick that has got out of hand). However, recreational drug use and the reasons for its popularity are really subjects for other articles. What we need to know to arm both ourselves and people we know with knowledge, is that it gets out of hand when people don’t realise how quickly and easily they can become seriously addicted.

So, with the facts out of the way, it’s perhaps useful to illustrate the problem by giving some examples of what opioid abuse has been doing to people.

Canadian issues

A BBC article told how Oxycontin (Oxycodone) has been responsible for devastating certain groups within the Canadian First Nation communities.

"The spiral of social decay then becomes speedy and almost inevitable and in the end becomes a criminal rather than a social problem."

Just three hours flying time north of Toronto is the small town of Fort Hope, where it is estimated that 80% of the working age population is problematically involved with Oxycontin abuse. A local artist, Dave Waswa, carves eagles from moose antlers and instead of selling them to art dealers and galleries, sells them to feed his addiction. One carving will earn him 5 or 6 Oxycontin pills and in Fort Hope itself, an 80mg tablet can cost up to $600. If ever a town was ironically named! Even more ironic is that in cities like Toronto, you can buy Oxycontin pills for roughly $40 each and the suspicion that drug dealers are targeting remote communities seems to be borne out. The result is that people will do anything to get their drugs, including selling themselves and their possessions. The spiral of social decay then becomes speedy and almost inevitable and in the end becomes a criminal rather than a social problem.

"It makes everything go away," Mr Waswa says of the prescription-only painkiller. "You don't have no feeling. You just want to stay high… but I'm tired of it. I lost a buddy last summer. He was 38 years old and took an overdose, went into a coma and never got up."

As an ex user of Oxycontin myself (prescribed for neuropathic pain) I know what it’s like. It’s said to be as potent as heroin and more addictive. For people who use it as prescribed, it is taken orally and absorbed into the body over twelve hours. The problem is that huge numbers of people are abusing it by crushing and smoking or snorting it – the high is then pretty much instant and the addictive effects kick in almost as fast.

You shouldn’t be tempted into making racist assumptions here. The First Nation communities are just one example of many, spread across society from the leafy suburbs of the big cities, to isolated communities where life is already under pressure. The BBC article is worth reading but you can find equally powerful case-studies across North America, in every type of social class and structure. Just like any other addiction problem, local circumstances may make the problem easier to find but it’s everywhere, irrespective of social background. The Methadone Strategy Working Group in Ontario states clearly... “Opioid dependence is a health and social crisis in Ontario that crosses all social and economic strata.” ...and that applies to every country or state facing these problems.

"They’re working on various alternatives but many people end up taking levels of Oxycontin for instance that virtually guarantee addiction."

The manufacturers of Oxycontin (Purdue Pharma) have recently stopped distributing the current format of the drug both in Canada and in many states in the US. It has been replaced by a version that is far more difficult to tamper with (OxyNeo) and only works on a time-release basis, thus bringing it back to its original purpose. It’s important to note however that even time released opioids are potentially addictive. The very nature of the way they work means that eventually you need more of the same drug to maintain the same level of pain control! They’re working on various alternatives but many people end up taking levels of Oxycontin for instance that virtually guarantee addiction. Many doctors don’t appreciate how easy a process this is. When I realised what it was doing to me, my specialist told me to come down from 80mg a day for instance, to nothing within a week! Six months later, I was down to 5mg a day and a couple of months later finally came off it altogether but it was a struggle and telling people that weaning off the drug is a short term process is nonsense and guaranteed to add to people’s insecurities.

Oxycontin was introduced as a wonder drug in the late 90s and was pitched as a less addictive option than other opioids. Cancer patients especially saw this as a huge breakthrough in dealing with their pain but in fact Oxycodone turned out to be twice as strong as morphine. Doctors were at first unaware of its addictive strength and many still are but fortunately, local and state medical authorities across North America  are waking up to the problem and removing it in its current form from the market; with the FDA in the States  leading the way.The problem is that the more controllable alternatives are not yet available everywhere, leading to addicts heading onto the black market and underground dealers. These alternatives are basically exactly the same as Oxycontin or other opioids but can’t be crushed or liquefied. Unfortunately, this is a typical governmental approach to all sorts of addiction: pass a law, remove the drug but don’t have realistic alternatives in place so that addicts can wean themselves off slowly and with guidance. This often leads to further misery for the addict and a rapid growth of an underground market.

It’s important to remember that Oxycontin is by no means the only opioid that has these troubling side effects. Morphine family members, including amongst others, Tramadol, Dilaudid and Percodan all have their own stories of widespread addiction after delivering relief from chronic pain.

A paper produced by the Ontario Addiction Treatment Centres  makes for very interesting and alarming reading, the chief points of which are as follows:

• The main causes of drug-attributable deaths are suicide, overdose and AIDS contracted from sharing needles—all of which are strongly associated with injection drug use.
• Each year, about 1% of opioid users will die from an overdose.
• In 1995, opiate poisoning was the cause of about 160 out of 804 drug-related deaths in Canada, and opioids accounted for 11% of the 6,947 hospitalizations attributed to illicit drug use. (This does not include the hospitalizations for inappropriate use of prescription opioids.)
•  People who are opioid dependent are also extremely vulnerable to life-threatening blood-borne diseases, such as HIV and hepatitis C. Between 1985 and 1999, the proportion of people in Ontario diagnosed with HIV through injection drug use rose from 0.45% to almost 15%. In 1999 alone, injection drug users accounted for 24% of new HIV infections in Northern Ontario and 15% of new HIV infections in Ottawa. As of 2000, 63% of newly diagnosed cases of hepatitis C are related to injection drug use.
• In 1999/2000, drug possession or drug trafficking accounted for 7% of new admissions to correctional institutions (2110 people), 5% of new admissions to probation (1,809 people) and 16% of new admissions to conditional sentences (694 people). These figures do not include the number of people convicted of theft or other crimes to support a drug habit.
• The Ministry of Community and Social Services estimates that about 3% of users of the social assistance or welfare system have a history of drug dependency, which affects both their employability and their ability to maintain employment. 

It’s again important to remember that this paper was drafted some years ago and since then the opioid problem is said to have ‘exploded’, which if true, is a frightening thought. Whether the problem has really become so much greater since 2000 is open to discussion. The truth may be closer to the fact that the media in western countries has finally cottoned on to the extent of the problem and has devoted column inches to lurid and sensationalist headlines which make it look as though the opioid addiction problem is explosive and threatening to the social fabric.

So what is the ‘real and present danger’ to us as people living with HIV, its co-morbidities and any resulting extra health problems? If your pain does not respond well enough to analgesics and other drugs (anti-depressants, anti-convulsants and other drugs meant to interact with nerve signals to the brain), you may be advised to move onto opioids of one sort or another. This shouldn’t alarm you too much, despite the content of this article. Opioids work really well, if they are kept under control and you are consistently monitored by your doctor or specialist. He or she should make every effort to ensure that you don’t become addicted whilst still getting the most relief out of the pain killing effects. The problems often begin if the doctor writes you a prescription and then leaves you to get on with it. You should always discuss any potential side effects and problems before beginning with opioids. You should get his or her reassurance that you will be carefully monitored and that the right level of opioid medication will be found with as little risk of addiction as possible. Anything less is really unacceptable but the reality is often harder than this advice suggests. If you’re given a ten minute appointment, it may be difficult to discuss things in any detail because the doctors are under so much time pressure. However, in this case, you can be sure that a little time spent establishing ground rules now will save much more of the doctor’s time later if it goes wrong. If you want to get off the drugs at a later date, make sure that the close monitoring continues: weaning yourself off opiates is no casual matter and isn’t easy; you’re going to need support. In your own interests, make sure you get it.

"Addiction also involves a physical, psychological and behavioural need for an opioid and can dominate a person’s life."

The American Institute of Addiction Medicine points out that the World Health Organisation recognises opioid addiction as a brain disease. Addiction also involves a physical, psychological and behavioural need for an opioid and can dominate a person’s life. They also say that opioids prescribed as pain killers are similar to heroin and can be equally addictive. Addicts will go to any lengths to satisfy their need, including shopping around the various doctor’s surgeries and clinics; stealing from friends, family and work and using the internet to order them from whatever suspect source. The withdrawal symptoms of coming off opioids should never be underestimated – it’s always possible but it’s going to be hard – you’ll probably need help, guidance and understanding. Never try to go cold turkey with opioids; you don’t need to; just get the right advice. Some people however, will continue their addiction rather than face the social stigma of admitting their problem and seeking help. 

The medical authorities and pharmaceutical companies are finally reacting to the problem and working on ways to reduce the potential for pill abuse by developing safer alternatives with longer delayed release effects, to try to cut out the possibilities for instant highs. They are also busy studying the best ways of directing and re-directing pain signals to the brain by creating more refined opiate derivatives but this will take time, especially as each new product has to go through hoops before it is officially approved. 

In the meantime, millions of people suffer from substance use and abuse and many more are affected by someone else’s problems. The best we can all individually do is keep our eyes open in our own circles. If you know someone who has been prescribed opioids for chronic pain, tactfully try to let them know that you will be there for them during any difficulties and watch out for signs of a personal struggle with the drugs. Of course this is true for all substance abuse; from over-eating via alcohol and smoking, to heavier medication abuse. If for whatever reason you personally take opioids for recreational purposes, I can’t judge but please make yourself aware of the facts and the dangers and if you feel that control is slipping away and the drugs are taking over, at least tell someone you trust. You really don’t want to become another drug abuse statistic, especially if you are also living with HIV; life is surely difficult enough! 

"I know I have a history of being open to temptation and may have a ‘suggestible’ personality."

I don’t want to come over as alarmist; the statistics surely speak for themselves and opioids are powerful analgesics that when properly and sensibly prescribed and administered, can bring much needed relief from physical pain and emotional suffering. However, they aren’t aspirins and need to be treated with the greatest of respect. If you take them because your pain is unbearable, you have to see them as a positive treatment; you may not have any choice but knowledge is power and being aware of what they can do if not wisely used, is half the battle against potential problems. If you’re honest with yourself, you may become more aware by looking at other things in your life. Do you find it difficult to resist smoking, drinking, eating, for instance? I know I have a history of being open to temptation and may have a ‘suggestible’ personality. Perversely, that knowledge helped me stop smoking, drinking and certainly helped when coming off Oxycontin. Knowing that you are susceptible to mild addictive behaviour may keep that thought in the back of your mind when dealing with opioids. Never be afraid to pester your doctors for help – they can’t read your mind.

Finally, the following by Jane Ballantyne and Steven LaForge from the official journal of the American Pain Society sums up how difficult the whole subject is.

“When patients are maintained on opioids for the treatment of pain, there is currently no satisfactory means of distinguishing true addiction from problematic behaviors caused by a variety of factors other than addiction. Unfortunately, advances in understanding the neurobiological foundation of addiction have not been matched by any improvement in physicians’ ability to recognize and diagnose the condition. There is no single diagnostic marker of addiction, no definitive change on brain imaging and as yet no genetic markers to provide a reliable prognosis of risk. When it comes to iatrogenic opioid addiction, the clinician is faced with even greater difficulty: the behaviors encountered do not resemble those outlined in the criteria for addiction to illicit drugs...

...One of the great difficulties of quantifying, recognizing, and treating iatrogenic opioid addiction is the subjective nature of the judgment on whether behaviors have crossed an ill-defined boundary between problematic opioid use and addiction. This judgment then becomes dependent on the reporting person’s experience, prejudices, and knowledge.”                                            

Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain. 2007;129(3):235-255

Opioid dependency is clearly a huge problem, partly because of the dichotomy of its causes. How can you balance the medical need for perfectly legal and effective drugs, with the potential for side effects and addiction? Addicts may become addicted because the opioids have overcome the original medical need and prescription parameters, or because they’re seeking a buzz or a high? The end result for both can be addiction, even if the original motives were polls apart. The lines are blurred and nothing is just black and white but there is no doubt that it’s another underestimated problem of the modern age, which is having wide ranging effects of certain groups in society. The authorities are, as is often the case, reacting instinctively by using sledge hammers to crack nuts by locally banning this and that and criminalising doctors and chemists, who have to turn legitimate patients away. It is complex and we have to hope that the pharmaceutical companies will ignore their cash cows and quickly come up with safer but equally effective alternatives. Let us hope that people living with HIV are amongst the most knowledgeable and level headed in society and that the problem within our community will be constrained, even if it can’t be removed.

 “Only the patient knows how intense and frequent a pain is – a pain is what the patient says it is.” Palliative caregiver

Further information:

http://pain-topics.org/opioid_rx/risk.php

http://www.whocancerpain.wisc.edu/?q=node/78

http://opioids911.org/

After seeing the very British E.L.James on a chat show recently and knowing straight away that if I saw her again on the street I wouldn’t recognise her, I became interested as to what all the fuss over ‘Fifty Shades of Grey’ is about.

The lady author is the absolute antithesis of sexy, sleaze kitten and could so easily be a kindergarten teacher and yet her book has apparently got half the women in the western world panting inappropriately in all the wrong places and at the wrong times. Now I’m not normally a fan of ‘chick lit’ (what an insulting term that is) but when I heard that sex shops and sexual accoutrement websites were selling out of whips, chains, dildos and butt plugs like there was no tomorrow, my curiosity was more than a little piqued. After all, if a first book, by a new author, sells 60 million copies to straight women and apparently significant numbers of LGBT readers in no time at all; you’ve got to take a look right? E.L.James has suddenly flown into the heady stratosphere that is J.K.Rowling territory!

After the first few chapters and several ‘mehs’ later, I almost abandoned the task, thinking I was definitely not the target group and then...it got me! The author claims there was no plan, no structure in her mind when she wrote the book; it just came pouring out of her. Well, to my mind, frankly it shows now and then but oddly that doesn’t detract from its overall impact.

Lots of scenes are pretty much unbelievable too; there’s no cleaning up of messy bodily fluids and next morning, semen breath is not an issue that is tackled. The hero can apparently have mind-blowing’ sex countless times during the day without taking a breath, or losing potency (that said he is only 28). He runs a massive business empire and is a gazillionaire with a bottomless bank account yet apart from a few phone calls and emails here and there, hardly conforms to the north American work ethic because he’s too busy having sex.

The plot line is wafer thin but is gripping enough to keep you wanting more (a bit like the nipple clamps the heroine learns to enjoy).  I don’t think it’s great literature; in fact the number of repetitions of high octane orgasms sort of leaves you wondering how she’s going to top that and reach a climax in the book (cheap pun, I know) and yet it’s still got something. Its high quality erotica; a sort of Mills and Boon meets ‘Debbie Does Seattle’ mix but with more class than you expect.

I suspect its success has left many straight men choking on their cornflakes, as she appears at the bottom of the stairs, baking spoon in hand, growling ‘Take me now!’ They’ve realised that the performance monitor expectations have just been raised another twenty notches. You have to feel sorry for them’ yet again they’re being emasculated, even though it may seem that the dominant man rules this book. The truth is that this book may be as liberating for women as “The Female Eunuch’ was, way back when.

So given that I’m a gay man who’s pretty much seen and read it all as far as yawn porn is concerned, what’s the attraction to non-heterosexuals?

Now, I’m not aroused by explorations of the female sex organs and I’ve never really been into S&M, however vanilla it might be, as many a man who has tweaked my nipples (having finally found them) has discovered. ‘Get off, it hurts!’ is not the best way to prolong a hot date! The Dom/Sub relationships are interestingly explored but really need much more elaboration. That said; they will open many people’s eyes as to what that world is like. This book however, has touched a chord, even with me. Even at my advanced age, my curiosity about this, that and the other from the SM spectrum has been reawakened.

We’ve probably all at least touched on S&M in our experiences, or at least thought about it. Many couples have tried things to spice up relationships; others have rejected it out of hand and yet others belong to regular circuit groups who take it very seriously indeed. I would dare to say that it fascinates us on quite a deep level. That’s one of the secrets of the success of Fifty Shades; it opens up a world that many people have never really dared to explore but have always been curious about.

Forget about the fact that it’s straight erotica. If you’re a gay man, you’ll lust after Christian Grey and if you’re a gay woman, you’ll lust after Anastasia Steele; trust me on this one, you will!

The names shouldn’t put you off (I know right; straight out of Barbara Cartland!) because the second major secret of this book’s success, is the unashamed Soap quality of the characterisation and plot. Basically it’s a love story. The man is on the surface, super rich, super powerful and unbelievably controlling in all aspects of his life. Of course the reason for that is that he is broken and comes from a severely abusive childhood. He compensates for his demons by controlling every aspect of his environment and making millions in the process. The woman is a virginal, girl next door type, with a low opinion of her own attractiveness. She meets the hero, falls under his spell, realises why he’s the way he is and subtly changes him. There’s murder and mystery slotted in to add a little more spice and there you have it. That’s it in a nutshell; a thousand and one soap opera plot lines in one book.

The huge difference and the thing that sets it apart from most others is the sex. Ana calls it ‘kinky fuckery’ and she’s right on so many levels. However, remember, the author has already got you if you like ‘Sex and the City’, or ‘Tales of the City’ or any number of good soaps on TV because the formula underpins the rest of the book. Love, good and evil, money, sex, death, overcoming seemingly insurmountable obstacles; they’re all here but the sex...now that’s pretty different for a mega best seller.

I’m looking at it from the viewpoint of a gay man with HIV but I’m certain all sexes and sexual colours of the rainbow will find something in this book because it appeals to a deeper, darker sexual need in human beings. LGBT people will be able to put themselves into every sexual situation in the book because it doesn’t matter that the two protagonists are male and female and heterosexual – they’re very sexual beings and that’s what counts. It also looks into the issues of control and release and how far you want to control someone else, or let yourself go and surrender. In LGBT relationships and even hook-ups, when both sexes are the same, that can be an interesting and confrontational scenario.

Apart from the erotic elements, you want to save Christian yourself; cuddle him when he can’t bear to be touched and help him defeat his demons. You cheer Ana on as she adjusts to her new world and discovers a deep longing for top quality human contact and new experiences via sex. You applaud her every breakthrough with this impossible man and adore him as he discovers previously unknown and lovable traits within himself.

You do all this because you can see yourself doing it. Who wouldn’t want to rescue a broken man/boy and change his life forever, whilst at the same time vastly improving your sex life and stretching your boundaries? Who wouldn’t want to make a virgin fall head over heels with you, bombard her with gifts and thrill as she takes tentative steps into your fantasy world? The point is that for gay people, Ana and Christian are interchangeable; you can switch their sexes and be both in your imagination without the slightest difficulty.

It has to be said, the money helps and is a brilliant device in the book because it takes away any need to ever do normal things, which let’s face it are generally boring for the readers and detract from the fantasy. Everything is bought in, including the staff and fantasy scene builders who can be and are, fired at a whim. Food is provided by the housekeeper (who also has the doubtful pleasure of cleaning up after sex sessions) and transport is provided by burly, inscrutable men and planes and helicopters.

Ana abandons her principles and overcomes her reservations just a tad too readily for my taste. She adapts to her world as soon as the white Audi A8 is presented for her birthday but she never comes over as a gold digger, it’s much more complicated than that and you end up feeling that she deserves every cent for what she has to put up with. The fact that money is no problem means that you can indulge yourself as a reader, in her quest for his soul and his battle to come to terms with his own humanity.

The sex is repetitive and pretty much unbelievable in terms of how many times they do it and how many earth-shattering climaxes are had by all but because of the nature of the ‘kinky fuckery’ it’s never really boring. I found myself, suggesting, do this or do that, or get on with it, several times during the story but that was shameless transference behaviour on my part. Believe me, if you’re gay, you’ll be into every scenario here, you’ll just need to suspend disbelief and make Ana a man or Christian a woman. Surprisingly, that’s not a problem.

So without wishing to give too much away if you haven’t read it; the trilogy, Fifty Shades of Gay (sorry couldn’t resist!) is a bit of a phenomenon. It ain’t going away in the near future either; there are three films in the pipeline and you can start compiling your lists of who will play who right now and the unassuming E.L.James is planning more saucy escapades.

To my mind the fantasy and imagination which make the book so appealing, will never be convincingly translated to film, especially in prudish America. You need the sex scenes to be exactly as they are in the book – not going to happen! Even the Sundance festival might baulk at three films about sex which are not meant to be porn but you can be sure Hollywood will cash in.The author says that it’s like living her life through someone else’s eyes at the moment and the success and fame is surrealistic. Oh lady, you ain’t seen nothing yet! I’d get on the phone to J.K.Rowling right away if I were you!

Fifty Shades of Grey by E.L.James, is actually a trilogy made up of: Fifty Shades of Grey; Fifty Shades Darker and Fifty Shades Freed.