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May12

Getting to undetectable

Sunday, 12 May 2013 Written by // Guest Authors - Revolving Door Categories // Health, Treatment, Living with HIV, Opinion Pieces, Revolving Door, Guest Authors

From TheBody.com comes the testimony of ten people living with HIV who share their stories about their own success in achieving viral load suppression.

Getting to undetectable

This article was originally published in TheBody.com here

An undetectable viral load: the point at which HIV, though still present, cannot be found in a person's blood with the most sensitive tests available. It's a powerful concept with profound implications to the life of a person living with HIV (and his or her partner). However, according to CDC's treatment cascade, for a host of complex reasons, 75 percent of people living with HIV in the U.S. have not reached the point of viral suppression. (Among some specific groups in the U.S., that number is even larger.) For many of those that have, reaching that point was a major milestone in their lives. We asked people living with HIV to contribute thoughts and stories about getting their own viral loads to undetectable.

Minister Rob Newells, Oakland, Calif.; Diagnosed in 2005

Reaching undetectable never seemed like a significant milestone to me. I waited for my CD4-cell count to drop below 400 (about 18 months after my initial diagnosis) before I made the decision to begin antiretroviral therapy. My viral load, which was never extremely high, has been undetectable on every test since I started HIV meds in 2006.

For a long time, I thought viral suppression was a normal result of taking the medications. I expected nothing less. The HIV treatment cascade was a visual wake-up call that I am in the 25 percent minority. Clearly, we have much more work to do to increase retention in care and adherence to the medications that both improve the health of people living with HIV/AIDS and help to prevent transmission of the virus.

Meta Smith, Baton Rouge, La.; Diagnosed in 2001

At the time I was told I was HIV positive, I was placed on meds and did not have any idea how being undetectable would help me. When I had been on the meds for at least three months I returned to the doctor after lab work and was told I was undetectable. I knew I was feeling better after the meds; but after being told what undetectable was and how it would affect my life, I need to say I was on TOP OF THE WORLD and have stayed that way since then. It meant the world to me and changed my life, for the better. I got busy living.

Nelson Vergel, Houston, Texas; Diagnosed in 1986

I'm on the last combination I can try. I take a lot of pills. ... There's a part of me that's been very frustrated, extremely frustrated, with the fact that I've had it really hard when it comes to HIV. I've never had an undetectable viral load until three years ago ... Twenty-six years with virus in my blood, no matter what I did, no matter how many conferences I went to, no matter how many papers I read ... I felt like a loser, like a failure -- really, they call us "failure patients."

Watch Nelson's full "Day in the Life" video.

Bernadette Berzoza, Denver, Colo.; Diagnosed in 1989 

Over the past few years I have really fought and struggled to get my viral load down. It's been 23 years that I have been positive, and in the beginning it was just keeping your T cells up. Then the viral load was added. I was so freaked out when they told me my viral load was in the millions and we needed to change my meds to get it to undetectable. I did what was recommended but it wasn't working for me as they thought it would.

Read Bernadette's full story of getting her viral load down after many years.

Joe Ohmer, Bronx, N.Y.; Diagnosed in 2002

Eight months after I was diagnosed with HIV, my gastroenterologist that was taking care of my liver issues did some blood work, and my HIV viral load was undetectable without any medication. I didn't realize that that was anything significant or insignificant at the time, until maybe eight or 10 years later when my GI doctor mentioned it to me. I went on a regimen of Epivir (lamivudine -- also used to treat HIV, in different combinations with a higher dose) and Hepsera (adefovir) for my hepatitis B, which since I've been on it has been undetectable as well. Except for one blip, my HIV viral load has been undetectable.

Recently, my GI doctor, who's the same one who saw me initially, brought up that I was undetectable before I went on any regimen.

Read the rest of Joe's unusual story of being undetectable without medication.

Melissa Baker, Mechanicsville, Va.; Diagnosed in 2007

I was diagnosed August 2007. By January 2009, I made the count-dependent decision to start meds. It took me longer than three months to become undetectable. If it had taken me any longer my provider was going to change my regimen, fearing a possible resistance. The day I heard "undetectable" finally came before he had to, and my virus has remained undetectable since. :) I was ELATED!

Reggie Smith, Atlanta, Ga.; Diagnosed in 1984

After being sick in 2005, I have been taking the antiretroviral combination that has kept my virus at undetectable levels, and allowed me to enjoy really good health. With God's grace, and enough desire to live well, I have been able to adhere pretty well to this regimen. My oldest granddaughter was 2 years old at the time. Now she is 9, and I have two other granddaughters, a grandson, and a set of boy/girl twins! I play softball and golf, take flying lessons, I am of service to my community, and I am blessed to share my experience and hope with you.

Read Reggie's full story of coping with being tired of taking HIV meds.

Lillibeth G., New York City; Diagnosed in 1992

When I was told my viral load was undetectable I felt 100 pounds lighter. My greatest challenge was getting to an undetectable status. I had multidrug resistance so getting to undetectable was a milestone.

I was diagnosed in 1992 and it was difficult for me to adhere to my treatment since I was in denial and angry at myself (I should've been more selective of my partner). During one of my doctor visits he found a clinical trial I was able to join for both Isentress (raltegravir) and Intelence (etravirine). I was determined to bring my viral load to undetectable since I have so much to live for; I needed to live for my son, my mom (she was alive at the moment), myself most of all; I have things to do, people to educate. After a 17-year fight, I got the GOOD news: "I'm undetectable!" It makes me feel so alive.

I have a whole new look at life: I'm going to live; I have a fighting chance. Now I can talk to others about the importance of getting to that point -- it gives you hope. I'm always smiling and laughing; life is so different for me now -- I have HOPE.

Pastor Andrena Ingram, Philadelphia, Pa.; Diagnosed in 1989

THAT was another day, I remember with clarity. Waking up and dreading my doctor's appointment, because I knew I was going to get my blood-work results, and because I was about sick and tired of injecting myself. I was tired of Fuzeon (infuvirtide, T-20), I was tired of medication, I was just tired of it all.

I sat down in her office, and she pulled out my chart and looked at the labs, and smiled. I was like ... OK, what is my CD4? And it had been explained to me months before that they were beginning to look at this thing called "the viral load" ... and how that was more important than the CD4 count. She told me what my CD4 count was, which had peaked a bit ... but she was still smiling. And then she said: Guess what Andrena? Your viral load is under 50 copies! She was cheesin'! Grinning from ear to ear! I still didn't understand what that meant, until she stopped grinning long enough to tell me. That it meant that the virus in my body was undetectable …

Even though she explained it to me, I still didn't quite get it, until a few days later ... my mind had to process it. It meant that the Fuzeon was working. It meant that I was NOT gonna die (anytime soon). ....

I was ecstatic!

Read Pastor Ingram's full story of getting to undetectable.

Shannon Southall, Denver, Colo.; Diagnosed in 1992

February 1996, four years after being given my HIV diagnosis, I found myself lying in a hospital bed, and hearing that I now have AIDS. My CD4 count was 131. I needed to add more medication. When I was initially diagnosed in 1992, I had 896 CD4 and my first doctor put me on AZT monotherapy. After a friend found an infectious disease specialist I was switched to Zerit and Epivir.

Now lying in the hospital my doctor came in and said there was this new drug available called Crixivan and he strongly recommended that I add this to my current regime. My viral load was 159,000 and these new meds show that they can reduce the virus in my system, therefore prolonging my life. So of course I said yes. By August, my viral load was undetectable, less than 200, and my CD4 count was finally up over 200. ...

A few years ago I started to wonder about switching or stopping meds for a while. Then I met the man who would become my husband. He is HIV negative and I know that keeping my viral load down is crucial to maintaining a healthy sex life and reducing the risk of transmission to him.

Read Shannon's full story of 21 years on HIV meds.

May10

Cure research takes off

Friday, 10 May 2013 Written by // CATIE - HIV and Hep C Info Resource Categories // Current Affairs, CATIE, Research, Health, CATIE - HIV and Hep C Info Resource

An end in sight? CATIE on where cure research stands today.

Cure research takes off

This recent article by Sean Hosein first appeared on the CATIE website here.

Une version française est disponible ici.

It has been 32 years since AIDS was first recognized and 30 years since the cause—a virus we now call HIV—was first isolated. In that time enormous advances have been made: There are tests that can detect HIV and treatment (commonly called ART or HAART) has transformed HIV into a chronic illness. Furthermore, the power of ART is so profound that a young HIV-positive adult who begins treatment shortly after diagnosis today, who takes his/her medicines every day exactly as directed and who has no or limited co-existing health conditions is expected to live for several decades.

Although ART has helped to transform HIV into a chronic illness—particularly in high-income countries such as Canada, Australia and the U.S. and regions such as Western Europe—there are still issues. This treatment must be taken at least once a day, every day, for the rest of a person’s life. Such high levels of adherence may be difficult to sustain for many years. Furthermore, medicines to treat HIV, particularly the newest and most tolerable drugs, are relatively expensive. As the vast majority of HIV-positive people live in low- and middle-income countries, some researchers have wondered whether it is possible to provide care and treatment for all HIV-positive people in those places. At present, not every HIV-positive person in those countries can access care and treatment. Thus, a cure would be very desirable for many reasons.

Know your co-receptors

HIV needs at least two receptors to enter and infect a cell. The first receptor is CD4+, which is found on many immune system cells. HIV usually then needs one of two other co-receptors, either CCR5 or CXCR4.

Some strains of HIV prefer to use CCR5, others CXCR4, and still others use both co-receptors.

Back to the cure

Since the late 1980s, researchers have attempted to cure HIV infection. However, in the first two decades of the AIDS epidemic, such efforts were largely dangerous and unsuccessful.

Then, in 2008, a major development occurred. Doctors in Berlin appeared to have cured an HIV-positive man, who was suffering from leukemia, of both cancer and HIV. The “Berlin patient” had been taking ART for several years prior to his cancer treatment and received chemotherapy, radiation and transplants of stem cells. What was unique in this case was that the donor of the stem cells had a rare mutation (called a delta-32 mutation by researchers) that resulted in his cells having no CCR5 co-receptors. This made the cells somewhat resistant to HIV infection. After intensive chemotherapy and radiation, ART was withheld and the stem cells were transplanted and took hold in his bone marrow, helping to create his new immune system. However, the man’s new immune system attacked parts of his body, a complication called GvHD (graft vs. host disease), and doctors had to prescribe a mix of powerful immune-suppressing drugs to manage this complication. His cancer returned and he had to undergo intensive chemotherapy again as well as another stem cell transplant.

The Berlin patient survived all of these interventions and recurrent cancer. He has not needed to resume ART and sophisticated tests have revealed that either he has no HIV or he has extremely low levels of this virus deep within his body from time to time.

Why the cure?

Researchers are divided about why the Berlin patient was apparently cured. Research teams have proposed different possible reasons for his apparent cure, as follows:

  • the intensive bouts of chemotherapy and radiation
  • the bone marrow transplant from a donor with a delta-32 mutation
  • the intensive stimulation of his immune system arising from GvHD
  • the use of transplant medicines, which dampen inflammation and reduce HIV’s ability to infect cells

It is likely that more than one of these factors played a role in his recovery from HIV.

Excitement

The apparent cure of the Berlin patient has excited the imaginations of many researchers and doctors around the world. Clinical trials are underway, mostly in the U.S and Western Europe, assessing different methods for attempting to cure HIV infection. Eventually some of these trials will occur in Canada.

Caution needed

Some of the attempts at a cure, such as genetic therapy, have been relatively safe. However, in attempting to replicate the success of the Berlin patient, other HIV-positive people have died. This is not surprising, as intense chemotherapy and radiation with or without transplant drugs are very debilitating.

Researchers at Harvard University have attempted a variation of the protocol used with the Berlin patient. Although two HIV-positive patients with cancer have volunteered for this experiment and have survived for several years, they remain weak, both physically and immunologically. A major difference between these patients and the Berlin patient is that they have not stopped taking ART. Due to their poor state of health, their doctors have been reluctant to withhold ART, so it is not yet clear if they have been cured.

These experiments with stem cell transplants and chemotherapy and subsequent transplant drugs are dangerous and will not be done on a large scale because among HIV-negative cancer patients such procedures carry a death rate of about 15%. No one is certain about the death rate for HIV-positive people, but it is likely to be at least as high.

Much caution with intense monitoring and hospitalizations will be needed for attempts at a cure. This will particularly be the case as researchers use multiple methods on the same person to attempt a cure.

Still, researchers should be praised for showing imagination and embracing cure research. Such encouragement is necessary because many of the complex ways that HIV interacts with the immune system are not fully understood. Therefore, much research on monkeys infected with SIV (simian immunodeficiency virus), mice transplanted with human immune systems, and HIV-positive people will be needed to gain such an understanding.

The journey toward a cure will not be easy and many challenges lie ahead. Some of the challenges are known, others may only become known as experiments proceed. As with any great scientific endeavour, there will be setbacks. This means that research funding agencies and the public need to be patient. The initial wave of cure research experiments over the next five years should be viewed as exploratory and their results preliminary. This research will seek to answer important scientific questions that can then be used to build a foundation as researchers work toward a cure.

To assist researchers in developing new ideas for cure research, Canada’s premier scientific agency, the Canadian Institutes for Health Research (CIHR), will be seeking proposals from research teams across the country. These proposals will be reviewed by scientists and the most promising proposal(s) funded for five years.

Resources

Hints of a cure—the future of stem cell transplants and HIV – CATIE News

Gene therapy for HIV—outcomes from a recent experiment – CATIE News

Attempts at a cure – TreatmentUpdate

—Sean R. Hosein

REFERENCES:

 1. Kent SJ, Reece JC, Petravic J, et al. The search for an HIV cure: tackling latent infection. Lancet Infectious Diseases. 2013; in press.

 2. Katlama C, Deeks SG, Autran B, et al. Barriers to a cure for HIV: new ways to target and eradicate HIV-1 reservoirs. Lancet. 2013; in press.

 3. Samson M, Libert F, Doranz BJ, et al. Resistance to HIV-1 infection in Caucasian individuals bearing mutant alleles of the CCR-5 chemokine receptor gene. Nature. 1996 Aug 22;382(6593):722-5.

 4. Moore JP, Kitchen SG, Pugach P, et al. The CCR5 and CXCR4 co-receptors—central to understanding the transmission and pathogenesis of human immunodeficiency virus type 1 infection. AIDS Research and Human Retroviruses. 2004 Jan;20(1):111-26.

 5. Huzicka I. Could bone marrow transplantation cure AIDS? Medical Hypotheses. 1999 Mar;52(3):247-57.

 6. Hütter G, Nowak D, Mossner M, et al. Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. New England Journal of Medicine. 2009 Feb 12;360(7):692-8.

 7. Allers K, Hütter G, Hofmann J, et al. Evidence for the cure of HIV infection by CCR5 Δ32/Δ32 stem cell transplantation. Blood. 2011 Mar 10;117(10):2791-9.

 8. Gorry PR, Zhang C, Wu S, et al. Persistence of dual-tropic HIV-1 in an individual homozygous for the CCR5 Delta 32 allele. Lancet. 2002 May 25;359(9320):1832-4.

 9. Soussain C, Ricard D, Fike JR, et al. CNS complications of radiotherapy and chemotherapy. Lancet. 2009 Nov 7;374(9701):1639-51.

 10. Krishnan A and Forman SJ. Hematopoietic stem cell transplantation for AIDS-related malignancies. Current Opinion in Oncology. 2010 Sep;22(5):456-60.

 11. Deeks SG and McCune JM. Can HIV be cured with stem cell therapy? Nature Biotechnology. 2010 Aug;28(8):807-10.

 12. DiGiusto DL, Krishnan A, Li L, et al. RNA-based gene therapy for HIV with lentiviral vector-modified CD34(+) cells in patients undergoing transplantation for AIDS-related lymphoma. Science Translational Medicine. 2010 Jun 16;2(36):36ra43.

 13. Hütter G and Thiel E. Allogeneic transplantation of CCR5-deficient progenitor cells in a patient with HIV infection: an update after 3 years and the search for patient no. 2. AIDS; 2011 Jan 14;25(2):273-4.

 14. Sauce D, Larsen M, Fastenackels S, et al. HIV disease progression despite suppression of viral replication is associated with exhaustion of lymphopoiesis. Blood. 2011 May 12;117(19):5142-51.

 15. Hunt PW, Landay AL, Sinclair E, et al. A low T regulatory cell response may contribute to both viral control and generalized immune activation in HIV controllers. PLoS One. 2011 Jan 31;6(1):e15924.

 16. Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annual Review of Medicine. 2011 Feb 18;62:141-55.

 17. Hatano H, Delwart EL, Norris PJ, et al. Evidence of persistent low-level viremia in long-term HAART-suppressed, HIV-infected individuals. AIDS. 2010 Oct 23;24(16):2535-9.

 18. Sigal A, Kim JT, Balazs AB, et al. Cell-to-cell spread of HIV permits ongoing replication despite antiretroviral therapy. Nature. 2011 Aug 17;477(7362):95-8.

 19. Mitsuyasu R, Lalezari J, Deeks S, et al. Adoptive transfer of zinc finger nuclease CCR5 modified autologous CD4 T-cells (SB-728-T) to aviremic HIV-infected subjects with suboptimal CD4 counts (200 to 500 cells/mm3). In: Program and abstracts of the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy, 17-20 September 2011, Chicago, Ill. Abstract HI-375.

 20. Henrich TJ, Sciaranghella G, Li JZ, et al. Long-term reduction in peripheral blood HIV-1 reservoirs following reduced-intensity conditioning allogeneic stem cell transplantation in two HIV-positive individuals. In: Program and abstracts of the XIX International AIDS Conference, 22-27 July 2012, Washington, DC. Abstract THAA0101.

 21. Deeks S, Drosten C, Picker L, et al. Roadblocks to translational challenges on viral pathogenesis. Nature Medicine. 2013 Jan;19(1):30-4.

 22. Towards an HIV cure: a global scientific strategy. International AIDS Society Scientific Working Group on HIV Cure. Nature Reviews Immunology. 2012 Jul 20;12(8):607-14

 23. Deeks SG, Barré-Sinoussi F. Public health: Towards a cure for HIV. Nature. 2012 Jul 18;487(7407):293-4.

 24. Pasternak AO, de Bruin M, Jurriaans S, et al. Modest nonadherence to antiretroviral therapy promotes residual HIV-1 replication in the absence of virological rebound in plasma. Journal of Infectious Diseases. 2012 Nov;206(9):1443-52.

 25. Bangsberg DR, Haberer JE. Lifetime HIV antiretroviral therapy adherence intervention: Timing is Everything: comment on "Managed problem solving for antiretroviral therapy adherence". JAMA Internal Medicine. 2013 Feb 25;173(4):306-7.

May09

The other side of love (Part two)

Thursday, 09 May 2013 Written by // Dave R Categories // Gay Men, Youth, Health, Opinion Pieces, Population Specific , Dave R

Dave R writes… in the second part of a report concerning same sex abuse, about how it works, why it happens and what to look out for. What should we as a community be doing to help and how can we look out for our friends?

The other side of love (Part two)

 

''People feel, 'Why should we air our dirty laundry? People feel so negatively about us already, the last thing we should do is contribute to negative stereotypes of us.' ''

Dave Shannon, (coordinator of the violence recovery program at Fenway Community Health, a gay and lesbian clinic in Boston)

You’re afraid to leave and afraid to stay. You’re afraid of other people’s reactions if they find out. Your gay friends will look at you differently and assume that you’re a walkover, or weak with possible masochistic traits and unable to stand on your own two feet. They’ll snort and claim they would never allow themselves to be in that position. Your family and the world at large will jump to conclusions. You can hear them saying it; they’d really never expected anything else from a same sex relationship; they knew nothing good would come of it. In short, the world will mock and criticise and somehow assume you must have deserved it. ‘After all, you’re not the easiest person to live with’.

All these things terrify you and you’re trapped, unable to move one way or the other and the keys to all your locks belong to the person you love and purports to love you back…your abuser. 

Can you imagine how lonely that must feel for a man or woman, totally dependent upon someone who batters them, whether verbally, physically, or mentally? What must they do and why don’t they do it? What’s wrong with them? Get out already! If only it were that simple.

This sort of situation has various names: domestic abuse, same-sex abuse, intimate partner abuse; the point is; it’s all abuse. Furthermore, according to almost universal organisations, both LGBT and otherwise, between 25% and 33% of LGBT people are either living in, or have experience of an abusive relationship. Now statistics can say anything and frequently do. If it’s true that there’s evidence of abuse in a third of LGBT relationships, what about all those who never report their problem and solve it themselves? That would surely push the figures even higher, or maybe the statistics are taking that into account and thus become little more than guesswork. We’re used to hot air stats in the HIV community but the point is that even if just one in a hundred LGBT people is being abused, isn’t that one too many! 

But as a community we don’t want to talk about it; why is that? Wouldn’t you think that the LGBT community has learned over the decades that strength and support lie in unity and looking after our own? Apparently this subject is as taboo in the LGBT community as husband beating for instance, is in heterosexual society. 

“LGBT communities have been reluctant to discuss same-sex domestic violence for fear of validating negative stereotypes and detracting from the push for legal recognition of such relationships. The relative silence on this issue continues despite the fact that individuals in same-sex relationships are more likely to be abused by their partners than beaten in an act of anti-gay violence. The political downside of discussing same-sex domestic violence is obvious. Anti-gay organizations invoke same-sex domestic violence to bolster their assertions that homosexuality is a dangerous lifestyle and that same-sex relationships are unhealthy, unstable, and violent... …Same-sex domestic violence also challenges our highly gendered (and heteronormative) understanding of domestic violence because it cannot be explained by reference to gender difference, the historical subjugation of women, or the private nature of family violence.”  Read more here.

Whether you agree with the above is for you to decide. I believe one of the main reasons why this is such a taboo subject is the shame engendered by intimate partner abuse. The victims don’t want to talk about it, so impress on their immediate circles not to talk about it and so on.

Going to the authorities is also seen as deeply shameful and potentially opening you up to ridicule and publicity. The only people who really want to bring it to the fore are the people who have to pick up the pieces in the hospitals, abuse shelters and LGBT organisations. They can see the results of abuse at close quarters but come up against a wall of indifference or unwillingness when they try to raise it as a community social issue.

 (CNN) - Patrick Dati had reached his breaking point.

With a metal pin in his arm and Vicodin coursing through his veins, he picked up the phone to call his psychiatrist. Dati had undergone surgery for a broken arm after his then-boyfriend allegedly threw him down the stairs when he tried to leave their home. Now he sat on the phone with his doctor, explaining why he couldn't carry on, as he tried to overdose on painkillers.

The attempt to end his life, which landed him in a psychiatric ward for two days, resulted in part because he felt trapped in the abusive relationship and saw no way out.

"I couldn't let my boyfriend go because he wasn't allowing me to," Dati said.

Dati is one of a quarter of gay men in America who report having encountered intimate partner violence’  Read more here

One of the biggest problems is that the word ‘abuse’ is so generic and covers a multitude of sins. It may be worth reminding people exactly what constitutes abuse. It’s not just a question of physical injury and bruises; there are far more damaging elements. If you recognise yourself, or any of your friends in any of the following, it may be worth asking yourself if there’s something more going on than at first appears. 

  • Physical abuse; everything from the lightest slap, via severe injury, to food and sleep deprivation.
  • Emotional abuse; from continuous criticism, to humiliation in front of family and friends. Lying, undermining, exploiting, convincing someone to behave against the grain and pressurizing them to behave against their nature.
  • Isolation; reining in personal freedoms; controlling contacts with friends and family; destroying existing external relationships. Restricting information and participation in hobbies and leisure groups. Monitoring phone calls, internet use, reading letters. Physically preventing people from going out.
  • Threats and intimidation; threats to harm the partner, or his family or friends or even pets. Threats to his or her job and work colleagues. Threats to inform the authorities. Threats to disclose HIV status or sexuality to family, friends, neighbours and work.
  • Stalking; by turning up at family occasions, or the workplace. Following you to check up on your movements. Creating traps on internet to try to establish infidelity. Repeatedly phoning or mailing victim, family, friends or colleagues.
  • Financial abuse; taking control of bank accounts, domestic finances, wage checks. Stealing money, encouraging dependence and making financial decisions without consultation.
  • Sexual abuse; forcing sexual acts, rape, pressuring into unwanted sexual behaviour with partner or others. Criticising and denigrating performance.
  • Destruction of property; breaking things which have emotional value to you; furniture, windows. Throwing and smashing objects in rage; destroying clothes and other personal possessions. Crashing the car. 

There are more; these are just an overview of classic abuse symptoms. I’m sure most people in a relationship will recognise certain of these traits; the question is, when is the line crossed and will you be aware of it when it does? As a basic guide, you should always ask yourself if you’re afraid that your partner is going to hurt you, either physically or emotionally. Are you scared of challenging them for fear of a comeback? Do you trust him or her to have your best interests at heart? Are you happy in your relationship and if not, why not? These are simple questions you can only answer after really thinking about them. Negative answers may not always mean abuse but you will know when you’ve lost full control of your life and surrendered important elements to your partner. After that, you need to ask yourself if the situation is going to get better or worse. Blind faith that it will get better, when this, that or the other situation improves, may reflect your own fear of change more than the truth of the matter.  

In heterosexual society, women are far more abused than men, which may seem like stating the obvious but in LGBT society the statistics vary widely. In general, the pattern of abuse is thought to occur in roughly the same proportions for both sexes. Lesbian abuse is therefore as big a problem as gay male abuse and both seem to be growing across all LGBT communities. The occasional lurid headlines and reluctance to bring the problem out into the open, have led to a number of myths and misunderstandings about the nature of same sex abuse. These myths persist even in the LGBT communities who should know better. 

. The first is that aggression in LGBT relationships is largely mutual, on the assumption that both partners are physically and mentally equal, in contrast to the obvious strength advantage in heterosexual relationships. It’s nonsense of course, because most often physical strength is not the driving force behind abuse. The need for control of another person is. However, initially a same sex partner may well try to fight back.

. Same sex abuse is based on something sexual; a sort of extension of S&M practices. The receiver of the violence either enjoys it or puts up with it to satisfy the partner’s desires. More complete nonsense. Violent behaviour is never sexual. There is no mutual contract as with S&M relationships. The victim is unwilling and the aggression is enforced.

. The victim needs to change his or her behaviour in some way and then the violence will stop. No, the person who needs to change and stop is the perpetrator. Battering is a behavioural choice. If the person being abused is forced to change behaviour then there is no reason to assume the abuse will stop there.

. Victims exaggerate the extent of the abuse. If it was as bad as they say, they would leave. Actually, most people being abused understate their experiences to the outside world. Self-shame and guilt prevent them telling the full story. If they eventually find the courage to leave, they have to leave everything they know behind in order to find some peace and the fear of being pursued is very real. Perversely, it may sometimes feel easier to stay.

. The victim gets the blame. It’s true; many people look at the victim of abuse and subconsciously feel that they should have done something about it and if they haven’t, why not? They should have read the signs. In fact, the emphasis should be lain on the abuser and his or her reasons for resorting to aggression to get their way. They deserve the criticism, not the victim.

. Alcohol, stress and drug use cause domestic violence. In many cases, they can be the triggers but it’s all about responsibility for decision making. Abusers themselves use drink or drugs, or stress as excuses but that’s just shifting responsibility away from themselves. After all, they don’t attack their bosses, or the bar staff for serving them too many beers.

. Females are by nature not violent and won’t physically abuse their partners. Many women put more faith in their female partners, especially if they also have experience of dominant males in their lives but lesbians are just as capable of controlling and aggressive behaviour as anyone else. Abusive behaviour is actually non-discriminating in this sense.

The following paragraph perfectly sums up how abuse begins and develops: 

“Domestic abuse is always about power and control. One partner intentionally gains more and more power over his/ her partner. Tactics can include physical, emotional or verbal abuse, isolation, threats, intimidation, minimizing, denying, blaming, coercion, financial abuse, or using children or pets to control your behavior. Domestic violence runs in a cycle. Typically, things are wonderful at the beginning of the relationship. Gradually, tension starts to build. Finally, an act of violence occurs. This may be verbal or physical. The victim is shocked. The relationship then moves into the "honeymoon" phase. The abuser is remorseful and attentive, and the victim wants to believe the abuse was an isolated incident. Again, the tension gradually builds until another violent act occurs. The longer the cycle goes on, the closer together the acts of violence happen.”

Read more here.

So what can you do about it if you find yourself trapped in an abusive relationship? Look for the warning signs.

First of all, stop blaming yourself and stop making excuses for the person who is hurting you. If he or she is abnormally jealous and claiming that’s a sign of their love for you, it’s not, it’s possessive behaviour. Jealousy has little to do with love and trust and more to do with claiming ownership.

Look out too for controlling behaviour; someone who wants to take over the running of your life, claiming that they’re doing it for your safety and organisational purposes. They may get angry if you’re late, or angry if you make a mistake. They may begin to question you about every move you make and eventually you won’t be able to make personal decisions for yourself. They may even take pleasure in bringing you down in company, to reinforce the fact that you are the lesser being in the relationship. Time to think about if you really want this or not.

Don’t jump into a domestic, ‘living together’ situation too soon. You don’t know that person yet but he or she may already be desperate to ‘acquire’ you as a possession. They may start the courtship with a whirlwind of intense compliments, praise and declarations of undying devotion and you will feel pressured into commitment; like the spider and the fly! This can especially apply to people who have just come out, or are new to the scene; these people are especially vulnerable to flattery. Watch out too if you find your friends gradually falling off and your partner becomes unwilling to socialise. They may be trying to isolate you. Innocent flirting may get you into a heap of trouble but you should retain your own social structures; they’re there to fall back on.

Many abusers will blame the world and his dog for their problems and shortcomings. Eventually you will be pressured into compensating and going out of your way to make their lives more comfortable. It’s a tactic to increase your dependence and loyalty. As a result of this, you may also get the blame for things, including their anger and aggression. Your partner will become the ‘victim’ in the relationship and it will turn out to be your fault. Can you see the pattern? Look out for hypersensitivity too. Even the most innocent remark may set them off and it will become your responsibility to keep them happy. They may become Jekyll and Hyde and you will end up walking on broken glass before you realise it. 

Check out their past before entering into the relationship. Look at their friends and ask about past relationships. If they react aggressively to questions about their past, that may already be a warning sign. It may sound cynical but asking them their views and attitudes on various subjects may reveal signs of a cruel or dominating nature. You need to develop a sixth sense and although you’ll make mistakes, it’s better to be safe than sorry. Finally, on the list of red flags to watch out for: walk away and stay away the very moment a hand is raised in anger and it looks as though you may be struck. You may be the biggest bitch, the worst lover and a complete douche bag yourself but you never, ever deserve physical abuse and you should have zero tolerance from day one. Never give second chances to abusers; they feed on them. 

If it gets to the point where you’ve got to get out and are strong enough to do it; go to friends, find a safe place and get away to gather your thoughts. Create a safety plan. Gather your important documents together ready to go (passport, driving licence, insurance papers etc). You can leave your other things behind for now; your safety must come first. If you feel you need to report the abuse to the authorities (and in the best of all possible worlds, you would do that) then contact your local LGBT organisation first. They may have invaluable experience about the best way to go about that and the best people to turn to. If you do go to the police, you have a right to a sympathetic hearing and action but whether you get that often depends on where you live and the climate at the time. Again, your local gay organisations should be able to advise. In cities like New York, Los Angeles and Seattle, the police are being trained in same sex relationships and same sex abuse cases but in other more remote places, that may not be a realistic expectation. 

We're just now beginning to take same-sex domestic violence out of the closet,'' said Jennifer Rakowski, associate director of Community United Against Violence, a group that provides crisis intervention and court advocacy in San Francisco. ''We had to get acceptance as individuals first.'' Read more  here

The bottom line is that the more you learn about same sex relationships and the potential for abuse, the better you will be able to make informed decisions. The problem is that very few people enter into relationships with this in mind; it’s just not realistic. It’s important then to be a good friend; if you see someone in a relationship withdrawing into themselves and being clearly unhappy, don’t hang back to give them privacy; ask as a friend would do, if anything’s wrong and then keep a close eye on the situation. Any bruises, cuts, bone breaks etc that don’t have a perfectly reasonable explanation may give you reason to worry but don’t confront your friend with the question; ‘Are you being abused’? They may run a mile or react angrily. Make sure first but use tact and diplomacy; someone being abused doesn’t want you to know about it! As I said, be a friend.

We need to learn again how to support each other. Our community organisations need to open up and talk about an issue that takes place behind closed doors and develop support systems to catch the victims when they fall and support the prosecution of the perpetrators. Abuse is never okay; it’s the last resort of a coward and a bully but realising that the victim is not in control of his or her destiny is equally important. We support the victims of drug use and disease within our communities; those who are battered by their partners deserve better than closed doors and lack of understanding. You abuse one of us, you abuse us all!

Finally, this short but moving video below encapsulates the whole problem and sums up why constructive help is so necessary.

More information:

http://www.endthefear.co.uk/information/help-and-advice/same-sex-domestic-abuse/

http://www.facebook.com/pages/STOP-Same-Sex-Abuse/117765481609219

http://www.cdc.gov/media/releases/2013/p0125_NISVS.html

http://www.sp2.upenn.edu/ortner/docs/factsheet_ipvinsamesexrelationships.pdf

May09

Reinventing HIV prevention

Thursday, 09 May 2013 Written by // Guest Authors - Revolving Door Categories // As Prevention , Health, Sexual Health, Treatment, Population Specific , Revolving Door, Guest Authors

Guest Jason McDonald says “there needs to be a new call to action, one in which the new ways of the internet and the social media expertise of the young are merged with the proven, effective methods of prevention."

Reinventing HIV prevention

The challenge for the new Safe Sex 2.0 effort will be trying to capture the attention span of someone who lives life and thinks in 140 characters. In this Internet age, we in the HIV+ and HIV- community (basically that is everyone) have been given the dual-edged sword of the internet as a tool for advocacy and outreach.  The internet is definitely useful in finding the answer to almost anything, and it has exponentially increased the means by which information can be disseminated to the masses.  However, the internet has also created vast, huge, and deep canyons between us, where we are only as connected as our wi-fi signal allows us to be. 

Back in the “old days”, we in the older gay community used to go to gay bars.  At those gay bars there were bowls of free condoms.  They were right there on the bar or by the door so that they were always on hand. Back then, we cared about protecting our community.  Back then it was not as controversial or offensive to talk about or insinuate safe sex. Safe sex was viewed as a normal, healthy part of the greater gay conversation. 

At some point though, this changed. Bars are no longer the meeting places of gay men.  Grindr, Scruff, and Adam4Adam have taken their place. Face to face caring was replaced by the cold glow of a computer screen.  Our community became diffused and fragmented and it dispersed like smoke in the wind. There were always those that didn’t go to the gay bars, just as there are those who do not go online today, but they were in the minority I believe.  

Our sense of community has been replaced by a transactional approach, where one’s personal opinions seem to trump the collective wisdom that has been tempered by experience.  Collaboration and compromise have been thrown down the toilet, to be replaced by the louder squeaky wheel of personal, selfish freedoms.

Now, if you were to talk about safe/safer sex or condoms, a method that is clinically proven to reduce HIV and other STDs, you are yelled at, or someone posts a pages long diatribe about how out of touch you are, and how it is their God-given right to have unsafe sex. They pull one tenuous statistic (that successful HAART treatment prevents 96% of HIV transmissions) and they have built an amendment to the sexual constitution, much like gun proponents clutch onto the 2nd Amendment. They ignore the fact that an undetectable viral load in the blood is NOT equal to an undetectable viral load in semen or in anal fluids/tissues. 

And so, the uninformed and unwilling shun proven methods of safety: condoms, HIV testing, non-sexual forms of intimacy.  (Apparently in the age of Grindr, intimacy seems to be an outdated concept as well.)  And then when they contract HIV, they then have this sense of confusion and incredulity, knowing in the back of their mind that they knew their risk all along but chose to ignore it and live in the moment.  There is even a hashtag for that, #YOLO (You Only Live Once).  

Because one in five urban gay men do not even know their HIV status, it is imperative to again find a way to encourage HIV testing and to advocate condom use. People proceed with actions based upon their perception of risk, as opposed to the actual risk at stake.   Stigma is still very high and the pervasive HIV stigma within the gay community (as well as outside of the gay community) prohibits those at the highest risk for HIV from getting tested. When those at highest HIV risk continue to contract the virus year after year after year, there should be a more aggressive approach to HIV testing and condom use.   

It is ironic that studies have shown that when a person is diagnosed with HIV, that person’s sexual behavior becomes safer. They care more about not wanting to infect others. But on the flip side of that is the callous carelessness that pervades young gay men, who believe their greatest source of angst is over what to wear to a Lady Gaga concert.  These guys repel conversations about HIV/risk/safety like Teflon repels an egg.  If you try to mention HIV, they all the sudden stop texting you back, or they fade from your Facebook...they become silent and they disappear.  

I believe there needs to be a new call to action, one in which the new ways of the internet and the social media expertise of the young are merged with the proven, effective methods of prevention.  And through all of this we must figure out how to burn of the fog that has settled on everyone regarding HIV:  for the older people who are tired and exhausted from 30+ years of advocacy and for the young, know-it-all youth who live in ignorance and bliss.

I wish I had the answer on how to do that, because until that answer is figured out, I fear we will again see a rise in HIV infections.  I believe the coming storm will rival the pre-HAART era. Before HAART, people died because there was no medicine.  Now, I believe stigma and indifference has become just as deadly as those early days. 

About the author: I am 38, a gay male from Knoxville, TN who is not ashamed of my HIV+ status. I am optimism personified. I am strength realized. I am just me.

Website: embacingpozitivity.blogspot.com.Twitter @jjemcdonald 

May08

PrEP – How did I end up here? [Part 2]

Wednesday, 08 May 2013 Categories // As Prevention , Gay Men, Health, Treatment, Opinion Pieces, Population Specific , Revolving Door, Guest Authors

Guest Marc-André LeBlanc: “as a smart, responsible, well-informed, sexually active gay man with good self-efficacy and good access to healthcare and accurate information, I’ve come to the conclusion that PrEP makes sense for me at this point in my life.”

PrEP – How did I end up here? [Part 2]

Click here to read the first installment.  

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). How did I end up in this situation where I feel like I need PrEP?

As I mentioned in my previous post, a look back at the phases of my sex life gave me some clues about why PrEP makes sense for me now. After more than 20 years of being sexually active, I only recently found myself veering away from perfect 100% condom use.

How did that happen?

Ironically, this is in part because I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. I know what the research is telling us about HIV transmission. I know what proportion of new infections is driven by people who are undiagnosed. I know what undetectable viral load means for transmission risk.

I started serosorting, but not in the conventional sense. More and more, I’ve been dividing guys up into 3 categories.

1. The first category is small. With HIV-negative guys I know and completely trust, we arrive at a form of negotiated safety—if we have been tested for HIV and all STIs recently, and not yet had sex with others, we usually have condomless sex.

2. The second category has been steadily growing—positive guys. We have discussions about treatment, viral load, STIs and decide how to proceed from there. Sometimes without condoms.

3. The third category is basically everyone else—HIV unknown or undisclosed, and HIV-negative men I don’t know well. I consider guys from this third category as potentially being in the acute infection phase, whether they know it or not. This is the category of men with whom I am most adamant about condom use. All too often, their prevention strategy is dubious at best (e.g., “r u clean? how big r u? wanna bb?”). If I see another highly stigmatizing "disease free"/"no poz" message on an online profile, meant to be some kind of stand-alone, ill-informed HIV prevention strategy, I might reach through the screen and cyber-throttle someone.

So gradually, I’ve found myself feeling much less worried about having condomless sex with a positive guy after a conversation with him about treatment and viral load and STIs than about having condomless sex with a guy who says he is negative, but could be in the acute infection phase with sky-high viral load without even knowing it.

Paranoia? Rational, effective, evidence-based risk-reduction strategy? Both? You be the judge.

But let’s be honest. I also started “slipping up” more and more often because, well… sex feels better without condoms. *gasp* That’s right folks. Sex without condoms feels freaking amazing. You heard it here first.

So while I still maintained a relatively high rate of condom use, I found myself having condomless sex every once in a while. Of course, I also know how effective inconsistent condom use is over time (i.e., not very).

An illuminating peek inside the Little Black Book

Three years ago, I started to keep track of my sexual encounters in a proverbial little black book. (OK fine, it’s blue and has a Global Campaign for Microbicides logo and a Rectal Pride for Microbicides sticker on it. It’s super pretty and seemed appropriate). Every time I have sex, I write down what we did, what I know about my sex partner’s HIV status, and whether or not we use condoms. Yup, every time for 3 years. I do this partly so I have very accurate information at my fingertips to relay when I get tested for HIV and STIs. Partly so I have very accurate information at my fingertips when I start to worry. I can look at my list since my last tests and say: look, you had this many encounters, this is what you did with whom, this is how often you used condoms, and this is what you know about his HIV status. Sometimes that helps alleviate the occasional panic attack and insomnia. Sometimes.

I had never seen myself as being “high risk” for the first 20+ years of my sex life. But I’ve been working in HIV for 20 years. So I know the behavioural characteristics of “those people” at high risk. Armed with about 3 years of hard data about my own newly evolving behaviour (i.e., my stylish little blue book), I decided to look at it objectively.

• Multiple sex partners? Check

• History of STIs? Check

• Partners of unknown or HIV-positive status? Check

• Inconsistent condom use? Check

Well then. It’s hard to ignore what this spells.

I like to think I’m at least moderately intelligent. I know how HIV is transmitted. I know how effective condoms are.

I like to think I understand the consequences and the stakes. Yes, people living with HV are doing much better today. But I saw my dad die of AIDS in front of my eyes. I saw countless other friends, colleagues and clients become HIV-positive or die of AIDS. That leaves an impression, to say the least.

I like to think I’m a responsible person. I get tested frequently. I stay informed.

I like to think I have high self-efficacy. I have several years of experience using condoms consistently, and I am more often than not the one wearing the condom, so little to no negotiation is required.

I’m not depressed. I never drink. I don’t so drugs. My judgement is not clouded by any of those.

I’m not in denial. I know that the combination of inconsistent condom use, multiple partners, history of STIs and having partners of a different/unknown HIV status is a very strong predictor of seroconversion over the course of a few years.

If all of this doesn’t make me an ideal candidate for consistent condom use, I don’t know what more it would take, short of using Super Glue to permanently bond a condom to Mr. Happy.

Yet here I am.

So as a smart, responsible, well-informed, sexually active gay man with good self-efficacy and good access to healthcare and accurate information, I’ve come to the conclusion that PrEP makes sense for me at this point in my life. I don’t know how long this new “PrEP phase” will last. But I am glad it is available to me while I need it.

To be continued . .

About the author: Marc-André LeBlanc has worked in the community-based HIV/AIDS movement for 20 years.  He does community engagement, capacity-building and policy work related to biomedical HIV prevention research, both in Canada and globally. He is a co-founder of International Rectal Microbicide Advocates (IRMA), serves as secretary on their steering committee, has authored two reports on the global state of rectal microbicide efforts, and leads IRMA’s global efforts to ensure the safety of sexual lubricants. Marc-André loves movies. He got a film studies degree while working full-time, just for the sheer fun of it. He is now leading advocacy efforts to get ice cream and popcorn recognised as new basic food groups in Canada’s Food Guide

This article first appeared on My PrEP Experience here

May08

When is it “too much:” do gays have a problem with unpleasant facts?

Wednesday, 08 May 2013 Written by // Josh Kruger Categories // Josh Kruger, Gay Men, Mental Health, Health, Opinion Pieces, Population Specific

Josh Kruger looks at depression – his own - and how mental health issues play out in the LGBT community.

When is it “too much:” do gays have a problem with unpleasant facts?

A decade ago, Dr. Susan Cochran at UCLA’s School of Public Health published  findings from a comprehensive study conducted on the mental health of gays and lesbians. In the November 2002 issue of American Psychologist, Cochran’s conclusions on depression were depressing themselves: gay and lesbian youth suffer from higher rates of substance misuse than their heterosexual peers; LGBT folks need to utilize mental health professionals more than heterosexuals; and, gay men seem to experience recurrent, debilitating bouts of depression more than almost any other group in the overall LGBT community.

Confirming these findings, Michael Kerr writes on a study conducted in 2009 that reinforced Cochran’s findings, pointing out that “research shows that things are even worse for [LGBT] people. Depression affects LGBT people at much higher rates than the general population.”

In addition, Northwestern University’s IMPACT Program focusing on LGBT health asserts, based upon an even more comprehensive study last year, “Taken together, these results indicate health disparities for…LGBT youth are strong and pervasive. Due to the presence of these disparities at such a young age, they are likely to influence to health and well-being of LGBT [individuals] throughout their lifespans.” 

I can always tell when I’m letting my own depression get the better of me because of the responsive actions of my friends. Truly, my better angels prod me to be nicer. More specifically, there’s a small group of friends I’m lucky enough to have, people who are quizzically good-natured in spite of the arguably self-centered nature of mankind, who either directly say to me “Be nice” or who implicitly say this by responding to my gruffness and misanthropy with emailed pictures of llamas visiting elderly hospice patients for pet therapy. Based upon the amount of animals I’ve looked at lately, I must conclude that I am in a very bad place emotionally. And, admittedly, I am.

Yet, I do not feel utterly hopeless about my future nor do I not have a long list of blessings in my life: in fact, I have a better life than most of the billions of homo sapiens walking the planet. Instead, I am tired.

Now, perhaps some of my depression, this tiredness, is indicative of the ennui of our age, of our complete and total dissatisfaction with institutions of power that we are supposed to trust. Indeed, with growing frequency we expose these people and governmental bodies as clownish caricatures of the worst motivations of man rather than accurate reflections of the grotesque, and compassionate, nature of humanity. Instead of allowing for the unpleasantness that is requisite to be labeled human, too often we as gay folks have taken our social lead from the very discriminatory and ridiculous institutions once subjugating us, including institutions rooted in the necessary evil of politics, a field which, upon mention, should elicit nausea in the thoughtful, common man. We have become dismissive, sometimes, of anything that does not fit into our Facebook and online personas, personas who are apparently all very well coiffed, doing very well with that new small business thank-you-very-much, and who are madly in love without any semblance of negativity or strife whatsoever. And, one of the most grave sins as a public figure is, apparently, admitting flaws, contradictions in character, poverty, or sadness.

I need only point out the fact that when I was homeless (a fact most people still are unaware of) very few individuals had the time of day to actually consider for a moment what it meant to worry everyday about how to maintain proper hygiene without showering or how to remain warm and dry at night to demonstrate our society’s general hostility toward unpleasant facts surrounding human nature. Indeed, I myself am guilty of this intolerable sin of selective ignorance; I would much rather focus on my work than consider how to reallocate my own resources to help others out of those figurative holes in which they find themselves.

Then again, life is a consequence of action, so if bad things are happening to people, then these people behaved poorly, right? Unnervingly, this oversimplification is completely contrary to fact; sometimes, bad things happen to good people for no apparent reason whatsoever. And, “bad things” often include, at least in the case of a disproportionately high number of LGBT folks, anxiety and recurrent bouts of deep depression like I’m going through right now.

Most interestingly, I know a great many individuals whose lives are divorced significantly from the general public understanding of who they are as men and women; their collective loneliness weighs on me to a profound degree. Part of me thinks that if everyone was more candid, offered more details surrounding his need to move (from couch to couch, not apartment to house), explained her decline to my dinner invitation (she cannot afford the meal or the inevitable awkwardness when the check comes), provided context to his anxiety (his father has cancer), then we’d all get along better.

Unfortunately, because we live in society and, as such, must navigate society on its terms otherwise we’ll soon stop being mentioned in society pages, we cannot talk about the fact that we are sometimes sad or sometimes poor or sometimes sick or, inevitably as human beings, dying.

Yet, when we provide these details, people are embarrassed for us; they consider such unsolicited personal details as inappropriate or awkward. Rather, they find anything aside from their unsolicited braggadocio, personal “fabulousness,” or maudlin revision of history to fit into a sentimental simplified narrative as completely out-of-bounds. Even worse, they go one step further and, at least in the case of a critic of mine, begin to publicly call you “psychotic” for no other reason than their own apparent pathological discomfort with facts.

Of course, these same folks portray a fabulous image that is completely divorced from the modest reality in existence; but, naturally, this is unimportant to society. Indeed, it is a curious world we live in when facts are presented and those embarrassed by the facts find comfort in dismissing the presenter as psychotic. Then again, I cannot imagine that the King of England felt much affection for Jonathan Swift after “A Modest Proposal” or that Christopher Hitchens received a warm reception from the Vatican after “God is Not Great: How Religion Poisons Everything.”

Inconveniently, these unpleasant components of humanity are inherent to the experience of being alive. Without our downs, we cannot identify our ups. And, there are some human beings with a propensity toward depression; interestingly enough, there seems to be a strong overlap between those with a sincere desire for man to do the right thing and a profound sense of sadness when this does not occur.

The fact that we as LGBT folks suffer from depression higher than straights might just mean that we care a little too much about the world, in that case. And, while that’s a quaint thought, I nonetheless think the reality is much less noble and much more banal. After all, as some of the most talented members of society, we as LGBT folks are, by our very nature, different and more sensitive. 

So, it’s no wonder that we would rather portray an image as well put together, successful, well-decorated, and fabulous. Who’s got time for reality when we’ve got the theatre?

This article originally appeared on Josh’s own blog here

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