In late September of 2010, while walking my dog with a friend along the banks of the Harlem River in Manhattan's Inwood Hill Park, my life was changed forever. In a shocking moment right out of 'Law and Order', I came upon a dead body floating face-down in the water. That experience alone was quite traumatic, without a doubt. But little did I know just how traumatic and life-altering it would turn out to be.

You see, that lifeless body in the water turned out to be young Tyler Clementi, the Rutgers University student who took his own life by leaping off the George Washington Bridge. Learning the identity of that man’s body hit me like a thunderbolt. It was as though the universe itself was trying to send me a message, telling me that there was a role I needed to play in this tragedy.  Since then, I have felt it my duty as a gay man to do anything and everything I can possibly do to raise awareness for the serious problem of, not just anti-LGBT bullying and its repercussions, but the insidious homophobia behind it.

On the eve of a tribute walk just a few weeks later across that bridge from which Tyler Clementi ended his life, I came to a realization that I still find fascinating and frightening. I’ve tweeted; posted on Facebook; written blog posts; wrote to Rutgers University’s president; been interviewed by media, including a journalist for a French TV documentary and quoted in The New Yorker magazine’s recent story about Tyler Clementi in my little crusade against homophobia and the toll it's taking on all of us, but mostly LGBT youth.  Throughout all of that and in turn the incredible show of support I've received from friends, family and total strangers alike, there has been one group of people who seem to be “sitting this one out”.

Though I’ve talked to a few who are genuinely troubled, men —specifically, straight men — don’t seem to want to speak very loudly, if at all, on this issue. Now, I’m not trying to over-generalize; I’ve gotten some wonderfully supportive messages from a few straight guys. Most certainly from Led Black, the editor of The Uptown Collective, an online magazine covering news and issues in my local neighborhood of Upper Manhattan. He wrote a great piece that I would love for you to read in which he speaks passionately to this issue. But, just ONE straight man out of hundreds in my social network and circle of friends feels as strongly about changing this awful condition? I simply refuse to believe that's the case.

This is an observation, not judgment. And I’m not subconsciously seeking approval from straight men either. Trust me: I have ranted, cried, screamed, and spoken about this issue and will continue to do so whether any straight people like it or not. I have to wonder though: are these men feeling guilty? Do they fear possibly being labeled as gay themselves for speaking up? Why do I not see more of them upset and concerned, or hear them talking about all of this? To me, this seems to be the clearest indication of just how deeply homophobia is entrenched in our culture. Personally, I know a lot of really wonderful, caring straight men, so I feel certain that they DO hurt for kids like Tyler who've lost all hope that "It Gets Better".

So...why do I all this? Why, after more than a year am I still talking about Tyler Clementi and my experience?

Because I will try anything -- EVERYTHING -- to be heard by straight people (especially the men) and make them understand: You simply MUST get involved. I know you don’t want to see kids in pain like this. Homophobia isn’t a gay problem, nor is it a straight problem — it’s a HUMAN problem. That being said, I truly believe the change in how it affects kids lies with you, straight people. Kids will continue dying — YOUR kids.  I’ve taken on this crusade to fight for LGBT youth because I was personally affected by one young man's senseless, tragic death but, frankly, it’s not mine to fight.

No, this fight is really yours, straight men. You are the key. I don’t know exactly what’s stopping you from joining the battle, but I’m here to tell you: it is never seen as weak or “gay” to save kids' lives.  It’s seen as compassion, as caring, and as love…love that comes from Fathers, Brothers, Grandsons, Uncles, Sons.

This article first appeared on Swish, the blog of a gay-straight alliance fighting for the equality of LGBT families, co-workers and loved ones.

Jim Swimm is a forty-year-old Texan transplant in New York City: Gay, HIV+ and simply trying to make the world a better place... “ ‘cause I’m a superhero like that”. You can follow him on Twitter @Jims_Whim

Youth in the Caribbean and the Caribbean Diaspora in Canada face many similar issues with respect to the risk of contracting HIV. An international project that linked youth from Jamaica and Ontario to address these issues resulted in a powerful 20-minute video documentary that takes you into the hearts, experiences and struggles of those living with and affected by HIV.

You can see the video here.

You can also read more about the issues facing these youth on the website of the Interagency Coalition on AIDS and Development that, along with partners in Canada and Jamaica, produced the video. But to summarize:

In both the Caribbean itself and in the Caribbean Diaspora in Canada there are challenges in capturing the full picture of HIV among these young people. In the Caribbean there are inconsistencies in data collection and methodology while neither Ontario nor Québec, where 94% of the people of Caribbean descent in Canada live, report ethnicity information with their HIV statistics. However, some broad facts are clear:

• Half of new HIV infections worldwide are among young people. More than half the Caribbean population is under the age of 24.
• HIV prevalence in the Caribbean is higher than in any other world region outside sub-Saharan Africa.
• In Canada, there are a disproportionate number of African, Caribbean and black (ACB) people living with HIV. Since reporting began, youth have accounted for 27% of all positive HIV test results in Canada.
• The Caribbean is the only region, aside from sub-Saharan Africa, where the proportion of women and female youth living with HIV (53%) is higher than that of men and male youth.
• In both the Caribbean and the Caribbean Diaspora in Canada, heterosexual sex is the main mode of transmission, with steadily rising rates of HIV infection among women and female youth.
• In both Canada and the Caribbean, the highest prevalence of HIV infection is found among gay men and other men who have sex with men. In Jamaica, 32% of these men are living with HIV. In Canada, in 2009, 44% of new HIV infections were among this population.

There are a number of social factors - or determinants of health - that shape HIV risk at an individual level. These factors influence how people’s lives unfold as well as the choices available to them and, in turn, their health outcomes. Key factors for youth in the Caribbean and the Caribbean Diaspora include the following:

1.  Gender norms. Norms of masculinity and femininity in Caribbean societies play an important role in shaping HIV risk. Young men’s masculinity emphasizes multiple partners, aggression and the need to affirm heterosexuality through these behaviours. These norms of masculinity pose challenges for women and female youth in negotiating safer sex, increasing their vulnerability to HIV. These same norms, as well as the pervasive homophobia in Caribbean culture, also lead gay men to hide their sexuality which increases their own risk and that of their partners.

2.  Popular culture can also play a role in influencing gender roles and sexual expression - and also HIV risk among youth. In the Caribbean and the Caribbean culture, music, for instance, can be an important part of the lives of many young people. Some researchers have linked genres including dancehall in the Caribbean and hip-hop in North America - both of which project unapologetic sexuality and hyper-masculinity - with increased sexual risk taking and multiple partners among youth.

3.  Poverty. An important factor that significantly influences the context of people’s lives, and, in turn, their HIV risk, is income and social status. In both the Caribbean and within Canada’s ACB population, poverty and unemployment rates are significant challenges. In the Caribbean, youth living in poverty may have less control over their sexual rights and less access to education, therefore increasing their HIV risk. Young women may engage in transactional sex with older men to pay for school fees, food and money.

4.  Migration and acculturation. Caribbean people commonly migrate within and away from the region to improve opportunities for employment and education. Sometimes children are left behind and can as a result face increased risks of physical and sexual abuse and may suffer from psychosocial problems. Immigrants from the Caribbean to Canada also face challenges that may increase their risk of HIV. They may have to cope with racism, difficulties with the immigration process and problems in finding and maintaining housing and employment. Fitting in with the dominant culture can also cause problems. This is especially true for lesbian, gay, bisexual and trans youth who may experience rejection from their families and multiple forms of oppression, including racism and heterosexism within white society, racism and sexualization within the white gay community, and heterosexism and homophobia within the ACB community.

5.  HIV stigma and discrimination. In Caribbean societies, gay men, sex workers and sexually active youth are stigmatized and marginalized. As a result, in the Caribbean itself, these groups are often excluded from targeted HIV-related programming and from school sexual health curricula. This results in limited access to essential HIV prevention information. There are also conservative attitudes towards gender roles and sexuality within the Caribbean Diaspora in Canada that contribute to HIV stigmatization and prevention messaging.

PositiveLite.com’s own Scott Foley has experienced many of these issues first hand and he is currently writing about them in his own series of articles which you can read here. Scott has this to say about the One Blood: Youth Linked in Action video:

“It really touches on some of the issues I myself have faced. The stigma of going to a public health care facility is very real. If my trip to New York City to get an HIV test hadn’t happened, I probably would never have gotten tested in my own country. Even if I’d strongly suspected I had HIV, I still wouldn’t have gone.

“The music is another thing. Dancehall and reggae promote way too much violence towards gays and promiscuity. I got caught up in dancehall music at a very young age and that’s where I learned about sex from a Caribbean perspective. I surprise myself that to this day I still listen to dancehall music even though I should know better. It’s so powerful in my culture.”

Clearly, many factors influencing HIV risk are rooted in cultural and social contexts. To stem the rise of HIV in Caribbean and Caribbean Diaspora communities in Canada, collaboration and targeted education and care are required. The youth who made and participated in the One Blood: Youth Linked in Action video documentary that we are highlighting here are taking a lead in this effort.

When HIV and AIDS first appeared on the scene thirty years ago, it was a terrifying illness that quickly killed those who became infected. Yet through scientific and community efforts it’s now turned into a condition that, if diagnosed and treated in a timely manner, can be managed into old age.

Thanks to such advances in treatment, people with HIV are living much longer than ever before. According to information compiled by CATIE, it’s estimated that 12% of HIV+ people in Canada are 50 years of age or older. This number is expected to increase by as much as 20% over the next decade. Unfortunately, the number of people aged 50 and older who are newly diagnosed with HIV is also growing.

So it was with particular interest that I attended a presentation at the recently concluded Ontario HIV Treatment Network research conference in Toronto on the challenges experienced by older adults living with HIV. The presenter was Dr Patty Solomon, the director of the School of Rehabilitation Science at McMaster University in Hamilton, Ontario.

I had the opportunity at the conference to speak with Patty about the research that she and her colleagues at McMaster are doing. Here’s our conversation.

John McCullagh: Thank you, Patty, for agreeing to talk to PositiveLite.com about your research into the challenges faced by older adults living with HIV. Before we start, perhaps you’d tell us a little bit about yourself and what led to your interest in this subject.

Patty Solomon: Thank you, John. I teach and do research at McMaster University. My background is in physiotherapy. I became interested in the role of rehabilitation over a decade ago when I realized that there was a tremendous role that could be played by physiotherapists and occupational therapists in improving the quality of life of people living with HIV. I became involved with the Canadian Working Group on HIV and Rehabilitation and, with other colleagues, developed a program of research which focuses on HIV-related disability. As people are now living longer and developing disabilities related to both the virus and to the side effects of medications, rehabilitation is becoming more and more important. As HIV is now a manageable chronic illness and no longer a death sentence, this need will only increase as more and more people with HIV age.

JM: Your research, then, is based on interviews with people with HIV who are 50 and older, right? How were they recruited?

PS: Yes, that’s right, John. We recruited people living with HIV (PHAs) through AIDS service organizations and hospital clinics. We also enlisted people through “word of mouth” as many of those we’ve interviewed contacted their colleagues and friends and informed them about the study.

JM: Were these face-to-face interviews?

PS: Yes, the majority of the interviews were face-to-face. We also wanted to include people who were living in more rural areas to make sure that our findings reflected their experiences. So we conducted a few interviews by phone.

JM: Can you tell me about the age range of the participants and how long they’d been living with HIV?

PS: The participants ranged in age from 50 to 74 years and their average age was 55.

JM: I’m interested to know whether they were a mix of women, gay/bisexual men and people of different racial/ethnic backgrounds?

PS: We had 20 participants who identified themselves as gay or bisexual men, one who identified as a lesbian or bisexual woman, 12 straight women and two straight men  With respect to ethnic background, we had 29 people identify as Caucasian, four as persons of colour and one as Latino. Currently, as our research continues, we’re trying to recruit participants who’ll provide us with more cultural diversity.

JM: Patty, aging brings with it challenges for us all, but there are specific concerns faced by older people with HIV, aren’t there? What are the sources of these challenges? I imagine that issues about present or future physical needs are a real concern.

PS: Yes, our findings suggest that the uncertainty that older adults living with HIV experience is a major challenge. Some of that uncertainty is related to understanding whether some of the physical changes are related to “normal” aging or to the virus.  There were also other concerns related to what I refer to as the episodic nature of living with HIV; that is the fluctuating or changing nature of the virus that results in good and bad days. As we’re entering new territory with respect to knowing all the long term physical consequences of aging with HIV, many of our participants are concerned about the physical challenges they’re experiencing, or might experience, and how these could affect their ability to carry out their day to day activities.

JM: And what about cognitive changes and mental health concerns?

PS: Well, participants in our study worried about whether some of the cognitive changes they were experiencing, such as difficulties with memory, were related to the normal aging process or to their HIV.

JM: Patty, did the participants in your study have any concerns about the quality of care they’re receiving, or might receive, from health care providers? Did they worry that these providers might not understand the unique needs of getting older when you’re HIV positive?

PS: Yes, John, they did. They were worried about having health care providers who didn’t have experience in treating older adults living with HIV. Geriatricians work with older adults, and infectious disease specialists and HIV doctors deal with HIV, but there is a need to combine these two specialties. And it’ll be important to have other health care providers involved in the care of older adults living with HIV. For example, rehabilitation therapists such as physiotherapists and occupational therapists can help with managing pain, improving strength and maintaining mobility and independence. And speech language pathologists and psychologists can help with cognitive strategies. It’ll be important to have many different kinds of health care providers involved in order to maintain the best health outcomes for older PHAs.

JM: Of course, getting older with HIV isn’t just about our health needs, is it? It’s also about transitioning to retirement and financial security. Could you talk a bit about that?

PS: Sure, John. Many long term survivors didn’t plan on living long lives when they were first diagnosed. Therefore we found that they didn’t save money or have a long-term financial plan. Others were not motivated to complete their education or training as they didn’t think they’d be working for too many years. So it is going to be important in the long term that there’s a disability or pension support system for long term survivors who  were diagnosed early in the epidemic that enables them to maintain a reasonable quality of life.

JM: Patty, did the participants in your study worry about who’d take care of them as they aged? And I’m thinking not just of social support but also housing. Was there a fear of social isolation and concerns about the future need to move into a long-term care home?

PS: Yes, there was a great deal of concern related to the availability of housing for older adults living with HIV.  Participants worried about the extent to which they’d encounter stigma in nursing homes where employees and residents might be unfamiliar with HIV and have misconceptions about it. They worried about being a burden on their loved ones. Others who’d lost partners worried about whether there would be anyone who would be able to take care of them.

JM: What about HIV disclosure and discrimination? And homophobia?

PS: Well, concerns related to stigma are ongoing. This is highlighted in the lives of some of the older adults who grew up in an era that was much less tolerant of the LGBTQ community. Many participants are still very concerned about disclosure and how it could affect their supports and housing options.

JM: Growing older isn’t all doom and gloom, even for those of us living with HIV, is it?

PS: No, it isn’t. I think it’s important to state that we found that there were older adults living with HIV who were doing well and were looking forward to growing old. It’ll be important for future research to learn what enables PHAs to maintain a positive attitude as they grow older and what supports we’ll need to put in place to allow them to do so.

JM: Patty, what are the main conclusions that you’ve drawn from your research so far?

PS: We’ve identified that even though our participants are relatively young, with an average age of 55, they’re experiencing challenges in what I term social participation.  Many have difficulties in forming new relationships and feel socially isolated, are experiencing difficulties maintaining work or volunteer positions and have given up some of their discretionary activities. We’ve also learned that there are other important factors that contribute to the disability experienced by PHAs, such as the presence of other health conditions, the amount of social support they have available to them, and stigma. We’re doing further research to help us better understand these complex relationships.

JM: I know your work is ongoing. What are the next steps?

PS: We’re completing some additional analyses of 14 more interviews. After the analyses are complete, we’ll be presenting our findings back to some of the PHAs that were interviewed to get their feedback and to help us develop a model that explains our findings. Ultimately we hope to use these findings to inform the practice of health professionals and influence policy so that, as they age, PHAs will be able to have the supports and services they need.

JM: Thank you so much, Patty, for taking the time to talk to PositiveLite.com about this fascinating research into the needs of older HIV+ people and the relation between aging and having HIV.

PS: You’re most welcome, John.

In Part One, Scott described his early years, leading up to disclosing to those around him, at age six, that he thought Kevin Costner attractive.

Scott: That Kevin Costner episode left me totally confused. Why was I punished? Was it because I said he was cute? And what’s a fag anyway? I was only six and didn’t know the answers to those questions. I continued doing what I enjoyed which was playing with my cousin Michelle.

One day we were running around the front yard where my uncle Jim was working on his car. I don’t recall the exact game that we were playing but I had another case of the slip ups and said that I wished I was a girl. This of course didn’t go well with my uncle. He started shouting at me  - “Are you crazy?” or “You want to be a faggot?”, things like that. He was coming towards me while shouting all these things at me as if he wanted to punish me so I ran into the house to escape a possible beating. That’s what I usually did when I did something wrong.

It was like a chain reaction for the next few years. Almost everything that I did was met with opposition. If I danced a certain way or if I used my hands to express myself, I was told that I was acting like a ‘pantyman’ or a ‘bullerman’ (nasty words they use for “gay” in the Caribbean).

When I turned 13 and entered secondary school, I started to figure out what it all meant. My school was mixed so there was more than a fair share of girls everywhere I turned. I was very shy and quiet but I was still able to make friends with a few kids. Then puberty kicked in and brought with it tons of conflicting feelings. My friends were all interested in tits while I couldn’t resist staring at the guys in the changing room after phys ed class.

By this time I realized I was different. Even my hobbies were different. I played the piano and cello while my friends played cricket and soccer. I loved playing the piano and cello. It gave me a chance to express myself but my friends saw it as a girly thing. More and more I was checking out the guys around me. I suppose that it started to become obvious because out of nowhere I started being pushed around and called a fag and other hurtful names.

My group of friends started to shrink until I was left with only two. I hated being left out and made fun of. I went to the school counsellor and told him what was happening with my friends and about my attraction to guys and he told me that my feelings for them were unnatural. So I couldn’t wait to get out of high school. I still managed to do well academically, due to my motivation to avoid having to spend another year suffering in school.

I graduated in summer 2005 when I was 18 years old. I was grateful that the ordeal of being taunted was over but the intensity of my feelings for guys forced me to come face to face with my sexuality. I hated myself for wanting to be with another guy. I saw how society condemned anyone suspected of being gay and that terrified me. What was even more terrifying was that I internalized this hate. I began to hate not only myself but anyone who reminded me that I was gay. I even made jokes about gay guys to seem ‘normal’.

Everywhere I turned there were negative reference to gay people. There were songs on the radio about burning or killing ‘sodomites’, articles in the newspaper from pastors calling us sinful and political leaders saying that the laws wouldn’t be changed to protect homosexuals. I felt trapped. I felt like I’d be better off dead, in fact I did try to kill myself - although now I’m glad I didn’t succeed.

I was raised a Catholic and although I was never very religious, I decided to turn to my church for answers. Was it really a sin to be gay? If yes, was there anyway I could seek forgiveness? I confessed to my priest about my feelings and he suggested that we meet once weekly to discuss it. Our first meeting was scheduled for 6pm at his office located behind the church. I got there and met with him and he immediately suggested that we hold hands and pray. While we were praying my eyes were closed and I felt his fingers going up and down my hand. In the conversation afterwards he asked me what I liked about men, if I had ever slept with a man, if I ever looked at gay porn and whether I had met any men that I liked.

I felt uncomfortable in this situation. At the end of the meeting, I reached out to shake his hand and he said that he felt connected to me and wanted to give me a hug. I agreed since I thought it may have been impolite to decline to embrace my priest. This hug was very intense; our bodies were pressed together, he was rubbing his hand up and down my back and I felt his hard-on on my leg. I freaked out. I couldn’t believe that my priest, who condemned homosexuals regularly, was hugging me with an erection! I’d read in the paper about gay priests from around the world but didn’t expect to actually meet one. After he hugged me, he scheduled another meeting for the following week and then offered to drive me home. But I declined his offer. I vowed never to return to his meetings or church again.

 It was then I knew that I needed to find a way to trust myself and accept my sexuality completely. It was my first stage in coming out as a gay guy.

Stay tuned for Part Three where I describe how I started meeting other gay guys and how that got me into a load of trouble with my family.