Newly updated US treatment guidelines are recommending antiretroviral treatment for all people with HIV infection, rather than starting at a particular CD4 range. But for those about to start treatment and their doctors, it’s not quite that simple; the strength of the recommendations varies by category of patient. Here is how a simplified scale looks:

• CD4 count less than 350 – strong recommendation
• CD4 count 350 to 500 - strong recommendation
• CD4 count over 500 – moderate recommendation

Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions: pregnancy, a history that includes an AIDS-defining illness, HIV-related kidney disease and HIV/hepatitis B virus (HBV) co-infection. The guidelines also include an early treatment recommendation for anyone at risk of transmitting HIV to partners.

You can read a summary of the recommendations, including changes to existing guidelines, here or read the  full guidelines here.  

In contrast, recently issued draft British HIV Association treatment guidelines continue to recommend treatment when the CD4 cell count falls below 350, although treatment may be started earlier in people with hepatitis B or by people concerned about the risk of transmitting HIV to partners.

Canada has no national guidelines at present, a reflection of our provincially administered healthcare system, but our practice tends to follow the US guidelines.   BC and Quebec have their own guidelines.  But it’s likely that these new US guidelines will be influential in affecting treatment decisions here and around the world.

In Ontario, the advice you will receive currently depends, at least to some extent, on who is your doctor.  Some (many?) doctors are now suggesting treatment immediately on diagnosis, with the consent of the patient, of course. Others are suggesting holding off.  But clearly there has been a move towards earlier treatment for some time, driven in part by the evidence of better clinical outcomes   for those who start earlier, and in part perhaps by concerns about the perceived need to curb secondary infections that the treatment as prevention advocates frequently cite.  More on that later.

The issue of when to start treatment has been controversial. Previously, for instance, the panel that decided on the US guidelines was divided.

There has been little reaction to the new US guidelines from the Canadian HIV community to date.  But HIVers from Australia, in the form of NAPWA (National Association of People Living with HIV/AIDS) were quick to state their position.  In a March 28 statement, NAPWA president Robert Mitchell said “It is increasingly clear that untreated infection is bad for the health of people living with HIV, whether their infection is recent or long-term. We also think that people with HIV will value the added benefit of being on treatment in helping reduce the risk of transmitting HIV to others, when used with other proven prevention measures like correct and consistent condom use.”

This two-pronged rationale for earlier treatment contains elements which have been troublesome for people living with HIV in the past.  Over the years, there have for instance been issues raised about the potential side effects from long(er) term exposure to HIV drugs - longer term at least than if treatment were delayed.  Informed consent has also been an issue for some HIVers – nobody wants to be persuaded to start treatment when they are not ready for making that decision. But on this latter point the new guidelines are clear; “patients (who start) ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence. Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.”

The longer-term exposure to side effects concerns?  I raised this issue with Dr Julio Montaner, a long-time early-treatment proponent, when I interviewed him for PositiveLite.com earlier this year.  Here’s what he had to say about that. “There is no doubt that antiretroviral therapies have improved dramatically. They are simpler, safer and better tolerated. No doubt about it.  Are they perfect? No they are not….However, if we are having a discussion here on whether starting treatment immediately or on a deferred basis, the gap between those two decisions is somewhere in the order of months to a couple of years. It varies from person to person but when we’ve done studies, the rate of CD4 decline in an untreated person is somewhere between 60 and 120 cells per year. If somebody today says ‘no, I’m going to wait,’ what I say is ‘sure, you can defer antiretroviral therapy, no problem, we are not forcing anybody to start treatment.’ What we are saying is let’s have a discussion."

For an expert narrative on the new US guidelines, I interviewed CATIE’s Sean Hosein last week.  He’s an acknowledged expert on treatment issues and I wanted to gauge his feelings on the impact of the new guidelines for Canada.

Sean cautions against interpreting the guidelines as saying that once people are diagnosed they should start treatment then and there. “What this means” he says ”is that there is an opportunity for doctors and people living with HIV to start the discussion about therapy. Given the therapy that we have today, people are going to be taking it every day for the rest of their lives,  and so people have to be prepared for this – ready, willing and able.”

Do the new treatment guidelines represent a major change? Sean thinks so. ”It’s a major change compared to ten years ago, even five years ago, when they were saying ‘let’s wait ‘til the CD4 counts fall’. But what’s happened is that they’re finding that HIV just doesn’t affect CD4 counts. It causes inflammation inside the body that affects major organs like the brain, the heart, the lungs, the kidneys, the liver, the bones  - and so that’s why there is a push to start treatment earlier.”

I asked Sean to what extent the treatment as prevention arguments – which revolve around, in part, reducing the possibility of secondary infections by suppressing viral load to undetectable levels – might have had on the US decision to recommend starting  treatment earlier.  “I think it’s a mix of two things”, says Sean of the new guidelines. “It’s a mix of trying to do the right thing for the individual person living with HIV and also trying to do something for the rest of society in order to reduce the risk of transmissions.” But  of treatment as prevention, Sean cites the cautions in the guidelines about interpreting HPTN 052 results (the much-publicized study released last year which saw a 96% reduction in the risk of HIV transmission in heterosexual sero-discordant couples) too broadly, noting in particular the lack of data relating to MSM (men whoi have sex with men) , an issue discussed in my interview with CATIE’s James Wilton that you can read here.

On the side effects issue, Sean says the environment has changed. ”That argument, I think was important in the 1990’s and maybe ten years ago when the drugs that were used were much less tolerable.  With the drugs that are commonly prescribed today, the regimes are simpler.  There are side effects but they are generally mild and they tend to go away.  It’s true that people haven’t been on the latest drugs for fifty years so in theory there may be problems in years to come. . . . We need long-term studies to monitor people and those studies are underway.”

I asked Sean if the new guidelines are big news for the HIV community.  Sean thinks so. “It’s about strengthening doctor/patient relationships. I would encourage people who have recently been tested to see this as an opportunity to speak to their doctor about starting treatment early.”

Does he think the US guidelines will shift the Canadian response to HIV infection?  Says Sean “I think it will, because it’s good for people living with HIV. It will keep them alive longer.  It’s a good thing.”

I think so too.  Starting treatment earlier is likely a good thing for many people.  Whether the new US guidelines are driven by a desire for better clinical outcomes for people living with HIV or reflect treatment as prevention policies, or both, is almost immaterial.  I say almost because many of us have been vocal about our concerns surrounding treatment as prevention and we are cautious when some of its key tenets appear to go main-stream. But things have changed. Our knowledge of disease progression has changed. Treatments have changed. My own opinions have changed. So yes, I’m with the US on this one.

Let’s hope that Canada follows suit. 

Bio: I’m J, 22, residing in Singapore. I’m an aspiring… something. I’ll let you what that is when I figure it out. Until then, I’ve allowed my government to decide what I need to be for the next two years – a soldier. Drafted into the local army by compulsory service, I am hoping that it treats me as well as the pornographic fantasies filmed in army barracks. That, or I will forever live with the regret of opting to not take up the exemption extended to HIV+ individuals. But hey, I told myself my virus will not be a deterrent to living my dreams (and fantasies), even if it’s never again bareback.

I’m creator of SilenceSg.org, a local campaign for youth that tackles STDs I also sometimes write on my personal blog, where I hope to serve as a warning sign to others who are taking the road I did, to proceed with care - not with the reckless abandon I once had.

“Hi, I’m J and I’ve been living with HIV for almost two years. I was diagnosed with HIV even before I legally entered adulthood…”  It’s an introduction that’s unfortunately becoming surprisingly unsurprising, even common. What would have sounded shocking years ago would today garner but a few raised eyebrows.

Truth is, people have become oblivious to the virus, and resultantly, from those of us suffering from it. T The modern-day politically-correct term would be people living with HIV, but I think this does disservice to the people who have valiantly campaigned before us. You do not just ‘live’ with cancer or any other disease, it is a tough walk - and while most of us manage, it is can be tortuous. There is no other way around this truth. The desensitization from years of campaigning by those before me, who bore messages of hope and called for urgency, is in full effect. At the very verge of my teen-hood, I contemplated how I would lend my voice to the resounding echoes of those who stood before me, as an adult.

I realize we’ve got most bases covered. We have the activists who continually spread hope covered. We have the drug companies encouraging people by extending a lifeline so long as we can afford it. We have lawmakers fighting to undo discriminatory policies against HIV+ individuals. What I think we lack is honesty.

Honesty reminds people not to forget that today, over 30 years on and 25 million dead, the virus is still as prevalent in our society as ever, way past the deadline for the oft-promised but elusive cure, that is, if the drug companies who drive HIV research are still focused on looking for one.

It’s like when a relative or friend who knows about your condition asks how you’re doing, and you smile and take the easy route of saying “I’m good,” instead of offering  “I’m struggling, with a myriad of things like the increasing cost of maintaining my health, my mental well-being, and emotional turmoil when I look back in regret, but otherwise, I manage, as most people do with their problems.”

You ask, wouldn’t it be easier to smile, because smile and the world smiles with you,  right? Smiles we put on everyday hide problems like veneer masks a chipped tooth. It may be cracked, but people will never know until you tell them. They’ll never see that you’ve been broken underneath. This mentality that we are all ‘just fine’ really has, I think, undone the urgency to find a cure, and bred a new wave of activists who talk of rainbows and butterflies with the miracle of medication. 

When a call was made out for writers for PositiveLite.com, and I got the wind of it, I immediately wrote in about getting a feature spot. While I’m a country and continent away, HIV knows no borders, does not discriminate, and I think us activists should tread along the same path. Truth was, I just wanted to spread honesty. You see, there is no point in arguing a smoker does not deserve lung cancer if he’s already got it, it is nothing but meaningless sympathy. I however find great purpose in warning smokers who haven’t to try and quit, to minimise their exposure to the risk. To, at the very least, let them know where they are bound for  if they don’t get off. Hopefully while I’m at it, I’ll stop people from getting on board as well.

Now, if I’ve still got your attention, I’m Jan, 22, and while I struggle with the virus, I get by, just like everyone else.

A mother’s love is her biggest downfall  

My personal journey began clichéd enough - writing in a secret leather diary I intended to keep away from prying eyes, chronicling my life and emotions. Whenever I put pen to paper, I escaped the cycle of depression that seemed to rinse, lather and repeat on me.

What unfolded after, I did not quite expect.  My mother found my diary. As any curious mother would, she read it, probably expecting whimsical stories about schoolboy crushes, maybe even the resultant romps with them and the little babies we would have (adopted). Sure, it did have that, at least at first, but progressively, it got gloomier. My diary served as self-therapy after all, and one does not exactly go to a therapist to recite all that’s good in life. I had been writing pretty dark things.

Keeping yourself recluse can do that to you, and let me tell you, writing when you’re contemplating suicide doesn’t come out nice on paper. I imagine she was wincing, but my mother read on, perhaps stoked that life’s intervening allowed her into the sanctum that is the mind of a scared, misunderstood teen.

You see, weeks before she found my diary, I had been fearing that I could be HIV-positive. About a year before, I took a free HIV test during World AIDS Day that came out negative, as it did the year prior. Two successive years of being HIV-free tend to make you feel invincible. A feeling that was shattered when my best friend who was every bit of as promiscuous sexually active told me he had herpes… and gonorrhoea and syphilis.

Long story short, I had followed him to the clinic for his follow-up appointment for moral support, and had picked up brochures about HIV for casual reading to hide my face in, hoping I didn’t get seen by anyone I knew while in the clinic, or in disgusting ignorance, thinking I could lose my perceived STD virginity by catching it from sitting in the waiting room. I realised, wait a minute, I’ve got a few of these symptoms for HIV. I had shrugged it off (or more likely, entered a state of denial) to the seasonal flu. I did that until came the thrush, and nightly chills.

All this was penned in my sacred diary, defiled by my mother’s eyes. As a reprisal for her desecration, my words put her in a state of unrest - not unlike the frame of mind I myself was in. She got into cahoots with my best friend for an intervention. An intervention that would bring me to the very clinic I was afraid to be seen in, but this time less afraid of catching a disease as being diagnosed with one. My best friend came with me, my mother in tow. All of us were on edge as we waited over half an hour before the results came through.

I guess you’d have guessed by now that the test came up positive;  if not I won’t be here writing and would perhaps, more than ever be up in a place of self-righteous ignorance telling myself ‘it can never happen to me, it only happens in stories.’  I’ll save the sappy parts for another time, but for the matter, most of it came from my mother. I got my diagnosis and just sat stunned in disbe-grief. My mother did most of the crying, like she was crying for two, and my best friend ended up consoling her more than me.

A successive blow came when I had to put my family in financial strain with my month-long hospitalisation after my CD4 count came in with AIDS-level numbers.  I racked up hospital bills over $25,000 for treatments for TB, operations and regular scans.

It was during this time that my mother did her very best, forced not only to come to terms with my sexuality, my sexual activity but also my HIV and at the time, what looked to her like my impending death. She certainly put it that way whenever she spoke to me while I lied helpless in bed, with IV shackles. It’s like I skipped all the basic lessons and little journeys you need for parenting and just dunked her in straight in the deep end of the pool. Of course, with anyone who’s been thrown in to drown, she was furious when she got over the initial shock.

Not long after, our relationship took an even deeper swim than when I had first thrown her in, to the point we did not speak for weeks. Things got so bad, I moved out of the house for almost 2 months after a huge argument. Jobless undergraduate at 20 - not very common with us traditional Asians!  I relied on the compassion and support of friends, all the while thinking, is this the fate I’m resigned to?

The first step to fixing my life came from the most unlikeliest place. Grindr. This is where I would find the nicest 30-something-year-old-man who in the short time of knowing me, offered his house keys and trust after he figured out I was technically homeless. He even got me a job waiting tables. You’d be surprised to know he was an ex-convict,  fresh out of prison, living in a rental flat, who did not force himself on me or expect sexual favours in return. We really only went as far as talking, sometimes cuddling in the morning and me doing my part in cleaning the apartment (mostly my own mess though). It was during this time, when I had much time to think, that a revelation struck me.

All of the bad things had to happen, like my diagnosis, my subsequent hospitalisation and me moving out of the house (my friends would joke and insist on calling a spade a spade – I ran away, like a desperate overgrown teen). If these things had not happened, I doubt either me or my mother could have found it in us to allow reconciliation to happen. It could only transpire after we found ourselves from being lost and caught up in our own situation, hers with disappointment and myself with admitted guilt and self-pity. Amidst all this, we had no time to find the love that bonded us as mother and son. Our relationship had years of strain, and consequently needed time to rid itself of pain.

A year on, and I can’t say we’re perfect. We still have our spats and misunderstandings every now and then, but every family has those. What matters is the worst is behind us, and we discovered through it all how strong our love for each other is. If we could get through that, and find it in ourselves to forgive each other, and ourselves, to move on… we could get through anything.  We after all share the same blood - even if one has HIV coursing through it.

"Recently infected individuals: A priority for HIV prevention" by James Wilton first appeared in Prevention in Focus, Fall Issue 2011, a publication of CATIE. A French language version is available here. 

People living with HIV can potentially transmit HIV to others through unprotected sex at any time during their life. However, emerging research suggests that a disproportionate number of HIV transmissions—perhaps more than half—may originate from people during the first few months after they become infected with HIV. In this article, we explore why recently infected individuals are more likely to transmit HIV to others and how we can help prevent these transmissions from occurring.

 What’s happening in the body after HIV infection?

To understand why recently infected people are more likely to transmit HIV to others, we need to look at what’s going on in the body after HIV infection occurs.

After someone becomes infected with HIV, the virus begins to replicate very quickly and the amount of virus in the body and bodily fluids (such as the blood, semen, vaginal fluid and rectal fluid) rises rapidly. In some individuals, this takes its toll on the body and can cause fever, fatigue, night sweats, headache, diarrhea, sore throat and/or a rash. These symptoms generally appear about two weeks after infection occurs. Other individuals who become infected notice no symptoms at all during this period.

A few weeks after infection, the body’s immune system begins to fight back against the virus. An important part of this immune response includes the production of anti-HIV antibodies—small proteins made by certain immune cells, which can destroy HIV and prevent HIV from multiplying. Once antibodies to HIV have been produced, HIV replication begins to slow down and the amount of virus in the body (also known as the viral load) gradually decreases. Unfortunately, antibodies cannot fully control HIV infection.

Antibodies are not produced immediately after infection. The amount of time it takes for the body’s immune system to produce them varies from person to person. In most people, it is possible to detect HIV antibodies in their blood within approximately 34 days of infection, although this can take up to three months in some individuals. The presence of antibodies in the blood marks the end of the first stage of HIV infection—known as acute HIV infection—and the beginning of the next stage, chronic HIV infection.

The amount of virus in the bodily fluids is highest during the acute HIV infection stage. After antibodies are produced, the viral load slowly decreases but does not stabilize at a lower level until up to six months after infection.

Why do people with recent HIV infection account for a disproportionate number of transmissions? 

Higher infectiousness

The elevated viral load of someone recently infected with HIV is the main biological reason that they are more likely to transmit HIV to others at this time. The higher the viral load, the greater the risk is of transmitting HIV to others through unprotected sex. Researchers estimate that the risk of transmitting HIV to another person from one act of unprotected sex is 26 times higher during the first three months after infection than during the months and years that follow.

More high-risk behaviour

A high viral load alone is not enough to transmit HIV to another person; a recently infected individual also needs to be engaging in activities that can lead to the transmission of HIV, such as unprotected sex. Unfortunately, a person who has recently been infected with HIV is more likely to be engaging in high-risk behaviours than a person who has been infected for a longer period of time. There are two possible explanations for this. First, a recently infected individual is more likely to be engaging in high-risk behaviours because this is what led to their HIV infection. Second, many recently infected individuals are unaware of their HIV status and therefore may not realize the importance of having safer sex.

Reducing the number of transmissions from recently infected individuals: Challenges and solutions

Because recently infected individuals account for a large number of HIV transmissions, identifying these individuals and helping them reduce their risk of passing HIV to others is critical to HIV prevention. Research shows that when people become aware of their HIV infection and are provided with access to prevention and care services, most take measures to reduce their risk of transmitting HIV to others.

There are two major challenges to identifying recently infected individuals:

 1. the low levels of HIV testing in Canada; and

 2. the limitations of certain HIV tests.

As a consequence, many people who have recently become infected are unaware of their infection, as are their partners. Those who are recently infected may therefore continue to engage in high-risk behaviours until they are diagnosed with HIV.

Your organization may be able to play a role in overcoming these challenges, identifying these individuals, and reducing their risk of transmitting HIV to others.

Challenge: Low levels of HIV testing

It is estimated that 26% of people who are HIV-positive in Canada do not know that they are infected and many do not learn of their HIV status until they have been infected for several years.The low levels of HIV testing in Canada means that most recently infected people probably pass through the brief stage of HIV infection when their viral load is elevated without getting tested for HIV.

People who have recently become infected may be unlikely to get tested for several reasons. Firstly, many may believe that they are not at risk for HIV infection despite participating in behaviours that put them at risk. Secondly, there are no definitive signs that someone has become infected with HIV. Only some people who have recently become infected will experience symptoms and those symptoms are not specific to HIV infection. Therefore, many people who experience symptoms may confuse them with those of another illness and not get tested. Furthermore, for people who do believe that they are at risk of infection, there are several barriers that may prevent them from getting an HIV test, including stigma and discrimination, fear of criminalization, and barriers to accessing testing and other health services.

Solutions

 • Outreach and educational campaigns are needed to improve people’s awareness of their risk of infection and of the symptoms associated with recent HIV infection. People need to be encouraged to get tested if they are engaging in behaviours that put them at risk for HIV infection or have developed symptoms (such as fever, fatigue, night sweats, headache, diarrhea, sore throat and/or a rash) after a high-risk exposure.

 • Frontline service providers need to increase awareness of the need for, and benefits of, HIV testing among people who are at risk of infection. It is important that HIV-positive people learn about their HIV status as soon as possible after infection, regardless of whether or not their viral load is still high, so that they can access treatment and support services for people living with HIV and counselling on ways to prevent transmitting HIV.

 • Access to HIV testing, particularly for marginalized populations who are at risk of HIV infection, needs to be improved. Frontline organizations may be able to play a role advocating for improved access.

Challenge: Limitations of HIV tests

The limitations of tests used to detect HIV infection is another major barrier to identifying recently infected individuals.

Several types of HIV tests are available but for each type of test there is a brief period of time after infection during which they are unable to detect infection in a person who is HIV-positive. The time period from when a person becomes infected with HIV to when an HIV test can detect their infection, is known as the “window period.” During the “window period,” an HIV test may find a recently infected person to be HIV-negative. The length of the “window period” is different for each type of test and varies from person to person.

The HIV tests most commonly used in Canada look for antibodies to HIV in the blood. These tests cannot detect HIV infection in someone who has acute HIV infection because the body has not yet produced antibodies. The “window period” for antibody tests varies because some people produce antibodies faster than others. For most people (up to 95%), the window period of the antibody test is approximately one month, but for some individuals it may be as long as three months.

This means that for people at high risk of HIV, testing can be done as early as one month after exposure using standard antibody assays and rapid point-of-care tests. People who test positive will know for certain they are HIV-positive. Of those who test negative, 95% are indeed negative. Up to 5% of people who test negative at one month could later test positive at three months. It is important to ensure that people who test negative at one month are advised to return for repeat testing once the three-month window period is over.

Other HIV tests have been developed which detect the virus itself—such as the HIV RNA or the p24 antigen tests. These have shorter window periods (from seven to 14 days) than antibody tests and so can potentially detect HIV infection during the acute phase.20 Unfortunately, access to these new testing technologies varies across Canada.

Another limitation of HIV tests is the time it takes for many of them to produce results. Most HIV tests do not produce results immediately and require people to wait one to two weeks before getting the results. During this time, people may continue to engage in high-risk behaviours and some people may never return to get their test results.

Tests known as rapid or point-of-care (POC) tests can provide results on the same day that a test is performed. Most rapid/POC tests can provide results within minutes. This ensures that a person receives their results. Rapid tests that detect antibodies are available in some parts of Canada but rapid tests that can detect HIV RNA or the p24 antigen do not yet exist.

Solutions

 • Frontline service organizations need to increase people’s awareness of the different “window periods” for each type of HIV test, and emphasize that a negative result does not necessarily mean that a person is HIV-negative. Messaging should emphasize that a person who has recently tested HIV-negative may be in the “window period” and may be highly infectious. Knowledge of the “window period” and the increased risk of transmission during this time is particularly important for people who base their decisions of whether or not to have unprotected sex on knowledge of their HIV status or their partner’s.

 • People who test HIV-negative within the “window period” should be encouraged to refrain from high-risk behaviours and return for another HIV test at an appropriate time. A second test is important to rule out the “window period” as the reason for the test being negative. In Canada, we encourage people who test HIV-negative on an antibody test to test again at the end of the three-month “window period,” or sooner if appropriate.

 • Organizations should learn if, and where, rapid antibody testing or RNA/p24 testing is available in their area. A person who is suspected of being in the acute stage of HIV infection (for example, if they have recently had a high-risk exposure or they have experienced flu-like symptoms after the exposure) should be referred to a site where RNA or p24 testing is available. Service providers may need to advocate for improved access to rapid antibody testing and RNA/p24 tests in their area.

Conclusion

The goal of HIV prevention is to reduce the number of HIV infections in the communities we serve. A large number of HIV transmissions in your communities may be occurring from recently infected individuals, and therefore represent an important priority for HIV prevention efforts. Although several challenges exist in identifying these individuals and engaging them in prevention services, frontline organizations can play a key role in overcoming these challenges and reducing HIV transmissions.

James Wilton is the Project Coordinator of the Biomedical Science of HIV Prevention Project at CATIE. James has an undergraduate degree in Microbiology and Immunology from the University of British Columbia.

Check out Hottest at the Start  – a campaign by the Health initiative for Men (HiM) in BC to raise awareness on acute infection and transmission and to encourage gay men who have had a recent potential exposure to HIV to get an ‘early’ HIV test.

See PositiveLite.com’s John McCullagh interview HiM’s Jody Jollimore about this campaign here. 

For CATIE's full list of references, with links, to today's article, please go to the original article here. 

Check out CATIE's own blog on PositiveLite.com here.

We have our first complete run through of the play tomorrow evening, I can’t wait.  I’ve just completed memorizing my lines for all 3 roles I’ll be playing (hoorah).  I have to say that everyone in this production has full-reigns on this; it means a great deal to each and every one of us.  There is a young man on board with us who is an absolute joy to watch and listen to.  He is also a victim of bullying, and it tears me apart.

I believe most bullying consists of a true sense of boredom, jealousy and outright need to feel important.  The only means to ride out all of this hatred and criticism, to me, is to try your best to succeed and do it well, but to allow space for those who truly want to help because as I said before, we can’t do things alone. 

A friends put words (by Joe Lethbridge) to a video he put together regarding a close friend of his……………………”Intolerance and hateful words, action and inaction SILENCED my friend forever”.  Wonderfully said and I feel this statement should be engraved on every school as you enter the building.  Yesterday Joe sent me something he’d written with respect to when his son was quite young.  He said to his dad, there’s something scarier than AIDS…………..(AfrAIDS).  I thought this was quite cute. (Editor's not:  You can read it on PositiveLite.com here.)

Last night I walked to the variety store to pick up a couple of things.   I happened to walk in the store at the same time as another gentleman did, and we both walked to the freezer section.  I grabbed some half-and-half  and held the fridge door for him while he grabbed some milk.  We both went on to grab a couple of other items, and proceeded to the cash counter.  He instructed the cashier to include my items with his.  We spoke briefly outside, and then he got in his car with his wife and drove off.  This reminded me of a time when I heard that this woman spotted a couple in a grocery store who had helped her change her flat tire on the side of the road, and she paid for their cart full of groceries.  It truly is amazing how these gestures can make a person feel so good………if you haven’t tried it yourself or had it happen to you………..I hope you do.

Back to The Laramie Project,  I hope I’ve given people an indication of how important this play is, not only for myself but for others as well.  This story is only one of thousands, hundreds of thousands of unjustifiable events that have happened over our existence as human beings on this planet earth, and none of these events should ever have  taken place.  I feel it’s up to each and every one of us to find our own means to make the necessary changes to provide our lives with utmost simplicity and certainty.

I’d like to take a moment to notify people that tickets for the “Laramie Project” – 10 yrs later will be available starting the first week of April, 2012 and are only $5.00 each, in order to help encourage people to come.  Also, I’d like to express that if you wish to make any gift-like donations to help out with raising funds towards the cost of the production, please contact Deardra or Karen at 519-496-5383.

Runs April 25-27. Tickets can be purchased:

1. At SIZZLE in Cambridge, Ontario -- open Wednesday to Saturday evenings

2. Or by email -- This email address is being protected from spambots. You need JavaScript enabled to view it.

Items for donation needed by April 12 please!