This article first appeared on the website of Pacific AIDS Network here.  Republished with permisision of the author. Folllow PAN on twitter at @PAN_CBR

I didn’t attend AIDS 2012 in Washington last July, but I do remember that when others came back they were all abuzz about the concept of the treatment cascade as possibly the next “big thing” in the way that we conceptualize HIV prevention and treatment. Now, many months later, and numerous references to the treatment cascade in meetings, policy documents, articles, and other HIV-discourse hubs later, I have to give my AIDS 2012-attending friends and colleagues pats on the back because I think they were right.

This example of an HIV cascade of prevention and care appears in the 2012 document “From Hope To Health,” which lays out the BC government’s framework for the provincial expansion of the STOP HIV/AIDS program.

While the meme of “AIDS free generation” also took hold at AIDS2012, it’s purpose was mainly to offer hope and buoy a movement, while the treatment cascade seems to be a model that is transforming how we approach HIV treatment and work to identify gaps in the continuum of care (from prevention, to testing, to care and treatment) so that fewer individuals are lost along the way.

Roughly defined, the HIV treatment cascade (or the cascade in care) is a way of calculating what proportion of HIV in a country or community is on anti-retroviral treatment and is virally suppressed – meaning no detectable virus in the blood – and how many people “fall off” the cascade at each step. Below are some interesting and key documents to look at in order to build an understanding of this concept.

From Hope to Health: Towards an AIDS-free Generation – On December 1, 2012, the British Columbia Ministry of Health released a guidance document for the province’s expansion of the Seek and Treat for Optimal Prevention (STOP) project across the province. What was notable in the document was the inclusion of a figure illustrating a “treatment and care cascade for BC” (see image above), which was expanded from the traditional cascade model to also include “number of people at risk for HIV but not infected” as the starting point. It will be very interesting to see how the model is implemented. 

The HIV treatment cascade – patching the leaks to improve HIV prevention – This comprehensive article written by James Wilton and Logan Broeckaert at CATIE is excellent in that translates the treatment cascade by explaining each “step” of the cascade and provides real-world examples of interventions and services that are used to help stop the leaks in the cascade. Wilton and Broechaert also address a concern regarding human rights that arises when using models such as this, which may reduce people to numbers and risk the goal (ie of low viral load in a population) seeming more important than individual agency. They say, “It’s critical that human rights are respected and that people living with or at risk of HIV are empowered to make decisions about testing and treatment that are right for them.”

Grappling with the HIV Treatment Cascade – In this PositiveLite.com article (originally published aidsmap.com), Gus Cairns looks at reports from the USA and Europe in terms of the proportion of individuals that are virally suppressed. This piece is interesting because it indicates that – although that the treatment cascade is a model that allows us to conceptualize the proportion of a population that has been tested and is retained in care – it is not a simple task to obtain actual numbers for each step. As PositiveLite.com editors suggest, without reliable data on the actual numbers, more research is certainly needed to confirm the extent of treatment penetration and to monitor future treatment as prevention initiatives.

North American Housing and HIV/AIDS Research Summit VII: Closing the Housing Gap in the HIV Treatment Cascade – This upcoming conference, to be held in Montreal in late September 2013, is a great example of the where the concept of treatment cascade is going next. As the title of the conference suggests, there is certainly a need to query how the social determinants of health, such as housing, inequitable distribution of resources, gender, food security, etc., can impact how many people are “lost” at each step of the cascade. The Summit will explore the potential of housing strategies to improve HIV treatment effectiveness in various jurisdictions. I believe that this is the tip of the iceberg in how we will be seeing various segments of the HIV service and research community engage with this concept.

Questions? Feedback? Get in touch!

Andrea Langlois (above) is the Community-Based Research Manager, Pacific AIDS Network. She is on twitter at @PAN_CBR.

This article first appeared on the website of Pacific AIDS Network here. Republished with permisision of the author. Folllow PAN on twitter at @PAN_CBR 

Moving research on new “biomedical” HIV prevention technologies into practice

By James Wilton

Recent research findings have improved our understanding of HIV transmission and prevention and could change the landscape of our response to the HIV epidemic. In the past few years, several new HIV prevention approaches, such as post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and the use of antiretroviral treatment as prevention, have been found to reduce the risk of HIV transmission. These new strategies are often referred to as new “biomedical” HIV prevention technologies, or NPTs.

If moved into practice in an appropriate way, these new approaches could have a dramatic impact on the HIV epidemic in Canada and other parts of the world. However, translating this research into a reduction in new HIV infections within the communities we work with will be challenging. Community-based organizations (CBOs) – through programming and research – will have an important role to play in understanding these challenges, overcoming them, and effectively implementing these approaches.

Engaging people and communities in new HIV prevention approaches

At the most basic level, we know that the more people in a population who use a specific strategy, the more HIV transmissions they can potentially prevent. The number of people who use a strategy, often referred to as uptake or adoption, will depend on a number of factors, such as awareness (do people know about it?), acceptability (do people want to use it?) and availability (can people access and afford the technology if they want to use it?).

The impact of these strategies will also depend on “who” in a population uses them. More HIV transmissions will be prevented if the strategies are adopted by individuals who are at highest risk of HIV transmission, such as those who don’t use condoms consistently or share injection drug use equipment.

Focusing uptake among those at highest risk may be important for another reason. There is a concern that some people using these new approaches may feel a false sense of security and increase their risk behaviour, such as using fewer condoms or having sex with more partners (a concept known as risk compensation or behavioural disinhibition). Since none of these new strategies are 100% protective, this could potentially offset some of the benefit of NPTs and limit the number of HIV infections they prevent. However, the potential impact of risk compensation will be lower when used by people who are already at higher risk of HIV transmission.

Community-based organizations will play a key role in engaging individuals and communities and facilitating the appropriate uptake of these technologies. This will involve:

• Community mobilization to build readiness for new approaches and address barriers that may affect their acceptability, such as stigma and social, cultural, and political norms.
• Outreach and educational campaigns to improve awareness of these strategies, including information on who they are appropriate for and where they can be accessed, particularly among those at highest risk for HIV transmission.
• Accurate risk assessments for those who are interested in using these approaches and, if appropriate, referral to locations where they can be accessed.
• Community planning to ensure NPTs are provided in a way that respects human rights and supports informed decision making by the people using them.
• Advocacy to ensure the technologies are available and affordable.

Community-based research (CBR) will be essential to gain a better understanding of the acceptability, awareness and availability of these technologies in the community, the barriers to adopting them, and the characteristics of those who are using them.

Packaging new approaches with other strategies and supports

Among those who do use these strategies, what will influence the effectiveness of NPTs at reducing HIV incidence?

How consistently and correctly these strategies are used will be important. Research shows that these new approaches – such as post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and the use of antiretroviral treatment as prevention – are much less protective if not used consistently. Correct use means different things for different strategies. However, as none of these new approaches are 100% protective, correct use generally means that these new approaches are combined with, instead of replace, existing HIV prevention strategies.

Furthermore, the presence of certain biological factors that are known to increase HIV risk, such as sexually transmitted infections (STIs), may reduce the effectiveness of these new approaches. Therefore, correct use of these strategies also means combining them with STI prevention, testing, and treatment services.

In research studies and clinical trials, these NPTs have been credited with dramatic reductions in HIV incidence and this has generated a lot of excitement. For example, the HPTN 052 study found that antiretroviral treatment reduced HIV incidence among heterosexual serodiscordant couples by 96%.

However, we may not see the same large reductions in incidence in populations using these strategies in the “real world,” outside of a clinical trial. In clinical trial settings, participants are provided with ongoing prevention and support services including free condoms, HIV testing, STI testing and treatment, and intensive adherence and risk-reduction counselling. All of these services help to create “ideal” conditions that can maximize the impact of an HIV prevention strategy on HIV incidence. These new approaches may be less effective outside of a clinical trial if they are not provided in combination with these additional support services.

Community-based organizations will play an important role in packaging new prevention approaches with additional strategies and supports. This will include:

• Adherence support to help people integrate these strategies into their daily lives and use them consistently.
• Education on how to use the strategies correctly, including information on their advantages and disadvantages compared to existing approaches and the factors that may reduce their effectiveness.
• HIV prevention and risk-reduction counselling to help people understand their HIV transmission risk while they are using a prevention technology and to help them adopt additional HIV and STI prevention strategies. This will also need to include linkages and referrals to other services needed by people at risk of HIV infection and transmission.

Again, community-based research can play an important role in providing  insight into how people are using these strategies in the “real world” and the barriers to using these strategies consistently and correctly.

The role of CBOs and CBR in the changing HIV prevention landscape

The HIV prevention landscape is changing and CBOs have an important role to play in ensuring NPTs are used by the “right” people, at the “right” time, in the “right” context, and in the “right” way.

However, there is an increasing concern that the introduction of these technologies, particularly those based on antiretrovirals, will “medicalize” HIV prevention and reduce the role of CBOs in the response to the HIV epidemic. This is because most “biomedical” NPTs can only be obtained from a healthcare provider and need to be combined with ongoing medical services, such as laboratory and clinical monitoring, HIV testing (in the case of PEP and PrEP), and STI testing and treatment. Therefore, the worry is that these new “biomedical” approaches will shift the setting of HIV prevention from the community to the clinic.

In reality, it’s clear that these new prevention approaches are not exclusively “biomedical” and need to be packaged with several non-clinical services in order to prevent risk compensation, promote their appropriate uptake and sustained use, and ensure they are effective outside of a clinical trial setting. These are services that many healthcare providers do not have the time, knowledge, or expertise to provide effectively and, therefore, represent a gap that CBOs need to fill.

Moving forward

Dr. Kevin Fenton of the Centers for Disease Control and Prevention (CDC) in the United States gave a presentation at the 2012 International AIDS Conference in Washington where he discussed the implications of this new research for CBOs. He called upon CBOs to adapt to the changing HIV prevention landscape by:

• Learning new skills (improving their science base and understanding of clinical trial results).
• Developing new clinical alliances (improving their ties with organizations and institutions where these prevention technologies can be obtained).
• Providing new clinical and prevention services (offering HIV and STI testing, adherence support, and risk-reduction support).
• Promoting the uptake and correct use of these technologies (developing accurate, tailored, context-specific information; ensuring messages reach their target populations through a variety of different mechanisms, such as peer–peer outreach).

James Wilton is the Coordinator of CATIE’s Biomedical Science of HIV Prevention Project, he can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. .

It was my first year attending the Gay Men’s Health Summit this November (the 8th annual organized by the Community-Based Research Centre for Gay Men’s Health) and the organizers dished out an impressive program.

While efforts to de-stigmatize HIV testing have been encouraging everyone who has ever had sex to get tested (an important effort!) HIV remains a heavy burden for the gay community, an issue conference organizers insist needs to be brought into the light. While in Vancouver it is estimated that 1 in 1,000 people have HIV in the general population, when you look at just the gay male population, the number is 1 in 5. Needless to say, it remains as important as ever to gather to discuss how HIV is a key health concern for the gay men’s community. To keep the discussion going, I connected with Jaime Forrest (below left), the coordinator of the Momentum sexual health study, to hear his reflections on what was presented at the Summit.

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Andrea Langlois (AL): What does this year’s summit theme “Reconsidering the social determinants of health” mean to you?

Jamie Forrest (JF): Reconsidering the social determinants of health is about highlighting and recognizing the important social drivers of gay men’s health inequities. We are not all equal in our risk for any given health condition. There are social, cultural and economic factors that make us all more or less susceptible to illness. Research and practice that ignores this, by not considering the unequal distribution of access to resources and knowledge that protects our health, will be flawed in its approach. This year’s conference importantly reminded us that broadening the discourse to include elements of the social determinants of health framework is crucial to working towards a better and more holistic understanding of gay men’s health.

AL: A new (to me at least!) acronym that got more action than others at the Gay Men’s Health Summit was “UAI.” What does this acronym mean and what does it say about the focus of some HIV prevention research?

JF: Yes, the acronym “UAI” definitely was floated many times at the Summit! The acronym UAI stands for Unprotected Anal Intercourse. The term UAI historically comes from the field of epidemiology, the study of population health. In epidemiology, researchers use UAI as an outcome measure when trying to better understand what factors are associated with transmitting or acquiring HIV. However, this is an imperfect measure of risk of transmission. There are many forms of unprotected anal intercourse that vary in risk. Controlling for relationship status and sex with regular versus casual versus anonymous partners as well as partner serostatus is therefore important for researchers to account for in describing risk associated with UAI.

AL: Methods for measuring sexual altruism and HAART optimism were presented by Allan Lal and Ashleigh Rich, and Sarah Chown provided an overview of what gay men’s health literature says about resilience – what do these approaches offer to researching the social drivers of HIV within gay communities? Or not?

JF: Let me first remind folks that HAART optimism is the belief in/reliance on new HIV treatments, and how a lowered perception of risk may be associated with increased risk behaviour. I think that HAART optimism and resilience can be linked in a number of complex ways. Sarah Chown told us that resilience can be a strength in some contexts but can heighten vulnerability in others. In terms of exposing people to vulnerability, hiding behind optimism of HIV treatment and prevention innovations may be an effort to shield ourselves from actual sexual risks. For example, a belief in HIV treatment as a prevention tool may lead to reliance on “low viral loads” or as protection from transmitting HIV. More importantly though, we learned from these presenters that the ways in which we express HAART optimism and resiliency are both complex and unique and we must consider this when understanding sexual health in our communities. There was certainly agreement at the Summit that HAART optimism and the concept of “resilience” can serve to depoliticize gay men’s needs and that building resilience at the community level is an essential component to prevention.

AL: This year’s Summit included workshops on rebuilding the grassroots gay men’s health movement (Robert Birch) and several presentations mentioned the importance of community in building the health of a community, does this represent a shift in the direction of health programming for gay men?

JF: Community, in a broad definition, has always played a crucial role in the gay men’s health movement, but there are still ways in which our strength as a collective will accomplish more than our individual parts. This is especially true in a changing social landscape where gay men are more geographically decentralized than ever before. To keep our community movement building, we need to adapt to the new ways that gay men are seeking out others, and to pay attention to what gay men are looking for when we do this. Better community programming will need to include participation online, including social media and networking sites and mobile apps. Community building will also require us to take a more inclusive approach to gay men’s health that includes the social, sexual, mental and physical health domains important to gay guys today.

AL: In his plenary presentation, Dr. David Brennan spoke about health outcomes associated with viewing pornography, and Jody Jolimore from the Health Initiative for Men, Robin Parry from Qmunity and Del Stamp from Priape Vancouver shared thoughts on barebacking in porn. What can we conclude about porn and gay men’s health?

JF: Porn is a part of nearly every gay man’s life. Dr. Brennan shared research findings that show some positive outcomes associated with viewing pornography, such as a decrease in sexual risk that may be associated with viewing certain porn at particular ages of development, but that there may be some negative body image associated outcomes as well. Robin, Jody and Del’s panel engaged the audience in thinking about bareback porn, both professional and amateur, and the influences that watching porn may have on a person’s engagement in sexual risk. My conclusion is this — as something so much a part of every gay man’s world, we must continue having conversations about both the positive and negative outcomes associated with the frequency and content of the porn we watch.

AL: Okay, now just for fun, what was the social highlight of the Summit this year? On the fashion front I definitely saw a lot of checked shirts and skinny ties!

JF: Skinny ties were definitely in this year, Andrea. Next year, I’m hoping to see more suspenders and bow ties at the best-dressed academic conference in BC. The social highlight of the conference has always been the wine night after the opening. It’s a great opportunity to connect with great folks doing great work in gay men’s health across Canada. Another great conference under our designer belts!

Questions? Feedback? Get in touch!

Andrea Langlois

Community-Based Research Manager  This email address is being protected from spambots. You need JavaScript enabled to view it.

Follow Andrea on Twitter at @PAN_CBR

This article first appeared on the website of the Pacific AIDS Network here. 

This article first appeared on the Pacific AIDS Networks’s  own website here.  

Is there space for creativity in research? Yes!

Within the HIV/AIDS movement, we’ve been fortunate to have art play such an important role over the years, and for all the creative people in our midst. And, in some cases, this creativity has seeped into the research realm and led to the development of novel ways to collect and to disseminate knowledge, be it through photography, visual art, theatre or dance. The evolution of the online realm has opened up new possibilities for interactive ways of sharing information. Here are a few examples of creative research methods:

Photovoice is a participatory action research method that uses photography and group dialogue as a means for marginalized individuals to deepen their understanding of a community issue or concern. The visual images and accompanying stories are the tools used to reach policy- and decision-makers. This method has been used in different places around the world to document the experiences of people living with HIV/AIDS. BC has had its very own photovoice project – “The Way I See It” – that documented how housing impacts the health of people living with HIV/AIDS. Listen to an interview with researchers Surita Parashar and Valerie Nicholson talking about this project on Pivot Points Radio program.

Tea Time with Jessica Whitbread uses tea parties with women living with HIV as a way to bring communities together and talk about how community-based social support networks can address the health (psychological, spiritual and physical) needs of women living with HIV. This alternative to the traditional focus group was a way to map out women’s networks of support. Jessica, who was also a Universities Without Walls fellow and now works as CTAC’s capacity-building coordinator, will be presenting on her work at the OHTN Conference next month in Toronto. (The conference plenary sessions will be webcast, watch their website for more details.)

Here at Home webdoc from the NFB and the Mental Health Commission of Canada. Sometimes it’s important to look outside the world of HIV/AIDS research for new ideas. A cutting-edge, interactive, webdoc, Here at Home is a web documentary about At Home a radical Canadian experiment that aims to prove there is a way to end chronic homelessness. Small, local crews have been shooting documentaries in 5 Canadian cities, over a year. With 50 films, data from the study and the blog is a dynamic experiment in exploring the real cost of homelessness. Could this webdoc be a glimpse into the future of community-based research?

Andrea Langlois (above) is the Community-Based Research Manager, Pacific AIDS Network. She is on twitter at @PAN_CBR.

Some take on leadership by choice, others by accident.

Says Wayne Bristow, PositiveLIte.com writer from Guelph, Ontario “the first time I thought about learning more about HIV and myself was in 2006. I took the Positive Leadership Level One course. I was about to lose my job of 27 years and I thought the course could help motivate me to move forward with my future. It was during the course that I learned it was designed to find the leader in me. What I gained from it was the knowledge and confidence I needed to make a plan and work hard to make it a reality. A year later I was back in the workforce doing a job I absolutely loved, a first for me.”

He later applied for Level Two, “At the time I was on the Board of my AIDS Service Organization and had some training in Board Governance. On completion of the course I ran for a position on the Executive and I'm now the Treasurer. When an opening comes up for Level Three, I will be registering.”

Wayne is talking about the Positive Leadership Development Institute, a free training program for people living with HIV that was started by the Ontario AIDS Network (OAN), later partnering with the Pacific AIDS Network from B.C.  The institute’s mission is to offer HIVers “an opportunity to identify and develop leadership skills”, coming from a core belief that "strong leaders create stronger communities”. Since its origins in a 2005 strategic planning process which identified the need for a leadership development program for people living with HIV, some 300 HIVers have participated in the program.

These 300 include me, by the way. I only completed level one – as an old-timer I felt I already had the skills that the rest of the program offers – but I came out of it impressed by what was going on, and an enthusiastic backer of the program. I do remember how intensive the process was though; these are serious courses. Mine was residential, and it was hard-work, albeit lightened by a great sense of camaraderie and team building amongst those present.

Those were early days. Since then, as I thought it would, it has gone on to become a huge success. Participants love it; there is always a waiting list, and its two independent evaluations have both recorded significant benefits and the majority of its goals realized

What has got people fired up? My take is its relevance – a program that really does meet the needs of HIVers looking to step up their involvement, either inside the AIDS Service Organization (ASO) framework – probably the most popular route – or in outside endeavours.

The program consists of three modules. Level One asks the question “Who am I as a Leader?” in which participants are introduced to the practices of exemplary leaders. Here are five that they come to know well:

• Model the way
• Inspire a shared vision
• Challenge the Process
• Enable others to act.
• Encourage the heart

Module Two “Bored? Get on Board” introduces participants to, as the name suggests, board work. Module Three covers communications skills – conducting effective meetings, facilitation, public speaking and presentations.

I asked Rick Kennedy, Executive Director of the OAN, about their collaboration with their partner organization on the west coast. ”We’ve now formed a partnership with the Pacific AIDS Network” he said. “They are full partners with us – shared decision making, shared ownership – and what’s really interesting for us is that the facilitators, the trainers we are using now, are from both provinces, so we send them back and forth. The next few months we are going to Moncton and we’ve had people from Alberta come through as well. There is certainly an appetite for this nationally.”

Here is something else important: everyone teaching the workshops is HIV-positive. One of them,TJ, is coordinator for the entire program, working out of the OAN’s downtown Toronto office. TJ is an example of someone who came though the program. She took the program in June 2008 and. she says ”I knew they were on to something. There were many "aha" moments. I saw much of myself through examples. I know there were a lot of times those examples were talking about me. So I definitely came out of there with a different mind-set, different thinking.”  Ed Argo,one of the long-time trainers, asked her if she had ever thought of facilitating. She started last November, going out to BC for training there.

There are testaments aplenty. The Positive Leadership Development Institute published a book about the program in 2010 called Positive Change Makers that’s full of them. It’s dedicated to Pius White, a well-known figure in the movement. Pius graduated and was an enthusiastic backer of the program. Interviewed before his death in 2008 he’d said “I’m looked at as a peer and a leader by staff and clients of AIDS Thunder Bay. It feels good. It actually does. It shows that what I am doing counts.” Pius had parlayed his leadership skills to re-enter the workforce in fact, in an entirely new field for him, acting as a Peer Research Assistant for the Ontario HIV Treatment Network.

There have been two independent studies of the impact of the program, the last an impact evaluation conducted in January 2011. It interviewed twenty-five participants and heard from a further sixty-five responding to an online survey. Here are some of the results

• 80% of graduates reported having a greater sense of self-worth as a result of attending the institute (this was observed by 79% of ASOs responding)
• 85% reported improved confidence
• 60% of graduate reported they were taking in new leadership roles and seeking new skills
• 75% reported they felt more meaningfully involved in the HIV/AIDS movement

But many of the results are also good but less tangible. One leadership graduate, for instance, said “I just felt this overwhelming feeling of, I’m not alone. I really felt like that. I felt there were others out there just like me and I felt so connected to a new network of people.” Another said “being able to speak up and stand for what I believe in and fight for it - that has made me a lot happier. A lot easier to live with”. Another said ”I’m able to resolve conflicts better with my partner, with my co-workers and use active listening skills and just really effectively communicate , whether it’s on a social basis or on a professional basis.”

Memorable moments?  Rick Kennedy remembers a number of years ago, marching in a contingent in the Toronto Pride parade, with a “strong leaders create strong communities: banner. “It was a bunch of us saying we are positive leaders” that counted. “That and the fact that the training has now taken off in BC as strongly as it has is an indicator of success. People indicated that they were more comfortable with (HIV) disclosure, if they choose to do that. And as a vehicle for employment we’ve also seen some success”.

Graduates have acknowledged that some challenges remain. More support is needed to help HIVers become more meaningfully involved in the movement. For example, some people reported that few opportunities existed at ASOs for them to be more involved. Some graduates also suggested that they need more support for learning how to apply their leadership skills in the community.

Rick Kennedy stresses that the skills learned are readily transferable to environments outside the ASO network. “This is not an ASO aquarium, an ASO factory” he says.. “It leads to opportunities outside the ASO movement .You could equally go on the board of the Humane Society, for instance.”

He also cites the work being done to facilitate engagement of HIVers through the Living and Serving Project. This is a significant body of work which kicked off with the late Charles Roy’s 1995 evaluation of how ASOs were doing, and a follow up review conducted in 2007 essentially reporting not enough had changed. Living and Serving 3, a 2011 plan of action published just this last September includes the brand-new Ontario Accord, a statement of solidarity with GIPA (the Greater Involvement of People Living with HIV/AIDS)

Another challenge Kennedy acknowledges is reaching HIVers who are not tapped in to the network of ASO’s that the OAN represents Says Rick “our outreach is mostly through ASOs, although we have run ads in a number of publications throughout the province, with some success. We would like to do that more. However we still experience waiting lists, so it upsets people sometimes, but we do envision doing more.”

Then of course there are funding constraints. Enough said.

There is no doubt, though, that the Leadership Development Training Institute has upped the ante for HIVers in the jurisdictions in which it is available. Making a difference has never been easy, and it can still be a struggle, but there are ways now that HIVers can upgrade their skills at no cost and have a better chance of success, In fact that’s clearly happening already, in three hundred different flavours.

To find out how you can participate, go to the Ontario AIDS Network  website or the Pacific AIDS Network website for more information.

 Please pass the word on to your clients, networks, friends or anyone who you think might be interested.

***The B Side: Exploring Bisexuality***

A 10 week group for people who are exploring their attraction to more than one gender or struggling with what their bisexuality means to them and their lives.

When: Wednesdays, 6:30-9:00pm, October 13 - December 15, 2010
Where: Sherbourne Health Centre, 333 Sherbourne Street, Toronto

Topics: **exploring attraction ** bisexual myths & stereotypes ** relationships ** labels & identity issues ** coming out to friends, family & others ** bisexuality & our other identities ** finding support ** sex & safer sex ** biphobia ** health & well-being ** bisexual communities & resources **

The group will provide:
* Opportunities for self-reflection, personal sharing, connecting with others and learning new skills and information.
* Respect for the diverse possibilities of identity and a wide range of life experiences.
* A safe and supportive environment for exploring each person's unique relationship to bisexuality, with a focus on group members' needs and experiences.

Facilitated by:
* Cheryl Dobinson, a bisexual activist involved in bi-related education, health research and community development, and
* David Yeh, an LGBTQ community educator and expressive arts therapist.

Registration: Space is limited and pre-registration is required. To register, please contact Fatema Mullan at (416) 324-4100 x5256 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Impact, Resistance & Resilience:
Reshaping gay men’s thinking about mental wellness
Plan to attend the 6th Gay Men’s Health Summit

Thursday November 25 & Friday November 26, 2010
Harbour Centre, Simon Fraser University
515 West Hastings St., Vancouver

Call for Submissions: Presentations, Workshops, Video - for more information please go to the Pacific AIDS Network website for details.