The CBC this week reported Health Canada will allow men to donate blood if they haven't had sex with a man in the last five years, a change in policy that will go into effect in the coming weeks. Here is a statement from the Canadian AIDS Society received May 22. 

Ottawa, ON – The Canadian AIDS Society (CAS) acknowledges that Health Canada today approved a change to the blood donor deferral period currently imposed on men who have sex with men (MSM) from indefinite to five years from last MSM activity.

The Canadian AIDS Society has, along with other LGBT groups and patient groups, worked to support a proposal from Canadian Blood Services to Health Canada in December 2012 to change the MSM policy on blood donation. The proposal also calls for regular reviews based on scientific data to be collected.

CAS has been an active partner with Canadian Blood Services and others, working for many years to support the five-year time-based deferral as an incremental step towards a behaviour-based screening model for blood donation. Monique Doolittle-Romas, Chief Executive Officer of CAS said, “While a five-year deferral is still too long, we see it as an important step in the right direction. Ultimately, though, we’d like to see a model based on a donor’s behaviour rather than one based on sexual orientation and gender.”

With this important shift in the blood donation policy, CAS believes that there will be an opportunity to gather further evidence to create an even shorter time frame for the deferral in the future. However, Health Canada must continue their support through an increased commitment to research in this area.

“Protecting the safety of the blood supply in Canada has always been and will always be an important issue for the Canadian AIDS Society,” Doolittle-Romas reiterated

It’s taken me a long two weeks to get back on my feet post-Israel trip. Since then it’s been cold and rainy here, so it’s beginning to feel like all that sunny freedom from SADS has disappeared…(Technically it’s SAD, but it just doesn’t seem right unless I make sad plural.)

Just last Saturday I sent a message to a friend living in St. Martin for the winter. I was at my wit’s end, in "just get me the fuck out of here" mode.  But after Margaret Thatcher’s death I gave mother nature a bit of a break. She’s merely trying to detox herself from the shock of Thatcher’s body returning to earth. Even she doesn’t want her back, it seems.

Today there is some sun, and suddenly the veil of fogginess and fatigue begins to lift. This is why I start planning getting away a year in advance. For me it’s no longer about glamour, it’s about survival. Had I been around for March I either would have jumped off my balcony and/or killed someone. No doubt that person I’d kill would be a TTC passenger taking up two seats with his or her backpack during rush hour.

It was a great trip. The guy I was shtumping turned out to be an over aged gay hipster artist who lives in the moment and has no real attachments. That translates into having a great time when together, forgotten about when not, and tells me he doesn’t believe in long distance communication when I said I’ll give you my email and stay in touch.  After he said that I never saw him again. I wanted to get to know people so that when I return I’d know people.

I did make this objective of getting to know others there. I call this my introductory trip to Israel. There will be many more to come. Historically, I’ve picked a city and made it kind of my second home. When I lived in Winnipeg, I did that in Toronto. I had so many meetings out there (pre-internet days) and a social network that one day it became impossible to have to return to Winnipeg.

Both Amsterdam and New York were “second homes” for me. During my stay in Tel Aviv I knew that this was now becoming my second home. This time with a twist, that this is the homeland of spiritual ancestries, and a tribal connection to the land and people.

This month was a time for reflection. The past year I had let go to the foundations of what I need in life. I became so determined to do stand up that I’d become sick this last winter and part of the summer. I’d get up maybe four days in a row and then get knocked down with something. In fact right before leaving I got sick and had to cancel about three gigs. I’m so tired of getting smacked down all the time. I need my health.

That means focusing on storytelling performance and putting together the one hour long solo show that I’ve thought about for the last few years. I’ll still do some stand up but only when I have things I really want to try out.

In Israel there were times when I longed for the interpersonal connections I have at home. It was a Dorothy moment. If I just click my heels three times I have it all right in front of me, even in Tel Aviv.

The third part is my Judaism. There is this essence to the community, culture, language and another kind of connectedness.

Lastly, I need to get back to the gym. Nothing like seeing so many hot guys to get one motivated to getting back into some form of shape and introduce plain old-fashioned cardio in an internet-induced sedentary lifestyle.

For the one hour show, I want to be able to workshop it at The Flying Beaver by late fall or early winter of next year.  Eventually I’d like to do this solo show in Tel Aviv (very long term goal) as there will be some topics in there not talked about so openly in Israeli gay society.

Provided I can pull a couple various elements together for returning to Tel Avi, I’d like to return for three months. I’d also bring Hildy with me.

 My friend asked my last time, “I want to hear about all the hot guys you did!” I replied, “I’m not going to talk numbers (I only diddled 3 guys but we’ll keep that between us) but I did receive over 70 messages in my Atraf profile, the local sex site. 

Normally, I eschew Facebook “Like” contests and changing profile pictures en masse to show solidarity under the misguided notion that the modern equivalent of jingoistic chanting does anything to influence policy. Surprisingly, then, yesterday I changed my Facebook profile picture to a simple red square with a white equality symbol, as did seemingly everyone in the LGBT community I’m friends with, to demonstrate my support for opponents of Proposition 8 in California, who just wrapped up oral arguments in favor of gay marriage before the United States Supreme Court.

Originally started by the Human Rights Campaign, an organization I typically criticize for its lack of effect when it comes to advocacy and seeming dearth of actual programs helping LGBT kids, youth, adults, and seniors, this Facebook movement has grown to reflect that there are, seemingly, more of “us,” supporters of gay marriage, than there are of “them,” the opponents of gay marriage.

“At first you resisted. Now you’re all red, red, red,” messaged a friend of mine the minute I changed my profile picture. I admitted to him that I got on the Orwellian bandwagon, but I began to think about why, in this instance, I had a visceral, immediate desire to participate.

Frankly, I have a reputation in Philadelphia as a bit of a curmudgeon, the type of writer and critic who could have witnessed Jesus Christ turn water into wine and write down later, “The red was dry, the conversation was ultra liberal, and the speaker needs a haircut.” Yet, when it came to gay marriage, I was on board without a second thought, enthusiastically taking the lead of thousands of people before me. Upon reflection, I realize it is because I, like many others, am fed up with this false equivocation in American media and politics that, somehow, idiotic arguments deserve a seat at the table alongside thoughtful commentary.

For years, American media has strenuously attempted to give proper voice to those opposed to gay rights. Much like how those opposed to civil rights for African Americans had their arguments rooted entirely in their own queasiness with blacks, foes of gay marriage and, by extension, LGBT rights, seemingly have no proper argument aside from a red-faced, flustered, “But it’s…it’s…wrong!” And, much like how factually-challenged climate change denialists are given a speaking platform with nauseating regularity on Fox News, gay rights opponents are somehow put forth as though they have any substantive grievance or sound opinion that is rooted in anything aside from their own inherent bigotry. They do not.

At issue is whether or not homosexuals like I am should be allowed to, privately but officially, wed. This issue is not about whether or not you support leather chaps and bathhouses; this issue is not about whether or not you are conflicted on allowing transgender women to attend all-girls’ colleges; this issue is not about whether or not you are queasy about the fact that 40,000 children in California are currently living in same-sex households, as Justice Anthony Kennedy rightly pointed out this week; and, certainly, this issue is not about gay sex. Rather, this issue is about whether or not I as a human being am deserving of the same rights and privileges you are as a human being.

The fact that a conservative evangelical might find the fact that I like to kiss other men gross is irrelevant to this debate; the fact that, gross or not, this goes on and I cannot change this component of my identity as a human being is the essence of whether or not I deserve to be able to have my love publicly affirmed through marriage.

Contrary to the reprehensible, and completely discredited, notions propagated by gay conversion “therapists,” I cannot change my sexuality. In fact, if I could have changed my sexuality as a 13 year old gay boy growing up in a town called Quakertown, PA, obviously not the most progressive and cosmopolitan of rural Pennsylvania areas, I would have. Making the decision to live as a heterosexual would have been much easier; I would not have had to come to grips with the fact that society was telling me I was a faggot, an effete leftover from human evolution. If I could change my sexuality and produce a child with a woman naturally, I would be able to continue to pass along my mother’s DNA and my father’s surname; and, I could touch the hand of my son or daughter and feel my own blood, developed from thousands of years of mating on part of my German ancestors, my naval officer great great grandfather, my beauty queen mother, my NY Times crossword-puzzle addicted grandfather.

As reality would have it, however, my innate sexuality prohibits me from honestly doing this. Instead, I have, for years, had to figure out how to wed my physical attraction to other men along with my principles and desires as a human being. That is, try as I might, I cannot get pregnant by a man; and, as such, I cannot physically, bring together my DNA with the DNA of the man I love to produce a new human being worthy of the same rights and dignitites as my brother’s son, my nephew. And, while I can certainly, at least in some states that don’t outright ban gay adoption, adopt a child, I cannot produce one with the person I love just as my mother or brother have done.

While this is, at best, annoying and, at worst, tragic, I, and millions of other homosexuals like I am, have figured out that family is what we make it, that friendship is key to a life of happiness and love as a gay man, and that so long as the government concedes that I am not biologically inferior but, instead, biologically different than my straight counterparts, we can peacefully coexist, society and LGBT folks.

Today, however, and for the past several decades, there are entire segments of the American population who, despite these facts, have caused me and continue to cause young LGBT folks great sadness, anguish, and pain about their innate identities. We are told routinely that we are separate, different, and, logically then, inferior to heterosexuals. We are made to feel badly about the fact that we like to kiss other men; we are made to feel dirty for wanting to express our sexual and romantic identities publicly.

Specifically, I remember being called a faggot on Walnut Street for holding the hand of the boy I was dating when I was 18. And, immediately, we stopped holding hands; after all, it was totally inappropriate of us in this straight world to try to publicly affirm our affections for one another. Similarly, I was called a faggot and then punched in the face because I, unlike the 18 year old version of myself years earlier, passionately protested this slur last year. The difference between these incidents, along with their separation in time, is the fact that no reasonable or legitimately thoughtful person thinks either incident is okay today. Ten years ago, however, a good number of folks would say things like, “Well, you should be careful, you never know who is around.”

Everyday, we hear news that more and more Americans are supporting gay marriage. And, everyday, we hear news that more and more gay Americans want to get married. And, everyday, we hear the truthful argument against gay marriage coming out more precisely; that is, they simply have an issue with us faggots and their issue has nothing to do with public affirmation or love or extending rights guaranteed by the US Constitution to American homosexuals. Rather, opponents of gay marriage rely exclusively on their own personal “ick” factor in relation to homosexuality and pretty much every sexual and gender difference that isn’t straight, missionary style, and monogamous.

This opinion does not deserve a voice in thoughtful media or commentary. It belongs in the dust heap of history along with Plessy v. Ferguson’s “separate but equal” distinction in relation to different facilities, including drinking fountains, pools, and public schools, for blacks and whites. And, just as the Supreme Court overturned Plessy v. Ferguson with Brown v. Board of Education, the Supreme Court is positioned to affirm what everyone knows but what American media still has difficulty conveying.

Gay people are equal and deserving of the same rights and dignities as straight people. So, I changed my Facebook profile picture. And, I suggest you do too.

This article first appeared on Josh’s own blog here.

This article by Michael Carter first appeared on aidsmap.com here. 

The long-term effectiveness of antiretroviral therapy means that many HIV-positive people should be eligible for affordable life insurance, European investigators write in the online edition of AIDS. Even though HIV-positive people doing well on treatment had a higher mortality risk compared to insured HIV-negative individuals, this excess was within acceptable limits for life insurance cover.

“Our study provides evidence that could allow life insurance up to 20 years term to be offered to lower risk HIV positive individuals at affordable premiums,” write the authors. “Whole life insurance at guaranteed rates may become feasible when data on mortality with longer duration of ART [antiretroviral therapy] become available.”

Improvements in HIV treatment and care mean that the life expectancy of many HIV-positive people is now approaching the average. A small number of life insurance products offering limited cover are now available to people deemed to be 'low risk' – those doing well on treatment with no history of injecting drug use or hepatitis C co-infection.

Despite this, access to life insurance still remains limited.

Investigators from European Antiretroviral ART Cohort Collaboration (ART-CC) were concerned that fair access to life insurance was being denied to people doing well on HIV therapy.

They therefore estimated the relative mortality risk for HIV-positive people from six months after starting antiretroviral therapy compared with the insured population in France, the Netherlands and UK, and with adjusted mortality rates for Italy, Spain and Switzerland.

The analysis was based on data provided by approximately 35,000 people who started HIV therapy between 1996 and 2008. Most (70%) were male and aged between 30 and 49 years (65%). Three-quarters had a CD4 cell count below 350 cells/mm3 when they initiated treatment. None were infected with HIV via injecting drug use or had baseline hepatitis C co-infection.

There were 1236 deaths during 174,906 person-years of follow-up, a mortality rate of 0.71 per 100 person-years of follow-up. Mortality rates fell with age (p < 0.005) and duration of antiretroviral therapy (p < 0.005) and were lower for people who started treatment after 2001 (p < 0.005).

The investigators compared mortality risk between the insured HIV-negative population and the subset of the lowest-risk HIV-positive people – individuals with an undetectable viral load and CD4 cell count above 350 cells/mm3 six months after starting treatment and no history of AIDS-defining illness.

People with these characteristics aged between 30 and 39 years had a relative mortality risk of 459% compared to insured HIV-negative individuals.

The investigators emphasise that this risk was well within the 500% limit normally used as the threshold for insurability.

Mortality risk fell with increasing age and duration of therapy. Individuals in their 40s who had been taking treatment for over seven years and who had a CD4 cell count between 200 and 349 cells/mm3 had a relative mortality risk of 238%.

“Relative mortality compared with insured HIV negative lives declined with increasing duration of ART, and decreased with age despite increases in mortality rates with age, a phenomenon that has been observed in other studies of HIV populations,” note the authors. “The lives of people with HIV tend to become more insurable with increasing duration of successful ART.”

Overall, 61% of people taking treatment had a mortality risk below the 500% threshold and 28% had a risk below 300%.

“Our results imply that more than 50% of patients – those with lower relative mortality – in an HIV positive population with similar risk profile to that analysed in this study cold be insurable,” comment the investigators. They believe their estimates are likely to be conservative as modern HIV therapy is much more tolerable and effective than that taken in the late 1990sand early 2000s. “People newly diagnosed with HIV can be expected to survive longer than those recruited to cohorts between 1996 and 2010: studies such as ours necessarily provide trailing indicators of mortality rates.”

The investigators conclude that the lack of insurance products for people doing well on HIV treatment can no longer be justified, “since the excess mortality of those with HIV is comparable to many other groups with morbidities that are insured…our study provides data that will allow the insurance market to open up to people living with HIV.” The authors intend to communicate their findings directly to insurance companies so that they can amend their policies, “with consequent improvements in the quality of life for HIV positive people”.

Reference

Kaulich-Bartz J et al. Insurability of HIV positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies. AIDS 27, online edition: DOI: 10.1097/QAD.0b013e3283601199, 2013.

Exactly twenty years ago, in the first three months of 1993, more than thirty men in care of Her Majesty’s Prison Glenochil (Scotland) (below, right) were on heroin, sharing needles and syringes. During a prison-wide HIV testing campaign, it came to light that 12 of the men had become HIV positive as a result. 

Today, twenty years on, HIV treatment has radically improved the health and longevity of people living with the virus. For anyone receiving an HIV diagnosis in the early 1990s, however, prognosis was poor and society less than accepting, especially of men infected through sharing needles in prison. When an official report of the outbreak warned of the risk of spread from the ‘Glenochil twelve’ they were unaware just how prophetic their words were of what was in fact a human tragedy.

In one case at least, the infection of a partner would trigger the first trial in the UK of someone with HIV for ‘reckless and culpable behaviour’. The High Court found the accused, Stephen Kelly, guilty and returned him to the custody of the prison service in whose care he had contracted the virus in the first place. Implications for him, his partner and family were disastrous, and created a knock-on effect among people with HIV. A string of other stories was related in a tabloid newspaper a few years later, naming individuals and their closest connections, while also feeling entitled to breach intimate details of the men and their families.

The first report globally of an HIV outbreak in one of Scotland’s prisons created a stir. Even with the well-known high rates of injecting among the young men and women of the housing estates on the edges of Scotland’s biggest cities, it was headline news when it broke.  Drug education measures for drug users in prison had been insufficient to protect the ‘Glenochil twelve’.  A subsequent enquiry by the Scottish Affairs Committee of the House of Commons (London, HMSO 1994) concluded that anything between 22 and 43 inmates might have been infected, while another 258 were missed from the study having been released or moved to another prison with the six-month study period.

Outside prison, in contrast, a raft of measures including needle exchanges had started to turn around an epidemic of HIV infection that had peaked in 1986, six years previously. Day to day, the majority of drug users in communities would have made use of these harm reduction measures. Once behind prison gates, however, inmates addicted to heroin found a different set of rules.

In a rapid response, prison authorities introduced counselling on admission, detox and rehab, and eventually sterilising tablets to clean syringes and needles. Syringes and needles themselves, however, were excluded. They still are.

The official report at the time recommended ‘urgent measures’ to prevent further spread among prison injectors. (Taylor and Goldberg, BMJ, 1996). Experience in the community was clear.Harm minimisation through provision of needle exchanges, oral substitution treatment with methadone, support on release, and good links with community and health agencies would mirror strategies in the community from which prisoners came and where they were accustomed already to protective measures. For those twelve men infected in Glenochil, in 1993, time in prison had taken them right back to experience the self same conditions that had fed the epidemic a decade before.

Now, 20 years on, what has changed? Pressures have increased with soaring occupancy rates. The majority (64%) of people entering prison have used drugs in the previous twelve months, and many (39%) worry that drug use will be problematic on their release.  Positive advances have been made in prison drug policy. Provision of clean needles and syringes, however, remains taboo to Scottish prisons.

Proposals to pilot a needle exchange in 2009 were met with threats of a walk-out by the Scottish Prisons Officers’ Association. Despite having been Scottish Government policy stated in its Hepatitis C Action Plan (2006), the pilot remains in the red zone. In response to SPOA concerns for its members, the SPS undertook a thorough study and concluded, “It is important that, where possible, inmates of prisons have access to the same services in prison that they would have if they were living in the community”.

It was also found that needle exchange schemes in 46 prisons in four other European nations had successfully reduced rates of HIV and Hep C. Despite similar safety fears expressed by Scotland’s prison officers, no single instance of use of needles as weapons had been recorded. Where these schemes have been stopped, it has been due not to opposition from staff, but to political interference. Indeed, whereas 85% of staff in the European study had opposed introduction of the schemes, 100% wanted them kept when politicians closed them, a remarkable change based on direct staff experience.

As long ago as 2001, a review of the HIV strategy in Scotland received evidence from the then SPS Medical Adviser on HIV prevention and concluded, “We recommend that the Scottish Prison Service considers whether it can do more to reduce the potential for HIV transmission in prison”. SPS Standards currently support an enlightened approach to drug use in prison. Harm reduction is integral, taking the form of substitute prescribing, harm reduction packs, condoms, lubricant and dental dams. In some prisons, there is even a needle replacement scheme at reception and the offer of sterile injecting equipment on release.

The one gap is in provision of clean needles and syringes during custody itself, and it seems that the whole project is off the agenda.

It might be argued that not only are needle exchange schemes unacceptable to prison officers, they are no longer necessary due to the success of other existing educational and harm reduction measures in prisons.

This latter point was scrutinised by the same researcher and her team as reported on the original Glenochil outbreak. This time, the primary focus was on Hepatitis C not HIV. This study, published in the latter part of 2012 found that the rate of illicit injecting drug use and of HCV in injectors in Scotland’s 14 prisons is the lowest in the literature. This is due in great part to drug treatment in Scottish prisons, including harm reduction.

It found, however, a 3% incidence of Hep C in the prisons during the period of their study, meaning that Hep C transmission occurs within prison. The researchers conclude that although the risk and rate of exposures to Hep C, including injecting, during current imprisonment was low, risk accumulates the longer someone is in prison.

Scotland has an internationally recognised reputation for the success of its pragmatic drug policy in tackling HIV. This has not stalled in our prisons, with excellent treatment and support from local specialists and voluntary agencies. Local NHS Boards now provide prison medical services. NHS Forth Valley, where Glenochil is situated, hosts the largest number of prison establishments of any NHS Board area, and is an example of positive change in the relationship between prisoners’ health and prison.

There is a renewed opportunity to revisit a pilot of prison-based needle exchange schemes in a less threatening context.

Based on all of the evidence, policy, and the real risk of exposure and infection, Scottish prisons must introduce needle exchange schemes to complete its strong harm reduction approach. It is long overdue, two decades after the notorious Glenochil outbreak.

This article appeared in ‘The Herald’, 08/03/2013

Republished from Roy's own blog scottfreehiv here.

Needless to say, I feel a rant coming on. What's provoking me this time? A series of events around the issues of police and criminalization of HIV. I would be more precise and say criminalization of non-disclosure of HIV status in a context of risk of transmission, but you will see that not all my provoking stories fall into that category. 

First of all, a terrible case in Québec where an HIV+ woman was being arrested and spit on the police officers. If we are to believe them, she managed to spit into each of their mouths and eyes, which would be quite a feat, but surely irrelevant to the risk of HIV transmission. The trouble is that they were ignorant of the modes of HIV transmission and their fear led them to post-exposure prophylaxis (PEP), the "horrible" suffering of taking HIV meds for a whole month, paid time off work…and one of them even had to move back home with his parents. Considering the uselessness of prescribing PEP in such a situation, my first thought was that I hoped they would experience every conceivable side-effect of the medication during their useless paid month off of work. Consider also that the woman was considered to be such a menace to society (such a talented and accurate spitter, I guess) that she was denied bail and spent more than ten months in jail. While all parties later recognized that there was no chance of transmitting HIV in this way and the charges were reduced from aggravated to simple assault, the fact that the woman was HIV+ was considered as an "aggravating factor" in her sentencing. HIV bigot say what? 

Now, the case of the woman seems to have emboldened a collection of police unions and others like them to re-propose a law that would allow a police or correctional officer who is exposed to a biological liquid to require that the person in question be tested for a variety of infections, including HIV and Hepatitis C. Some provinces, as I understand things, have such laws, and this is not the first time that these groups have tried this here. It has been pushed back as being useless in practice and I have every confidence it will be again, but there is really nothing like trampling uselessly on others' rights because of your own unfounded fears. Maybe we should invest in teaching police officers how to arrest people without making them bleed. 

And my final trigger element was a news report of yet another person being charged in Ontario for non-disclosure and the police going public with name and photo, looking for additional "victims". You found your victim: he's the one you arrested and decided to convict in the public sphere before his trial. 

All of these things in the shadow of the recent Supreme Court decision, which was supposed to give us more clarity. All it gave us was more doubt and more fear. 

I think the basic injustice has been in addressing the issue of non-disclosure in a sexual assault/assault framework. Let's be clear here that the thing people are being accused of is not saying something, but the language related to the charges is violent, leaving the uninformed outsider with the impression that a violent act has taken place. No wonder the general public is scared of us. 

We might be in a different place today in the realm of public opinion if these cases were prosecuted as fraud instead of constructing an infrastructure of violence on top of them. Not that I'm endorsing the use of the criminal law, but let's be a little more honest about the nature of the offence. 

When someone steals another person's life savings through some kind of dishonest investment scheme, do we call that financial assault? Withholding the necessities of life? Attempted murder? Not at all. We don't see this person as inherently dangerous to society, as reprehensible as the results of their actions are. After all, what this person did was lie or not tell the dupe that the investment was going into a pocket and wouldn't be coming back, not more. Can someone explain to me how that is different from not disclosing HIV status? Is not saying some words more violent than not saying other words? 

Yes, I can hear the justifications. Silence or misrepresentation means that the other person didn't consent to sex, so it is sexual assault. But the other person did consent to sex, and did so in a context in which we all know that there are sexually transmitted infections and ways to avoid catching them. This against a backdrop of public health messaging over the last thirty-something years telling us all that we are responsible for our own health as well as that of our partners. So is there an excuse for the magical thinking that I alone am the exception and therefore your silence is a physical assault on me? Is that analysis not even less valid in a community where HIV prevalence is high, meaning that we are even more targeted by the public health messages and ought to be even more aware of the chances we take? 

I might have a whole different take on HIV disclosure if we lived in a world where people didn't suffer discrimination and exclusion for their HIV status that amount to nothing more than unfounded fears and moral judgments. In this world, however, the choice is to expose yourself to those dangers and all their consequences or be accused of being a violent predator. Now THAT is victimization.