. . . And everything you say is meant with good intentions and not in any way meant to upset or undermine, however there are times it just comes across as presumptuous and patronizing.

I am talking about people who when entering discussions with people who on a daily basis manage chronic conditions decide that it’s wise to enlighten us or question our methods of managing these conditions. 

The actual condition that the person being lectured has is almost irrelevant; it could range from insomnia or sleep apnea, through to cancer and HIV. It just seems that at times people who in fact know very little, feel the need to tell us how much they do know and in doing so show that they in fact know nothing about the condition they are commenting on. 

It’s not everyone by any means, but the offenders are often repeat ones. I have friends who, knowing little or nothing about HIV, ask me questions about my condition; they have an actual desire to learn more about whom I am and what I have to deal with. Likewise with insomnia, they ask what remedies I have tried and are genuinely interested in what, if anything works and what doesn’t. On the other hand  there are people, and unfortunately they make up the majority, who know EXACTLY what I need to do. Or ask in a patronizing tone (conscious or otherwise) “I’m assuming you have tried all the other remedies before you resort to medication?”, enough of them that it’s just beginning to make me angry about their ill informed rhetoric. 

While settling to write this piece I was listening to some music and Basement Jaxx (remember them?) ‘You Don’t Know Me’ came on shuffle and it really summed up exactly how I have been feeling over the last few days. Armchair Doctors offering up their opinions on stuff they know nothing about. It makes me want to scream the title of the above-mentioned song at them. 

On Monday I was cutting the hair of a friend. He, like me, is positive and also has had to deal with his own battles with illnesses other than HIV. We were just catching up. We are not the closest of friends, knowing each other through the work we respectively do in raising HIV awareness and also by sharing our stories via blogging and twitter. Each of us has developed a persona for social media. Everyone does it. It’s not that it’s not who you are in the flesh but that you hold a little of yourself back for your personal life, friendships, relationships and partners. Yet in being so honest and upfront about who we are and the curve balls that life has thrown at us means that people feel they own a little bit of you. And it gives them the right to comment on what’s going on for you. Usually, as I said, it’s filled with good intentions, but the advice is usually redundant as anyone managing a chronic condition does just that - they manage it on a daily basis and it’s likely that they have been managing it for a long period of time. And having done just that, we have researched and experimented with remedies and tools to alleviate whatever the conditions might be. Not to mention the phalanx of medical professionals we see on an all too frequent basis.

If these people really want to help, they should do what we who blog and share hope they will do - get an education on the subjects we talk about. That’s why we do it, so that people less well informed will find out what they need to know and be prepared should they ever go through it themselves, or even better than that, by being educated they will have the knowledge to protect themselves. 

So while cutting my friends hair on Monday, getting to know a little more about the person behind the AVI and blogger personality we touched on the fact that there are times we just get angry and feel like screaming but hold back so as not upset others in our lives or circles of friends. My reply was something to the effect of, ‘oh come on ______ surely we have earned the right to get angry every once in a while?’ Oh how we laughed, great big tear-inducing belly laughs. But I guess this has been bubbling since then. 

So please people, don’t stop asking questions, never stop learning, as one day it might help you. But stop with ‘answers’ that are at best unintentionally patronizing, but are oft wrong or completely unfeasible.

The Sex

I was a freshman in college when I started sleeping around.  I was reckless and unsafe and did not make an effort to take care of myself. All I ever cared about was to be a hedonist. I slept around, indulged in debauchery and celebrated in my decadence. I was young, wild and free. I thought I was liberating myself, unshackled by the norms of society. I am the captain of my own ship. I thought my personal freedom would make me stronger. I thought it would make me more desirable.

I met a lot of men online. I joined several gay dating sites where there are plenty of hot and handsome men who are as addicted to sex as me. I would exchange numbers with them and plan our conquest. I would go to their place, undress, and just let them do whatever they wanted with me. I was a bottom. I enjoyed being penetrated a lot. Some of my partners would use a condom but then, some of them preferred to do it bareback and I would allow them. I see myself as a perfect sex slave, a whore whose only purpose is to serve my masters.

Since I was sixteen, I must have slept with at least a hundred men, 95% of them were random strangers and casual encounters. I only had three serious boyfriends. I indulged in all kinds of sexual encounters. I would go to threesomes. I experienced an orgy and a gang bang where all the guys came inside me. I usually just had sex once with a man except for rare times where I would sleep with someone twice or thrice. Sleeping with as many men as I could was feeding my ego. It made me feel I was beautiful. It made me feel desirable and worthy of love.

Symptoms

I might have had HIV for years. But since this illness is asymptomatic for a long time, and that its signs and symptoms are so similar to most common diseases, I just ignored what I felt even though I started finding strange disturbances all over my body. I was constantly troubled by colds and coughs. I would have fungal infections, especially on my groin area which would come and go. I would have constant diarrhea which I ignored because I thought it was just the result of my constant consumption of street foods. I also had a disturbing case of gingivitis where my gums would literally bleed torrents of blood while I was in class or inside a vehicle. I endured all of those with a firm conviction that there was nothing wrong with me.

For a long time, I led this kind of life until I met my third boyfriend. We lasted for two years. I gave up my promiscuity in favor of monogamy. All our sexual sessions were without a condom and all the time, I would allow him to come inside me. I also learned how to be a top with him so that sometimes, I would be the one who would ejaculate in him. It was a relationship filled with love, hate and passion. 

During our second year as lovers, having graduated from college , I started working in a call center, on a night shift from 12am to 10am. I balanced my work, personal life, love life and family but it proved to be difficult. I started getting sick from all the stress. I began coughing a lot and having terrible colds. Then I would have fevers and my throat was sore occasionally. Like before, I ignored these symptoms because I just thought they were a result of my work since I was on the phone all the time and the load could be really tiring.

For months I just got sicker and sicker until I was forced to resign. I was reluctant because I had a good job and a great set of workmates. But I needed to because I had been absent a lot of times because of my poor health.  I and my boyfriend broke up too. I was really stressed and ill.

I  took a one week rest then I started looking for a new job. I found one immediately. I enjoyed it. One of the requirements was to pass a medical. I had myself X-rayed and that is when I discovered I had pulmonary tuberculosis. In fact, my case was a little advanced. The doctor assured me that I could still be cured so I had to start treatment immediately. He told me to rest for a while, so I took a leave from my new job, even though I was only employed for a month. I was just at home doing whatever I wanted. I had all the time in the world. However, I went back to my habit of sleeping around because I was bored and I missed sex.

After two months, I felt that I was ready again to work. During that time, I and my boyfriend got back together and I started working again in my last job. However, I started noticing that I was getting ugly. My hair would fall out with no reason. I owed it to my TB medication but it was just a way to explain it to myself. I also had a terrible case of dandruff. My face started losing its shape and it became sunken. My weight was dropping. Even my boyfriend noticed that I was getting ugly. He was worried. I became worried too. I could not sleep well because I was constantly thinking about what was happening to me.

Deep inside, I knew I was sick. I was scared that there was something terribly wrong with me.

Suicide Attempt

One day, I decided to end it all. I just wanted to die, so that I could save everyone from being miserable. If I became sick, I thought of the medical bills that would result. I thought of my boyfriend. I thought of my family and friends. I did not want to become a burden to them so I longed for death when I was still strong enough to do it myself.

I swallowed a lot of pills from my medicine cabinet, not caring what they were. I wanted an overdose that could induce a coma I would never wake up from. I left the house as if I was going to work but in fact, I already decided that I would succumb to suicide. I bought rat poison from the grocery with the intention of eating the whole bag so I had an internal hemorrhage. For two days, I was out in the busy part of the city in a daze. I did not sleep at all. I never got to consume the rat poison. I went back home because I became really hungry and thirsty and I did not know where to go.

Everyone was extremely worried about me. I did not tell them what happened to me in the last two days I was gone. I totally shut them off by deciding not to speak at all.

I became really sick. I was so depressed that I would just lie in bed all day, waiting to die. My body was in constant pain. I could not breathe properly, it was as if a huge stone was crushing my lungs. I was bedridden most of the time and I actually lost the desire to continue living. I would sometimes pee on the bed because I was so tired. I would refuse to eat because I just felt so miserable.

My mother and my younger sister would make me eat by feeding me like a small child. I would not take a bath unless my mother forced me to the bathroom and wash me. I could not sleep properly and I would hallucinate. I heard voices saying that they wanted to kill me because I was the plague. I heard men telling me that I infected them with disease. It was scary because all of them felt so real.

I was like a schizophrenic patient on the edge of insanity. I could not move much without the help and support of my mother. I could not eat solid food most of the time because my throat hurt so bad whenever I trie to swallow. Most of my sustenance came in the form of milk and curdled soya called "taho," a common Philippine beverage mixed with caramelized sugar and gelatinous balls that is sold by peddlers on the streets.

For almost six months, I was in that state. My mom never gave up on me. She would make me drink alternative medicines and a variety of health supplements. My mother was my only doctor. I was confined once in the hospital for three days because I suddenly collapsed due to low potassium levels and hypothyroidism. I was always sick.

The HIV Test

A private doctor suggested that I take an HIV test because she noticed that I was not recovering. She recommended me to an infectious disease doctor who was her colleague.

When I heard about the possibility that I had HIV, I actually started feeling better. I meditated on my past. I thought I would get love from the men I meet. I was hungry for their desire and worship. Instead, what I received was this virus. But I cannot ever resent it. I was in the throes of ecstasy when I got this affliction. This was not forced into me. No one raped me. A tainted needle was never introduced to my bloodstream nor was I into drugs. Rather, I invited the virus to thrive and dwell inside of me through my hunger for flesh and thirst for pleasure.

I was twenty-one when the result of the test came. I was frail and very weak after months of being in continuous suffering. When I heard from the doctor that I was HIV positive, I actually felt alleviated of my burden. This was the answer to all the strange and inexplicable infections I had gotten. It actually made me feel better. I thought I was dying of cancer or a severe life-threatening organ malfunction. I told myself, "Oh, it's just HIV," and I breathed a sigh of relief.

Healing

The first thing that I did when I learned that I got HIV/AIDS was to forgive myself.  I did not cry nor feel remorse. I did not ask why I have this because I know so well the answer to that. Rather, I just sat down in silence, pondering on my new existence as an HIV positive young man. Instead of being depressed about it, I told myself that I can survive this. No, I must survive this. There is no other choice. If I let this virus bring me down, I would just be another casualty. I refused to become a victim.

I forgave myself so that I could start to move on. I have no other choice but to stop breaking down and just welcome everything that life has given me so far. The comfort must start from within me. I need to heal myself. I started from inside of me. I forgave myself so that all the negativity that this virus may cause me will be overpowered by a dose of healthy and positive optimism. That is my greatest treatment, more than any antiretrovirals or drugs that will kill the countless replications of the virus inside my body.

Of course, being HIV positive is still a dangerous thing. This is such an unpredictable disease. Like the prosopons, the masks of ancient Greek theatre, HIV can wear a variety of masks. You are the main actor of the play and it is all up to you to get to choose whether you will act in a tragedy or a comedy.

Everything really depends on you. This disease is just there inside of you, but its effect in your life is solely on the basis on how you see and take it. You can choose to see this virus as a demon eating you from within so that you are slowly dying young and miserable. But for me, I chose to see HIV as an angel who will carry and guide me on a road to redemption.

I believe in mind over matter. I believe that this disease can be made more tolerable as long as I am always happy. I made peace with myself and with the virus. I am embracing this sickness with open arms. I want to be friends with it because it will now be my companion all my life. It will never ever leave me so I might as well start learning how to cope with it.

I am now infected by this virus. But still, I have no regrets of what I have done in the past. There is no one else that I can blame but myself when I became positive.  I told myself that I cannot ever complain and be dramatic about being sick because in the first place, I brought this to myself. I was the one who willingly opened the lock and bolt and let the mysterious stranger, the uninvited guest to take shelter in me. HIV is an uninvited guest who came knocking in the home of myself. How could I turn him away when it sought and wooed me through promises of joy and satisfaction?

Now, I am on my own crusade to recover back to full health. I was diagnosed HIV positive in Feb 2012. I am on the second month of my ARV treatment. My CD4 is a mere 2 but I am proud to say that I look so good and fine and I have no infections at all because I live each day positively and I do not let this disease bring me down. I want to influence others to have a positive outlook in life despite having this virus because it would really work and make them become better individuals too.

Advocacy

I am an advocate promoting safe sex, erasing the stigma and living a positive life with the proper attitude. I joined Twitter as @posithivecutie and started two blogs where I am sharing my life, loves and lusts as an HIV positive young man. I see my HIV status as a blessing because being HIV+ made me change myself a lot for my own good and I became a much better individual than I ever was.

Being HIV+ helped me achieve some of my dreams, such as becoming a writer. It also made me feel that people love me despite my status, It made me become a more mature and responsible person. It made me want to live a life worth living and to extend my hand to those who need help and attention.

I do not want any other person to be infected with HIV. I want them to learn from what I have experienced. I want them to realize the value of safe sex. There is nothing wrong with having sex. It is just that we must do it responsibly and with protection.

I want people to realize that learning to love yourself above anyone else is really the greatest love of all. If you love yourself no matter what, you can really see the beauty of everything this life will give you. I have HIV and yet I choose to love myself. And that is when my new life started. That is when I discovered that this virus is certainly not the end. This is just an exciting beginning of a life worth living, a life that will be filled with joy and learning.

I will never let HIV make me sick. I believe that it is only a disease of the body. I should never let this be the disease of my soul too. For me, God has given me a tap on the shoulder by granting me this virus. This is not His punishment. I see it as God’s way of telling me that he cares about me. I see it as a gift and a blessing. I like to think that God gave me HIV because he wants me to be better and to take care of ourselves more.

Being HIV positive should make you hungrier for life and be the best that you can be. We are always on the edge of death, even if we are healthy. The infections we are susceptible to are just around us. Since our existence is very fragile, be not afraid to finally start realizing your dreams before it is too late! There is a whole world that we have not yet seen. Rather than spend the time being depressed about your condition, pull yourself together and go out there and live the life that you want! Now is the time you all have been waiting for!

Every one of us should start empowering ourselves. We positives should never feel that we are less  a person than what we used to be. HIV is just a virus. It is not something that must degrade us. Instead, we must use this virus to make our lives better. We should take care of ourselves better. We should start reaching our dreams. We should be thankful for each day that passes. We should live a happy life with no regrets.

A poet, artist, author, polyglot, madman, fetishist and self-confessed deviant, Mirvan Ereon started his prolific career after he discovered he was HIV- positive in February 2012. Since then, he has become a full-time indie writer, translator and professional book reviewer. He maintains several sites, mainly on literature, his art, his writings and HIV/AIDS in Wordpress, Blogspot and Tumblr. His Twitter is @posithivecutie and his blogs include The Sexy Squid and http://posithive-cutie.tumblr.com. He is twenty-one years old and lives in the Philippines.

It recently occurred to me that coming to terms with my HIV status is a life long process. I must have been in major denial to think that because I had written a few blog posts about my status (under a pseudonym, mind you), volunteered in the HIV/AIDS community and reluctantly disclosed my status to a very select few, that I was now ‘OK’ with being positive. Was I ever wrong! 

The epiphany occurred when I was on my way to do long overdue blood work for my new family doctor located smack dab in the middle of the gay village. I started seeing this new doc a few months ago and she seemed pretty easy to relate to and non judgemental. At the time of my first appointment, I had just completed my routine blood work and check up with my other doctor, the HIV specialist, so there was no need to go sticking needles in arm again. We decided that we would wait the usual three month time frame before doing a new set of blood work for her to examine. 

At first, three months seemed like so far away. I didn’t even think twice about it. So I went on my merry way. A quick three months later, a reminder popped up on my phone with a message saying that blood work was now due. Ugh. I shrugged it off and decided that I’d wait until the following week.  The remainder of that week was spent strategizing about when I should visit the lab, which was located in the same building as my doc in the village. I didn’t want to go when there would be lots of people because I automatically assumed that everyone would know that I was there because I’m HIV positive and I didn’t want to be known only by my status. 

I finally decided that I should go the following Tuesday morning since I thought that most people would have gone in on Monday,  plus I had an appointment with my therapist directly after. So I got myself all pumped up before I left home that morning and I even had my favourite Britney track on repeat on my iPod so that I’d have a temporary sense of immortality.  But as soon as I approached the building I became cloaked in a sea of fear. Nevertheless I turned up the volume on my headphones and decided to push on through those heavy doors to the clinic. 

The lab was located in the basement, which sort of added to my unexpected sense of shame. As I made my way down, I just knew that I wouldn’t go through with it. When I stepped into the actual lab, it was packed. Suddenly it was hard to breathe. I saw a couple of familiar faces from my late night bar hops as well as the friend of a guy I used to know and I felt doomed. Then without thinking, I did a pirouette and raced out of there as fast as I could. 

For some reason, my feet were doing all the thinking for me in that moment. I ended up making several blocks around the building trying to muster the courage to go back in and get it over with.  But I just couldn’t do it. Luckily it was time for my appointment with my therapist so I had an excuse to postpone this for another time.

As soon as I walked into the therapist’s office, I felt a sense of relief. No more panicking or sweating or short breaths. I told him exactly what had just happened. I was so ashamed and upset at myself for thinking and acting the way I did. I felt like all the progress I had made with self acceptance had disappeared. Until my therapist looked me in the eye and said “Why are you being so hard on yourself?” He assured me that my mini panic attack was normal given my history and so I shouldn’t beat myself up about it. He said that the mere fact that I was in his office trying to find the root of the problem and fix it showed tremendous resilience. Then he offered to go to the lab with me as a means of support. Talk about going above the call of duty!

In the end, I was able get my blood work done on my own in the lab. And I survived! 

I’d like to start off by saying that our performances of  excerpts from The Laramie Project – Ten Years After for the Guelph Rainbow Chorus Picture Show were a blast.  The choir has been doing wonderful things since their new musical director has been on board.  Unfortunately, she is having to leave to concentrate on her teaching job, and they hope she’ll be able to return in a couple of years.  I was so inspired that I hope to be able to join the choir next season.

I’m having to have repeat surgery next month for potential bowel cancer, and keeping my fingers and toes crossed that this is not the case. 

I was recently informed that I was nominated in three categories for an award with ACCKWA (AIDS Committee of Cambridge, Kitchener, Waterloo and Area) at this year’s AGM ceremony.  The category I was chosen for was Education, for my community blogging and speaker’s bureau commitments.  I certainly have many to thank along the way for their encouragement and advice.

Also included in this year’s AGM is the formal announcement of the TTOA committee (Turning Toward One Another).  The Board of Directors, Staff and Clients of ACCKWA noted the need to start a new committee to provide a stronger voice.  AIDS Service Organizations were created during a time of sheer ugliness in years past, in terms of how this disease was not only portraying those that were infected but also communities and loved ones that were becoming affected.  ACCKWA is proud to be the first, with the involvement of AIDS Committee of Guelph, that has implemented and actively begun pursuing activities based around the structure of the TTOA committee.  One example of what has developed from forming this committee is that two of its members have been hired on as staff with the agency - June Moyo as Practical Support and Chris White as the Gay Men’s Support Worker.

 I had earlier this year been selected for an interview with the “Volunteer Action Centre” in Kitchener, and was one of those chosen in last weekend’s issue of the “Kitchener Record” for Manulife Financial’s acknowledgments of volunteers in our community.  I wish to say thanks to all those who take the time to make these acknowledgments happen. We’re all important in the roles we choose to take on for ourselves.

Here’s what the newspaper said

John Davie: ACCKWA (The AIDS Committee of Cambridge,Kitchener, Waterloo & Area)

John Davie’s courage, giving nature, and sense of humour comes through in every word when he talks about volunteering with ACCKWA. He’s volunteered with the organization for fifteen years, and sees it as “a way to help those in the community who aren’t ready to believe in themselves. By working together, we can keep the cycle going.” Volunteering has made him more compassionate, and helped him see the value of giving back. Drawn to the organization as a way to gain purpose and strength after

he was diagnosed as HIV positive, John wanted to encourage others to live in a safe environment and provide them with up-to-date and balanced information. ACCKWA is also a safe space for discussing challenges and moments of triumph. Volunteer roles at ACCKWA can be flexible, he says, and it’s often possible to follow your interests and support special events, social media, speaking, or fundraising. John’s volunteer responsibilities largely focus on reception at ACCKWA’s office in Kitchener, but he’s hoping to support a men’s group in the future, and has started sharing his story as a public speaker in the Speaker’s Bureau. A moment that’s stayed with him was when, after speaking to a group of high school students, one young man came up afterwards in tears. The student thanked John for speaking, and told him that his uncle was HIV positive; after John’s presentation, he felt he might be able to communicate better with his uncle. 

Here is the link to the article published June 9,2012 in the Kitchener Record – Manulife Financial – Applauding our community volunteers.

With respect to other fields of interest through ACCKWA, I hope to see this year be even better in so many ways, as this is also their 25th Anniversary.  They’ve certainly become my extended family, and I’m wanting to acknowledge each of their own commitments in life.  I have to announce that their incredible Support Worker (Tashauna Devonshire) is having to leave to pursue other obligations.  She will without a doubt be missed by many, many people for her compassion and strengths.  And I might add that she had an incredible amount of input in keeping alive their Education and Youth services in previous months.

This article by James Wilton first appeared on the CATIE website here.  

Une version française est disponible ici.  

In Canada, an estimated 83% of new HIV infections in 2008 occurred through sexual transmission, either among men who have sex with men (47%) or heterosexual men and women (36%). Among both groups a large number of these sexual HIV transmissions likely took place in the context of intimate relationships.

However, HIV prevention efforts in Canada focus mostly on changing the behaviour of an individual and often neglect the critical role partners may play in HIV transmission. Neglecting partners in HIV testing and counselling may be a missed opportunity for HIV prevention and treatment in Canada.

The World Health Organization (WHO) recently released “Guidance on Couples HIV Testing and Counselling,” which outlines the important role of HIV testing and counselling for couples in HIV prevention, treatment and care.

The guidelines encourage countries to increase the offering of HIV testing and counselling to couples in addition to support for mutual disclosure of HIV status. In the guidelines, the WHO also recommends offering antiretroviral treatment to serodiscordant couples (in which one partner is HIV-positive and the other is HIV-negative) regardless of CD4 count in order to prevent HIV transmission.

Benefits of couples testing and counselling

The guidelines outline several potential benefits of offering HIV testing and counselling, along with support for mutual disclosure of HIV status, to couples. Many of these benefits are relevant to all couples, including those in which both partners are HIV-negative or both are HIV-positive.

Prevention of HIV transmission within couples and to external partners

In Canada, many people are unaware of their partner’s, or their own, HIV status and therefore may unknowingly be at risk of becoming infected with HIV or transmitting HIV to their partner(s).

Research shows that when people become aware of their HIV infection, most take measures to reduce their risk of transmitting HIV to others. Furthermore, studies suggest couples who test and learn their status together are more likely to adopt preventive measures than those who test alone.

Couples HIV testing and counselling allows individuals to learn of their own status, and the status of their partner, and make decisions to prevent transmission together. In this context, counsellors can tailor prevention messages based on the couple’s test results.

Increased uptake and adherence to antiretroviral therapy

A benefit of couples learning their test results together is that they can support each other, if one or both partners are HIV-positive, to access and adhere to ART for their own health and to prevent transmitting HIV to their partner or infant.

Also, the HIV-negative partner in a serodiscordant relationship may be able to protect themselves from HIV infection by taking antiretrovirals. This strategy is known as pre-exposure prophylaxis (PrEP).

Safer contraception and conception

Couples testing and counselling can help partners make informed decisions together with regards to reproductive health and family planning, including contraception and conception. Antiretroviral therapy or PrEP may be options to prevent HIV transmission when attempting to conceive.

Increased relationship cohesion and normalization of HIV status; decreased intimate partner violence and stigma

Testing and counselling for couples, with support for disclosure, may help couples come to terms with their partner’s HIV status in a way that strengthens their relationship and can prevent stigma and violence. A counsellor can play an important role in creating a safe environment that can help ease tension and diffuse blame.

Recommendations on the use of antiretroviral treatment for HIV prevention

Over the past decade, evidence has been accumulating that shows antiretroviral treatment can reduce the risk that a person living with HIV transmits the virus to others. Last year, an important randomized controlled study known as HPTN 052 found that when HIV-positive partners in heterosexual serodiscordant relationships started ART early (with a CD4 count between 350 and 500 CD4 cells), HIV transmission was reduced by 96%.

Based on this study, and others, the WHO made two recommendations on the use of antiretroviral therapy to prevent HIV transmission between serodiscordant couples:

1. People with HIV in serodiscordant couples and who have started antiretroviral therapy (ART) for their own health should be advised that ART is also recommended to reduce HIV transmission to the uninfected partner.

 2. HIV-positive partners with CD4 counts greater than 350 cells/μL in serodiscordant couples should be offered ART to reduce HIV transmission.

     a. People who are offered ART at this CD4 count should be told why they are being offered ART and that, once started, ART should be continued for life.

    b. ART should be offered to people with CD4 counts greater than 350 cells/μL for safer conception.

Currently, the WHO treatment guidelines do not recommend that people start ART for their own health if they have a CD4 count greater than 350 CD4 cells. However, in contrast to the WHO treatment guidelines, guidelines in high income countries generally recommend people living with HIV start treatment when their CD4 count falls below 500 cells. These recommendations are based on observational studies, which suggest that earlier treatment may improve the health of people living with HIV. Recently the US Department of Health and Human Services changed its guidelines to recommend treatment for all HIV-positive people who are ready to start regardless of their CD4 count.

The WHO guidelines on couples HIV testing and counselling emphasize that counsellors must ensure that HIV-positive individuals who are offered earlier treatment fully understand the purpose of this option and make an informed choice to start treatment. A number of factors must be taken into consideration when making the decision to start treatment earlier, such as the potential for side effects, the commitment to lifelong adherence, and the possibility of drug resistance developing due to poor adherence. 

Counsellors must also ensure that couples are aware of other options for preventing HIV transmission, such as the consistent and correct use of male or female condoms. The following key messages with regards to condoms and antiretroviral therapy for prevention are outlined in the guidelines:

 • It is possible for couples to stay HIV serodiscordant indefinitely if they consistently practice safer sex using condoms.

 • Treatment for the HIV-positive partner is also highly effective in reducing the risk of transmission to the HIV-negative partner.

 • Combined, treatment and consistent condom use are likely to offer greater protection than either one alone.

The WHO guidelines acknowledge that there is a lack of evidence with regards to how much ART reduces the risk of HIV transmission among populations other than heterosexual couples, such as gay couples and people who use injection drugs. However, the guidelines state that an “international scientific consensus is emerging that ART significantly reduces the risk of sexual HIV transmission of HIV regardless of the population or setting.”

Pre-exposure prophylaxis to prevent HIV transmission among serodiscordant couples

In the past year several randomized controlled trials have found that HIV-negative individuals who take specific antiretroviral pills as pre-exposure prophylaxis are at reduced risk of HIV infection. The WHO is currently reviewing this evidence and plans to publish “rapid advice” on PrEP for heterosexual serodiscordant couples later this year. More detailed guidance will follow this advice.

Conclusion

Couples HIV testing and counselling provides an important opportunity to strengthen our HIV prevention efforts and should be offered in places in Canada where HIV testing is being done. Supporting linkages from HIV testing and counselling to appropriate treatment, care and support services will be important to fully realize the potential benefits of this couple-based intervention.

 —James Wilton

 Resources

 The Positive Side: Treatment benefits for all?

 TreatmentUpdate: HPTN 052 – the trial that changed everything

 References

 1. Guidance on couples HIV testing and counselling, including antiretroviral therapy for treatment and prevention in serodiscordant couples [Internet]. WHO. [cited 2012 May 22]. Available from: www.who.int/hiv/pub/guidelines/9789241501972/en/index.html

 2. El-Bassel N, Gilbert L, Witte S et al. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. Journal of Acquired Immune Deficiency Syndromes. 2010 Dec;55 Suppl2:S98–S101.

 3.  Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes. 2005 Aug 1;39(4):446–53

This article first appeared on TheBody.com here  

These past several weeks have been great on many fronts. While taking a shower this morning, I counted a few of the great pieces of news that have come our way amidst all the negative news that the media dwells on to increase ratings.

1. Obama supports gay marriage. Do I need to say more? This statement to the world will have ripple effects on many levels. I was more surprised when the NAACP (National Association for the Advancement of Colored People) also supported gay marriage right after Obama's statement. Even in Malawi, a country in Africa -- a continent where many countries are known for their brutally homophobic laws -- is now considering eliminating criminalization of homosexuality.

2. Pre-exposure prophylaxis (PrEP) is almost a reality with an FDA panel backing Truvada for PrEP. No matter what critics say, having an effective option to prevent HIV infections is a good thing, provided that people take Truvada daily.

3. One more once-a-day one-pill option is almost a reality with an FDA panel backing up QUAD for naive patients. The first once-a-day integrase inhibitor (elvitegravir) plus Truvada will likely be approved before August. Concerns remain about interactions and monitoring kidney function. Whether or not this once-a-day single-pill regimen will be a preferred option for naive patients will be up for discussion by the DHHS treatment guidelines panel, however.

4. Progress towards a cure. A paper evaluated data from the SMART trial and found that treatment interruptions for up to 16 weeks may be OK to consider in cure-related studies that are currently evaluating what happens to viral load in patients taking HAART who are exposed to different options and then stop their medications. Another review of several stem cell studies showed that modified T cells lived for at least 10 years and that no adverse events have been seen in patients exposed to different genetic manipulations of their T cells. There is so much happening in this field that I cannot keep up even with reading papers every day!

5. An over-the-counter fast HIV test is almost a reality with an FDA panel backing it up. Yes, we need to make sure people can call a counselor from home when they find out they are HIV+. That seems to be already in the works.

6. Expanded access of dolutegravir (DTG) started in the United States. DTG is the only unboosted once-a-day integrase inhibitor that can still be effective in the presence of most integrase mutations in patients who have taken raltegravir or elvitegravir. It will eventually be formulated by GSK-ViiV in a once-a-day, single pill with Epzicom for treatment-naive patients.

7. Effective interferon-free oral regimens are on the horizon for hepatitis C, even for hard to treat patients. Several studies presented at a recent liver conference showed great results with different all-oral regimens. Interferon causes side effects that are sometimes hard to tolerate for some patients. We will have them available through expanded access in 2-3 years.

8. A transgender woman is allowed to compete in the Miss Universe Canada. After much controversy and a rule change, the first-ever transgendered contestant competed in Toronto. Jenna Talackova, 23, is from Vancouver, and though she was born male, she underwent sexual reassignment surgery four years ago and was allowed to compete.

9. Denmark is considering eliminating an HIV criminalization law. Denmark's Justice Minister Lars Barfoed has suspended Article 252 of the Criminal Code -- the so-called 'HIV law' -- pending an inquiry by a government working group to consider whether the only HIV-specific law in Western Europe should be revised or abolished. A committee is looking at the legalities of this law after new data were published about a dramatic decrease in the risk of HIV infections caused by people on antiretrovirals with undetectable HIV virus in their blood.

10. People are getting ready for the first International AIDS Conference in the United States since 1990. After more than 20 years and following the lift of the federal HIV immigration ban, this important conference returns to the U.S. and will take place in Washington, D.C., in July. Thousands will be marching and protesting lack of treatment access and other issues affecting people all over the world. 

Nelson Vergel is a chemical engineer who has become a leading advocate for sports nutrition, supplementation and the promotion of wellness in the HIV-positive community since his positive diagnosis in 1986. He is also the author of "Testosterone: A Man's Guide" and co-author of the book "Built to Survive"; the founder of the nonprofit organizations Body Positive Wellness Clinic and Program for Wellness Restoration; the Nutrition and Exercise forum expert at TheBody.com; and a bilingual speaker on lipodystrophy, wasting, exercise, nutrition, testosterone replacement, metabolic disorders, HIV medication side effect management and HIV salvage therapy. Nelson also moderates PozHealth, one of the largest HIV health discussion listservs online.