In 2008, the Swiss Federal Commission for HIV/AIDS issued a statement, distilled from an extensive literature review and much discussion, that can be summarized as follows:

"An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact."

This, as long as the person continues to follow effective anti-retroviral therapy, regularly evaluated by a physician, has maintained a suppressed viral load for at least six months and there are no other sexually transmitted infections present. 

Almost to a person, public health authorities in other jurisdictions hastily issued statements distancing themselves from the Swiss Statement, just not ready to affirm what many treating physicians have opined for a long time. 

Now many are coming around, sort of. The more we hear about the strategy that can go under the name "Treatment as Prevention", "Test and Treat", "Seek, Test and Treat" or "Seek, Test, Link to Care, Treat, Retain in Care", the more it becomes obvious that these things are largely the children of the Swiss Statement: a recognition that effective treatment controls viral load to the point that the person living with HIV will not transmit the virus to others. But our public health authorities are still not ready to say that, are they? 

They are willing to assert that treatment is effective in reducing transmission rates as a reason for people with HIV to be treated as early as possible, but not ready to say that effective treatment for people with HIV will protect their sexual partners. Yes, that seemed a little like talking out of both sides of their mouth to me, too. 

Let's look at the kinds of things that public health authorities are saying. 

"There is no zero risk." I think we all know that, but nothing in our collective lives is without risk, even walking down the sidewalk. This is not to say that all risks are scientifically significant, however. 

"The studies were among heterosexual serodifferent couples, so we cannot draw the same conclusions for gay men." So you're not recommending early treatment for gay men as a public health measure to reduce infections? Oh, you are? Hmmm. Can you explain that one to me? 

"Earlier treatment will be beneficial to the person living with HIV." This, of course, is based on theories that may well bear out in studies to be conducted, but they remain theories for the time being. The last time there was a study comparing different starting points for treatment, it found no significant benefit for starting treatment above a CD4 count of 500, versus one above 350. If you can't extend the conclusions of studies conducted with heterosexual couples to gay ones, then how can you assert that early treatment is beneficial for the health outcomes of people with HIV when your assertion is not backed by the same degree of scientific proof? 

Now don't get me wrong: I am not against treating to prevent transmission. What I am against is providing dubious information and doubletalk as the means to get people to agree to embark on treatment earlier than might be necessary (or especially beneficial) for their own health. Yes, people can choose treatment in order to protect their partners, too, but that is an explicit choice the person taking the treatment ought to make. 

So now that we all agree on the fabulous wonders of treatment, whence the condom? Oh, our wise public health authorities are not ready to let go of that. Treatment AND condom, then. This adding early treatment thing is starting to look like something of an additional burden instead of a liberation for us. I have to add that many of our own community organizations take this cautious public health approach, too. 

I'm not trying to say here that condom and undetectable viral load is some kind of fashion faux pas (like belt and suspenders definitely is!). Some people will always be extra cautious (I count myself among these) and that is a valid choice. Just maybe not something we should be making everyone make when the science tells us it is not really necessary.

Now if we look back at the arguments that were presented before the Supreme Court of Canada in the Mabior and D.C. cases (on the duty to disclose one's status, with condom use or with undetectable viral load), there are governments in this country who would like the rule to be disclosure, indetecetable viral load AND condom. 

Anecdotally, the disclosure is already taking place (though not to legal standards) when we ask our partners to wear condoms. It seems that only the HIV positive are such sticklers for that these days. And whether it's presumed disclosure or explicit disclosure, we all risk exposing ourselves to rejection and discrimination for trying to be responsible in these ways. 

It's starting to look like the "shared responsibility" for ending HIV is becoming a little heavy on the side of the people living with HIV, and a little light on the other side. Yes, a little like belt, suspenders and tattoo across the forehead.

The city-dwellers among us — and even those who might live outside the city but head to the land of tall buildings on a regular basis — take elevators for granted. We get on, we know what floor we're going to and press the corresponding button and we're off! It is a handy way to get to the upper floors of a building without arriving out of breath. But how closely do you actually look at the elevators you ride? 

It might be because I live in a city that is a strange mix of cultures and traditions, but the elevators here in Montréal can tell a story about a building that can often be quite different from the story told by elevators in a neighbouring building. I'm talking about the numbering of the floors, of course, which really varies widely here. 

Many buildings start with a ground floor (rez-de-chaussée), which will be represented as either G or RC on most elevator panels, but also sometimes 1. That can be a little perturbing in a context in which the next floor up can either be 1 or 2. There's the strange thing I noticed when I first moved here many years ago: the first floor is often one floor up from the ground floor. It's certainly a good motivation to look at the floor indication when boarding an elevator in a building for the first time, just to be able to be sure which floor to return to for the egress. 

The next highly noticeable thing you might see here, if the building is tall enough, is the thirteenth floor. In many buildings, one leaps directly from 12 to 14, presumably because of the superstitions (triskaidekaphobia) of the builder or owner of the building. Not so true here. Many buildings have thirteenth floors and nobody bats an eye at them. I'm not sure that I've seen a thirteenth floor in English Canada. 

Then there are approaches that make the triskaidekaphobia look tame. The number 4 being so very unlucky in Chinese culture that every 4 is eliminated from the elevator pad: no 4, 14, 24, etc. I'm not sure what they do after the floor numbered 39, but I am sure it is likely an inaccurate assessment of how high up you might be. 

Just one more observation that I have to add, a sign of the times There's something that made me reticent to pull out my phone to take a picture of the elevator keypad as I was thinking about this story. Especially, but not only, when there were other people on the elevator I think that thing is an irrational fear of being thought to be doing something wrong, like snapping photos of people you don't know or of machinery that might be the target of….well, you're either with us, or you're with the people who take pictures of things. All of which to say that the photos you see were lifted shamelessly from the web. 

Do you dare to take your own photos of your elevator keypad to prove me right or wrong in my triskaidekaphobia theory? If you're brave enough, I challenge you to share them with PositiveLite.com  on Facebook. Until then, could you press 5 for me?

You know that thing that ardent ornithologists do? You know, writing down their sightings of each different variety of bird they have laid eyes on, where and when. This post is not about that. It's not about looking, and it's not about birds.

No, when I was a fresh-faced young gay, just out of the closet, I briefly kept a little list of the men I had slept with. No euphemisms: I had had sex with them, usually with very little sleeping involved. My WASPy prudishness caught up with me a few months in and I stopped with the list after a few entries where I didn't have names, but only situations or the make and model of the car that picked me up… Who am I kidding?! It was probably only the colour of the car, which pretty much exhausts my knowledge of cars! 

Even with this abrupt end and the short experience of my list, I was already up to about fifty entries when I stopped. Such a shame I didn't keep it up, as it might have been a very interesting sociological artifact by now. This came to mind in a conversation recently, as I also discussed filling out an online "How gay are you?" quiz with a friend. My friend got to the question about how many different men he had had sex with and he said, "There were only three spaces, so I put 999." I, much more modestly, put 500 at the time.

Now are you seeing how my list might have been interesting to revisit after a lifetime of encounters? 

You might actually be wondering aloud why I should be so proud of being such a slut, whore, whatever, and thinking smugly that you now know why I turned out HIV-positive. I have two answers to share on that topic. First, it isn't that I'm necessarily proud; it's that I refuse to be ashamed. Second, as I frequently assert in meetings with public health types in the context of my work, it really doesn't matter how many partners you have, it matters what you do with them. So clearly, I am on the sex positive side of this debate. 

The other thing that I feel the need to express is about the source and timing of my HIV infection. I don't know, and I have a smidgen — but not really more — of intellectual curiosity about the answers to those questions. They do not preoccupy me. 

I am a gay man who started having sex before we knew about HIV. This is not in any way to suggest that I was or wasn't infected before we knew, or that that would really matter. I was as human afterward as anyone who might be infected today. We aren't machines making cold rational decisions based on available data, we are humans who sometimes don't think about what they are doing or just need some human contact at the moment, or don't always make decisions about our pleasure based on fear of risks. 

When we found out about HIV with my sex life already underway, there was some adaptation around the equipment or the acts, but not around the attitude. I think that changed for those coming of age and coming out post-HIV, at least until recently, which only makes it more of a shame that I didn't maintain my life list. 

I could have written my autobiography as a thesis.

Well, since a certain "Pierre Poutine" has been in the news of late, I have finally decided it is time to give in to Bob's persistent exhortations to write about this gooey delight we know as poutine

I say "we know" rather loosely, because I suspect I am about to introduce you to some incarnations of poutine that do not resemble the dish you might love to "dis". Oh yes, there are many forms of poutine, and I suspect that the ones seen beyond the borders of Québec are but pale imitations of what they might be. This is a story of what might be.

Yes, every small greasy spoon and hamburger joint here has its version of poutine that follows a pretty basic recipe: fries, gravy and some kind of cheese (curd if you're going to be authentic, grated if you're not). But you have to step over to the specialists if you are to appreciate the variety that can be poutine.

One such specialist is La Banquise. A staple of the Plateau Mont-Royal (one of the coolest neighbourhoods on the planet, we are told), La Banquise offers no fewer than 28 versions of poutine on its menu, often drawing a crowd such that you will need to wait in line to get in. Believe me, it is worth the wait, as the poutine taquise (with guacamole, sour cream and fresh chopped tomatoes) will attest.

I recently discovered a new kid on the block, at least one that had recently opened a branch on a block more easily accessible to yours truly. Poutineville bills itself as "poutine reinvented" and you will see why when you visit their lovely website. My recent visit led me to bring out my creative side to make my own poutine from the checklist menu, while my companion chose from the pre-set selections. A little mix-up gave me the form of potatoes he had ordered, and vice-versa, but I have to say that I thoroughly enjoyed my creation of "patates écrasées" with chicken, brie and a lovely wine sauce. Oh yes, this experience took poutine up a notch.

Higher up the old cuisine chain would be the higher-end restaurants and their forays into poutine. Le Canard Libéré and Au Pied de Cochon serve classic-looking poutines, but the fries are cooked in duck fat, making them particularly special. There was even a rumour once of the chef of Toqué! having put together a lovely poutine featuring foie gras, but you won't find this on their regular menu. Not even the little sister of Toqué!, the Brasserie T! in a box on the sidewalk next to Place des Arts lists poutine, despite many dishes accompanied by fries.

Still further up the chain, an experiment by award-winning chef Martin Juneau of La Montée de lait. I haven't tried this and it looks like the restaurant may indeed be closed, but I have managed to capture a still photo of his "poutine jenga" and a link to a short video of him explaining his creation to Urbania magazine.  Even if you don't speak French, I dare you to watch his short video and then tell me you wouldn't want to have a taste of whatever he wants to dish out.

So the question, my friends, ends up being not "Is poutine worthy of my appetite?", but "Is my appetite worthy of poutine as it can be?"

Call me Old School. But Old School with some curriculum updates and nuances, not some kind of 3Rs situation (not that Reading, Arithmetic and Writing spells anything other than RAW, but I digress). I said this at the ACCM meeting I wrote about last time and I'll say it here: the first time I saw the "I Party / I Bareback / I'm Positive / I'm Responsible" poster, long before the anti-criminalization demonstration, I found it very personally confronting.

I'm a gay man of a certain age, as we say here in Québec. I was here when my community was developing the "condom every time" message and people we knew and loved were dying. I think it's important to point out that the condom message came from our community and was not imposed on us from public health: in many places, notably south of the border, the government didn't really care about a bunch of social undesirables dying and our community mobilized to address this epidemic on its own. Public health was late to the party.

I have long thought that the "condom every time" message was needlessly narrow. What about diversifying our sources of sexual pleasure? Not every act requires a condom to protect it, and focusing exclusively on the act that does sends another message that is counter-productive to prevention in a macro sense: only one thing counts; the rest is not really sex.

Yes, we have learned a lot of things in recent years, like the impact of a controlled and undetectable viral load on infectiousness, or the rarity of reinfection between people who are already seropositive. (I had a little trouble with that last phrase because I think I personally still need a little more convincing on that.) Our community (or part of it) has developed strategies for prevention that are sophisticated and rooted in scientific developments, just as members of queer communities have learned to adapt to survive through the centuries. It is for each of us to determine our level of comfort with these in terms of what we are individually willing to do.

There are some lines I cannot bring myself to cross in spite of evidence that might prove my fears unfounded. This is not to say I ought to apply my own values to others, but mine should be respected when they apply to my own actions.

This brings me to another realization I have had over the years, and how I continue to be reminded of its truth. We live in bubbles. We live in circles of people who have access to the same information we do, who think like we do and whose values mirror our own. Meeting someone outside our bubble is often shocking in its impact.

I had the occasion, based on some news stories, to have the discussion about criminalization of HIV with members of my family a couple of years ago. I was shocked and appalled at not being able to sway the point of view of two of my siblings, they seeing criminal prosecution for non-disclosure as reasonable. Same family, totally different bubbles.

So let's get back to the poster. When I saw it the first time, I had my "OMG why are we saying that out loud" moment. Then I had my "logical deconstruction of the message" reaction, adding information to which I have access within my bubble, just as the creators of the poster do. Then I had my "cautious public administrator" reaction, realizing that there would be people seeing this poster who do not have access to the same information, at least not as readily as the rest of us, and that those people would be outraged. Then I had my "appreciator of art meets activism" reaction which saw the intention to spark discussion and debate. Reactions aplenty.

Then I had my irreverent reaction and made my own version of the poster (just couldn't help myself!).

I am left thinking that yes, I get it. But what is this poster doing to lead the people who do not understand the message or its underpinnings — even those within our own community — to the sources of information which would give them the possibility of understanding and appreciating the message? When I can't see that action, I have to question the advisability, if not the arrogance, of circulating a message that is obscure and provocative to those outside our particular bubble.