This article by Michael Carter was first published by NAM/aidsmap. Republished with permission. 

The ongoing HIV epidemic among gay men in the Netherlands is due to increased rates of unprotected sex, investigators report in the online edition of AIDS.

Higher rates of risky sex, especially among undiagnosed individuals and men who are not taking anti-HIV drugs, are offsetting the benefits provided by testing and antiretroviral treatment.

“The resurgent epidemic in the Netherlands as a whole can be satisfactorily…explained by increased risk behaviour, predominantly in undiagnosed individuals,” write the authors.

Gay men continue to be a main focus of the HIV epidemic. Diagnoses have increased in recent years, and there is some evidence that HIV incidence in gay men is also on the rise.

Possible causes of the ongoing and possibly resurgent HIV epidemic in gay men include high rates of unprotected sex involving individuals who are unaware of their infection and those who are not taking treatment and the high rates of other sexually transmitted infections that are present in gay men.

An international team of investigators wanted to get a clearer understanding of the causes.

They therefore developed a mathematical model that was based on annual data for HIV and AIDS diagnoses in the Netherlands between 1980 and 2009. Incorporated into the model were assumptions about the efficacy of HIV therapy, and the infectiousness of individuals during the acute and chronic phases of HIV infection, as well as the impact of suppressive antiretroviral therapy on the risk of transmission.

Using this model, the investigators calculated transmission and diagnoses rates.

These were also estimated using information obtained from the Amsterdam Cohort Study. This was established in 1984 and the investigators focused on data concerning the proportion of HIV-negative men reporting unprotected anal sex in the previous six months with another man.

There was agreement between the two models. Both showed that risk behaviour fell by approximately a half between the mid-1980s and the mid-1990s. This limited the spread of HIV among gay men.

However, incidence then increased. This was primarily driven by increased rates of unprotected anal sex involving undiagnosed men.

“The increase in risk behaviour among untreated individuals is offsetting benefits in terms of reduced incidence offered by enhanced testing and treatment, which reduce transmission,” comment the investigators.

Thanks to the health benefits of antiretroviral therapy, there was no evidence that the resurgent epidemic was associated with increased mortality rates. “However the long-term healthcare costs and infection-associated morbidity will likely be substantial,” warn the authors.

They conclude, “reductions in incidence could be obtained by increasing rates of diagnoses, by reducing time to initiate antiretroviral therapy, and by encouraging individuals to practice safe sex.”

Reference

van Sighem A et al. Increasing sexual risk behaviour amongst Dutch MSM: mathematical model versus prospective cohort data. AIDS 26, online edition. DOI: 10/1097/QAD.0b013e3283574df9, 2012.

This article by San Patten first appeared in Prevention in Focus, a publication of CATIE.

Une version française est disponible ici.  

Biomedical tools for HIV prevention, also known as new prevention technologies (or NPTs), are often touted as tools that will give women greater control over HIV prevention. But will these tools actually empower women? Here, we explore this question and some reasons for optimism and skepticism. 

Women are more vulnerable to HIV

In Canada and around the world, many women are at a disadvantage socially and economically. These disadvantages mean that women are often at risk of HIV infection because they lack the power to negotiate the use of HIV prevention measures, such as condoms, abstinence and mutual monogamy. In addition, all women are biologically more susceptible to HIV infection through heterosexual sex than men for several reasons. Firstly, women are exposed to more HIV during sex than men because the volume of semen is usually greater than the volume of vaginal fluid and because semen contains a higher concentration of HIV. Secondly, more of a woman’s mucous membranes are exposed to HIV because the surface area of the vagina is greater than that of the penis. Finally, HIV has more time to cause infection in women because semen can remain in prolonged contact with the vagina following unprotected sex.1,2

 “Abstinence and condom use may be impossible for women to enforce. Fidelity is of no use unless it is mutual, and men’s faithfulness very often lies outside of women’s control.”3

Expanding the HIV prevention toolkit

Efforts are underway to develop several new technologies to prevent HIV, including microbicides, vaccines, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and HIV treatment as prevention. In recent trials, some of these NPTs have proven successful.

These new technologies may have the ability to expand the HIV prevention toolkit, giving women more options to protect themselves from HIV. When thinking about the potential value of NPTs, a helpful analogy is the range of contraception options available to women (see figure). Currently available contraceptive options are considerable and each woman can choose a method based on her personal needs and preferences. Similarly, potential new HIV prevention options would greatly expand women’s options for HIV prevention and provide a range of timing options (before, during or after sex) and modes of use (oral, topical or injectable), thus allowing each woman to choose the right option for her. 

Just as women have very different preferences for birth control, women would also have options for preventing HIV transmission. In other words, the more options to choose from, the better, because there will never be a “one-size-fits-all” option that is acceptable to all women. 

The potential for women’s empowerment 

Will these new NPTs increase women’s control over HIV prevention? 

Reasons for optimism 

One of the main arguments for the potential of NPTs to provide women with more control over HIV prevention is that women could use NPTs without the consent or even the knowledge of their male partners (this is sometimes called covert use). Therefore, NPTs may help women who experience problems negotiating safer sex and are less empowered to insist on condom usage—such as women who do commercial sex work and women in coercive relationships.4 While NPTs such as PrEP and microbicides are not likely to provide the same amount of protection as condoms, some protection is better than none in cases where the male partner refuses to use a condom.5 

Also, unlike condoms, many NPTs would not have to be used in “the heat of the moment” and therefore may make negotiating safer sex easier for women. Biomedical research is shifting from focusing on prevention methods that need to be used at the time of the sexual encounter to methods that can be used before and/or after sex.6 It may be easier for women to negotiate these methods than to convince a male partner to use a condom during each and every sexual encounter. 

Another key benefit of NPTs for women is that they could allow women to conceive while at the same time protecting against HIV infection. The primary HIV prevention method currently available—condoms—does not allow for safer conception between serodiscordant couples (where one is HIV positive and one is HIV negative). Developing HIV prevention tools that would allow for conception while still reducing the risk of HIV infection would have a significant advantage for serodiscordant couples wanting to have a child. 

Prevention methods such as condoms and abstinence are not always realistic options for women, especially those who are married, who want to have children or who are at risk of sexual violence. A safe and effective microbicide, PrEP or HIV vaccine could provide women with more options for protecting themselves from HIV infection. 

Reasons for skepticism 

While there are reasons for optimism, NPTs may not be the panacea for women’s equality and empowerment that they are sometimes thought to be. 

Even if NPTs become available and even though the use of NPTs would technically be under a woman’s control, it may not be possible for many women to use an NPT.6,7  Whether a woman decides to use an NPT is a complex process.8 Her decision will be based on several factors: Does she think she is at risk of HIV infection from her partner? Does she understand how the NPT works? Can she afford the NPT? What does she anticipate her partner’s reaction to be? Does she have enough autonomy to make her own decisions about her sexual and reproductive health? Finally, some studies have shown that, just as with condoms, many women are unlikely to use NPTs with their regular partners. The reasons given include the perception that an NPT could reduce their own or their partner’s pleasure and the concern that their partner may interpret NPT use as a sign of mistrust.8,9,10 

Although NPTs could theoretically provide women with more control over HIV prevention and allow women to use prevention methods discreetly, the use of some NPTs may not be all that easy to hide. For example, an attentive male partner might notice the extra lubrication or a different sensation from a microbicide, or find his partner’s stash of PrEP pills. In some cases, if women are discovered using prevention products, they could face adverse consequences, even violence, as the products might be seen as an affront to men’s power and the traditional gender norms.9,11,12 So, although NPTs could offer women more choices, there is no guarantee that they will empower women. 

A woman may also face negative consequences if she does decide to negotiate NPT use with her partner. For example, broaching the topic of NPTs with their male partners might signify mistrust and/or infidelity.12,13 Also, if women tell their male partners about their use of an NPT, men may decide that they no longer have to use condoms, which could increase women’s risk of HIV transmission since NPTs are not as effective as condoms.8,10 This effect is known as risk compensation. 

NPTs could also further entrench women’s responsibility for sexual health, rather than promoting a shared responsibility. Women are already primarily responsible for birth control, and NPTs could add to the burden on women to make sex “consequence-free” for their male partners.8

A lot can be learned from our experience with the female condom, which is currently the only female-initiated prevention tool currently available.14 Although touted as a tool that would empower women, the female condom has generally not lived up to its expectations for various reasons including difficulties with covert use, poor acceptability among some women, and its relatively high cost. 

Key messages that we can all get behind

When discussing the value of NPTs, we need to avoid over-simplifications of their (potential) link to “women’s empowerment.” Although NPTs may empower some women in some situations, they won’t bring about universal sexual empowerment.

NPTs should not be seen as a “quick fix” solution nor should they distract attention from the need for social change and multi-level interventions that address gender inequality, poverty, and other forms of discrimination that make women more vulnerable.8,10 It is clear that NPTs will not have an impact unless the underlying social, economic, political and cultural conditions that make women more vulnerable in the first place are tackled. Addressing these conditions will also help remove the barriers that prevent women from using these new prevention options.

Therefore, NPTs must be offered within a comprehensive approach to HIV prevention—one that balances structural changes (such as poverty reduction and gender equality), expanding and strengthening existing prevention strategies (such as behavioural interventions and the distribution of male and female condoms) and NPTs (such as PrEP and microbicides).

Frontline service providers and policy-makers need to understand the potential gender dynamics that will influence if and how women will use NPTs as they become available. Clearly, biomedical tools cannot replace women’s sexual and reproductive autonomy, but they could provide the means by which women exercise such autonomy.

Resources

 •The epidemiology of HIV in women – CATIE fact sheet

 •Post-exposure prophylaxis (PEP) – CATIE fact sheet

 •Pre-exposure prophylaxis (PrEP) – CATIE fact sheet 

References

 1. O'Brien TR, Busch MP, Donegan E et al. Heterosexual transmission of human immunodeficiency virus type 1 from transfusion recipients to their sex partners. Journal of Acquired Immune Deficiency Syndromes. 1994; 7(7):705-710.

 2. European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ. 1992 Mar 28; 304(6830):809-13.

 3. Dunkle KL, Jewkes R. Effective HIV prevention requires gender-transformative work with men. Sexually Transmitted Infections. 2007 Jun;83(3):173-4.

 4. Youle M., Wainberg MA. Pre-exposure chemoprophylaxis (PrEP) as an HIV prevention strategy. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill: 2002). Jul-Sep;2(3):102-5.

 5. PrEP Implementation Policy Forum: Developing Country-Level Participation and Capacity for PrEP Implementation [Internet].  Geneva: International AIDS Society; 2007 [cited 2010 Feb 5]. Available from: http://library.iasociety.org/MediaView.aspx?media_id=3340

 6. a. b. Sawires S, Birnbaum N, Abu-Raddad L, Szekeres G, Gayle J. Twenty-five years of HIV: lessons for low prevalence scenarios. Journal of Acquired Immune Deficiency Syndromes. 2009;51(Suppl 3):S75-S82.

 7. Koo HP, Woodsong C, Dalberth BT et al. Context of acceptability of topical microbicides: sexual relationships. Journal of Social Issues. 2005;61(1):67-93.

 8. a. b. c. d. e. Mantell JE, Stein ZA, Susser I. Women in the time of AIDS: barriers, bargains, and benefits. AIDS Education and Prevention. 2008 Apr;20(2),91–106.

 9. a. b. Hoffman S, Morrow KM, Mantell JE et al. Covert use, vaginal lubrication, and sexual pleasure: a qualitative study of urban U.S. women in a vaginal microbicide clinical trial. Archives of Sexual Behavior. 2010 Jun; 39(3):748-60. Epub 2009 Jul 28.

 10. a. b. c. Mantell JE, Dworkin SL, Exner TM et al. The promises and limitations of female-initiated methods of HIV/STI protection. Social Science and Medicine. 2006 Oct;63(8):1998–2009. Epub 2006 Jul 11.

 11. Tolley EE, Severy LJ. Integrating behavioral and social science research into microbicide clinical trials: challenges and opportunities. American Journal of Public Health. 2006 Jan;96(1):79-83. Epub 2005 Nov 29.

 12. a. b. Tanner AE, Fortenberry JD, Zimet GD et al. Young women’s use of a microbicide surrogate: the complex influence of relationship characteristics and perceived male partners’ evaluations. Archives of Sexual Behavior. 2010 Jun; 39(3):735-47. Epub 2009 Feb 18.

 13. Woodsong C. Covert use of topical microbicides: implications for acceptability and use. Perspectives on Sexual and Reproductive Health. 2004 May-June;36(3):127-131.

 14. UNAIDS. UNAIDS Report on the global AIDS epidemic. 2010.

About the author

San Patten is a health research and evaluation consultant who has worked extensively on issues relating to injection drug use, the sex trade, and new HIV prevention technologies. San completed a master’s degree in Community Health Sciences at the University of Calgary, is an adjunct professor in Sociology at Mount Allison University (specializing in social policy and non-profit leadership), and is a co-investigator of the Centre for HIV Prevention Social Research at the University of Toronto.

There are three challenges to writing about HIV, that is, the Human Immunodeficiency Virus, the underlying cause of AIDS, Acquired Immune Deficiency Syndrome.

One, you have to decide whether to use the raging language of the apocalypse (for the uninfected), all the better to scare the kids straight, no pun intended, on the danger of it, or (for the infected), the soothing tones of love, hope and survival.

Two, you have to decide whether to write about the medicine of it, the politics, the demographics, the support system, the brave folk battling the disease every day, your inevitably uplifting personal story (mine's here), so many options.

Lastly, if you write about it as often as I seem to be doing these days (three major pieces in the course of a week), you have to force something fresh out of your bleeding fingers even as your keyboard seems to be giving you, though how it does that remains unknown, an accusatory look. I suspect there's an app for that, Steve Jobs' late, lamented genius for perfection being what it was.

But KosAbility is a series about disabilities, more specifically, about how Kossacks live with them. Legally, I am disabled – not because of the virus, that's no longer sufficient, but because I had a real, red-blooded-American AIDS diagnosis at one point, which is. In actual, non-legal fact, I'm a man in his prime with the full panoply of physical and mental abilities the healthy male body provides. How that came to be, you can find out over the Orange terrorist-fist-bump Eye of Sauron.

Or whatever we're calling that..   thing... these days.

The simple fact is that, yes, I am infected with HIV, and probably have been for a decade or so. Am there, have that, literally own the t-shirt. Wore it in Providence, come to think of it. What always strikes me, however, is how much of a bigger deal this wardrobe choice, and the assumptions it creates, seems to be for everyone else than it is for me.

And yes, of course I'm going to start a post about a global pandemic by talking about clothes.

There are expectations, mind you. One of them is, to appropriate Joseph Chamberlain, of the weary titan, staggering under the too-vast orb of its fate – that one spends every waking moment consumed with the thought of this unvanquished disease slowly eating away, unseen, much as Dorian Gray was consumed by his portrait withering away in its hidden attic. Flowing presumably from this is the idea that, as one of the few gay men in the progressive blogosphere publicly out of the closet about my status – really, the sheer irony of it boggles the mind – I'm naturally qualified to be an information source, cautionary tale or poster boy.

It intrigues me that some people should think any of that. To be entirely candid, I don't spend a lot of time thinking about HIV. I don't have the funereal mindset this would require or the distance to see the subject dispassionately. If anything at all, I lose sleep over the kids, many or most of whom don't have my support system, my loving family, devoted partner, great circle of friends. As far as I'm concerned, however, as I live it, this virus is a routine, more an annoyance than a burden; large amounts of blood drawn every three or six months, a pill before dinner, done. HIV, for me, has receded into the background.

At first glance, not all that terrible, is it? And really, it's not. Which is maybe why....

Being positive, in my world, among my friends, is the new normal.

[HIV prevalence 2009, New York City by ZIP code, Source: aidsvu.org]

The picture above is a map of the five boroughs of the City of New York. See those purple areas? Going clockwise, they're the West Village, Chelsea and Hells Kitchen (the main gay areas), Harlem, The Bronx, and central Brooklyn. They correspond quite neatly to the main demographics HIV affects: gay men and African-Americans of all genders, and agonizingly, far too many young people of color to even contemplate.

Estimates vary, but I hear about one in four gay men here at home, the City of New York, carry the virus. Nationwide, the numbers at least in urban areas are similar, and we – men who have sex with men – are the only demographic that sees an increase, year over year, every year for now over a decade. Some statistical evidence suggests that new infections are occurring at a rate comparable to what it was before the advent of miracle drugs.

Why?

Among other reasons, because a lot of guys are fucking without condoms. It's called barebacking, and in my experience at least, is either already normative behavior or becoming such. Combined with the dramatically increased life expectancy of men like me and several other factors, it is a mathematical certainty that the absolute number of HIV-infected gay men will rise, even dramatically so, as will our share of the larger gay male population. We are living decades longer, and every year, every day, every nine minutes, more join the ranks.

And that's where we get to HIV Normal.

On the surface, for me at least, this new normal is tolerable. I know I'm not going to die, certainly not any time soon. I have the kind of killer body you get from going to a gym every day. Those baby blues are still sparkling, and I look a decade younger than I am. This year for Pride, I marched down Fifth Avenue, with ACT UP, in underwear and combat boots; quite spectacular, if I do say so myself. The side effects from the drugs - actually, the drug, singular – are few, if any. I know there is stigma out there; I just haven't experienced it. Only one in four HIV patients have the virus under control; I do. Even my blood pressure is perfect. As I said: I've been lucky.

Of course, t'was not always thus. That first year after the diagnosis was, not to sugarcoat anything, a living hell. I suspect it's the same for everyone who gets that new chapter turned, no matter what the heading is; if something can kill you, odds are, puppies and unicorns aren't going to be first to mind. For me, it fucked up my career, and slapped me in the face with the idea of my own mortality. The five stages of grief – been there, done that. There is a 'before', and now, there is 'after'.

The biggest problem, though, wasn't anything external, it was the film running through my head. All those awful pictures from the eighties, the dead friends, the funerals – great, my turn. Damaged goods, the one mistake I'd never be able to fix. In the crushing loneliness of that test result, you question every choice you've ever made. At that point of the journey, not a few people commit suicide.

And then, it gets better. Maybe because the very real distinction between 'automatic death sentence' and 'chronic disease' kicks in. Maybe because of some small kindness you give or receive. Maybe because a random hookup turns into such cinematically epic sex you walk funny for days and can't wipe that grin off your face. Maybe it's the realization that you're now a part of something much bigger than yourself, this grand tragedy, bitter and sweet, that is mankind's struggle with this newest plague, and that you have some fucking responsibility to those who came before.

Whatever it is, you realize that 'before' and 'after' don't need to be all that different.

So that's where I'm at – stage five, acceptance. Yes, there are changes. I take a much closer look at nutrition (that single pill, awkwardly, sucks calcium out of your body like a two-dollar hooker), get lots of exercise and sleep. My sex life is still – or rather, again – the stuff that mere mortals only get to dream of, and though I confine myself to men with my serostatus, that's still a big pool with many tasty, talented fish. My sense of humor is still quite intact, thank you very much, and I haven't gone off to find God. I'm both more kind and more skeptical than I was a decade ago, though still as insufferably full of myself as ever.

Of course, my glittering life in the Imperial City could be built on quicksand. People do still die. We have no idea what the long-term effects of those fabulous pills are, or if their efficacy has a shelf life. The political and societal environment could change beyond recognition.

But right now, at this moment in time, life is good.

--- The End --- .

This article first appeared in The Daily Kos/KosAbility. Republished with permission.

I’ve been asked once again to partake in another speak with the VOLUNTEER ACTION CENTRE  (VAC) in Kitchener, with a message that read as follows:

John, I was hoping to ask you to share your volunteer story once more; for the United Way's Day of Caring on September 19, the Volunteer Action Centre is working with a Day of Caring team to help develop their own volunteer stories and public speaking skills; it's been truly inspiring to see how the interview project you were a part of through VAC has inspired others, and we'd like to continue the ripple effect!

As you have experience through AIDS Committee of Cambridge, Kitchener Waterloo and Area (ACCKWA)'s Speaker's Bureau, I was hoping you might be available during the morning that day to talk about your journey towards becoming a storyteller to help inspire the team, and then, at the end of the session, sharing your own volunteer story.

The reason for today's title is again to emphasize on a statement I made in one of my previous blogs..............”If you told me I would someday be speaking publicly about my HIV status, I would have had to laugh through the tears.”  I find these public speaks extremely fulfilling and empowering, as we all have a story to tell and it encourages us all to hear other people speak of their own life battles and accomplishments.

When it comes to sharing our values as human-beings, I feel there should be no boundaries to what we’re capable of doing.  As I previously mentioned this is ACCKWA’s 25th anniversary.  The AIDS Committee of Cambridge, Kitchener, Waterloo and Area has been my 2nd family since 1997, and just a few weeks ago I was nominated for the Gretchen Sangster Award for Education.  I strongly feel that this world would be a better place sometimes if everyone simply took the time to volunteer.  You get back what you give in life, and from my own life experiences I have had immeasurable times of happiness and fulfillment from my volunteer work.

The agency continues to grow from its own strengths and need for services.  The office is currently in a shambles due to construction as the kitchen has been made smaller to accommodate yet another office and addition to ACCKWA’s family of staff.  I certainly hope to do my part to ensure ongoing success in their support for clients.  I get so stumped for things to talk about at times, life can be so overwhelming.  I have to go in for repeat bowel surgery next month and have a biopsy to check for cancer.  I’m awaiting my results to see whether I have a stomach hernia.  Today I go to be fitted for orthodics for a bone spur on my one heel, and I’m hoping it will assist with the neuropathy in both feet also.  We all have our problems I know, and talking about it helps somewhat, I suppose.

I’m very excited to be going to camp this next week which is organized through the agency.  Last year was my first time attending and I’m ecstatic to be returning this year.  It’s a week away for people living with HIV to just do nothing if they want, or participate in activities throughout the week.  I’m so proud of what the agency is doing for clients, keeping sources of activities available to participate at one’s own level.  I have to say this is not just an ASO (AIDS Service Organization).  It’s a place to feel connected with others and challenge yourself to become the person you once were or the person you want to become.  

I set out way back in 1987, two weeks after my best friend in the entire world at the time died, and I ended up on the public speaking track. Even though getting up in front of people was the scariest thing to do.

A fellow died on a Winnipeg hospital palliative care ward way back. After he died, the infection control nurse at the time said to one nurse, “At least Terry isn’t suffering anymore.” To which the palliative care ward nurse replied, “I don’t think he suffered enough.”

We had to form a human chain around Terry’s casket outside the funeral home to block CBC news from filming it.

In Regina, the guys were so afraid of anyone finding out about their status, they would not go to see a doctor, and would only receive medical care if dragged into hospital by ambulance. 

At the time there weren’t regular CD4 tests, and when they were, they had to be shipped up to Saskatoon to be processed. Finally we had arranged for once a month blood drawing. I literally had to hand hold a couple of people going to the hospital. The thought of sitting in a public waiting room was almost too much for them to handle. 

In Regina, I had a dental assistant give out my personal information to her husband who called me at home. I was shocked. The hour turned into a counseling session, and I managed to make my way through it. Being in a city of 180,000 people, I felt so vulnerable.

This was after I had agreed to have my name on a press release for World AIDS Day in Regina by Sask Health, not realizing what kind of media frenzy would ensue.

Ironically, in Saskatchewan, there maybe had been one other person who was courageous enough to be public. This was a time when there were no medications, people were dying horrible deaths, and to admit to being HIV positive was to admit to being a leper.

Truthfully, I was scared to go out to the gay bar after that. In my mind everyone would be pointing at me and talking about me. Instead I received a lot of respect. Once I finally did get out, I had a great time.

These are the roots and history I come from. This was a time when many services did not exist for HIV+ folks. It took a lot of advocacy work to get the Village Clinic operating at the time. I didn’t come on the scene until the Clinic was well set up. I hold the grand title of the first person they had to give a positive test result to.

Not related, but by chance, my attending physician at the time committed suicide three months later at the very hospital where the nurse whose empathy left little to be desired.

I was asked to speak to those palliative care nurses after the “incident.” It took all the courage I could muster to get up and talk in front of people, even a small group of eight. The evening went well, and I spoke to another group of nurses and that’s how it all started.

These are the kinds of things I mean when I tell others to muster up their own courage to do what they want in life. Find a challenge, take on a fear, do something to not have HIV be the sum total of all your parts. 

Back then we fought the victim stereotype. In the media we were  labeled as AIDS victims. By extension many felt there were innocent victims in all of this, especially wives of gay/bi guys, children and those infected through blood products.

Did I forget to mention that so many people were dying that I had lost count, meanwhile waiting for the other shoe to drop?

What got many of us through those dark times was humour. It was an essential part of our coping mechanism, especially when working and living with HIV.

This is why I snapped, when I shouldn’t have, at some guys on the internet. After the moment passed, I took everything down. It’s always frustrating to put a lot of oneself into something, and then have people sit back and judge, and I mean morally.

This is my truth, and this is my voice. I can safely say I earned it. Even if I let that voice go way off at times, it’s still my voice. Nobody is going to shut it down. 

If you don’t like what I have to say, then go out and do this kind of stuff on your own. Create your own voice. Take the  initiative to do something other than complain.Take part in a stigma campaign, get your face out there. Visibility is important. 

My own personal journey living with HIV has evolved so much over time. It's a journey full of experiences that someone newly diagnosed couldn't possibly understand, unless they were old enough to live through it and become positive later in life. One does have to be positive for more than five minutes before he or she could know what came before them, and how this informs today's culture.  

Many of us who’ve been living with HIV for such a long time are in search of more. I’m still here; now what? For me it was a question of pursing my long time held dream of getting into improv, sketch comedy, and doing stand up.

In a reactive moment I was actually being insecure, not secure.  I was coming off a very busy week where getting on a stage and opening up is an intense and vulnerable place. 

I just so happened to get this message from a straight male comic who has seem me perform, and it was perfect timing: 

Was talking bout you and your awesomeness the other day and thought you should know! KEEP UP ThE HONEST, LIFE MY FRIEND. 

The lesson this week: do not respond to detractors, and the more people tell me I can’t say something, the more committed I am to saying it.