Positive Living Spring 2015 by NAPWHA

positiveliving FOR PEOPLE LIVING WITH AND AFFECTED BY HIV | SPRING 2015

AN AUSTRALIAN STORY

SCALES OF INJUSTICE

David&Sebastian

When he was diagnosed, Michael Johnson was compelled by law to sign a form acknowledging he was living with HIV. Two years later, that signature would seal his fate. PAGE 5

The challenge for the older generation is — not just to be living longer with HIV — but to be living well with HIV. PAGES 8-9

PAGE 7

An oldie and newbie discuss stigma, disclosure, activism and survival. For a long while, the most pressing question in the world of HIV has been: when is the best time to start antiretroviral treatment? It seems we now have a decisive answer. PAGE 6

positiveliving ISSN 1033-1788 EDITOR Christopher Kelly

David Menadue Vicky Fisher CONTRIBUTORS Daniel Brace, Jake Kendall, David Menadue, Dr Louise Owen DESIGN Stevie Bee Design ASSOCIATE EDITOR PROOFREADER

COVER IMAGE XX

Truvada It’s more than a year away. Why the wait?

what’syourproblem? PAGE 10

Suppressing the virus

thepillbox PAGE 10

Free subscriptions are available to HIV-positive people living in Australia who prefer to receive Positive Living by mail. To subscribe, visit napwha.org.au or call 1800 259 666. CONTRIBUTIONS Contributions are welcome. In some cases, payment may be available for material we use. Contact the Editor EMAIL: christopher@napwha.org.au ALL CORRESPONDENCE TO: Positive Living PO Box 917 Newtown NSW 2042 TEL: (02) 8568 0300 FREECALL: 1800 259 666 FAX: (02) 9565 4860 WEB: napwha.org.au Positive Living is published four times a year by the National Association of People With HIV Australia and is distributed with assistance from Gilead and ViiV Healthcare. Next edition: December 2015 SUBSCRIPTIONS

n Positive Living is a magazine for all people living with HIV in Australia. Contributions are welcomed, but inclusion is subject to editorial discretion and is not automatic. The deadline is 21 days before publication date. Receipt of manuscripts, letters, photographs or other materials will be understood to be permission to publish, unless the contrary is clearly indicated. n Material in Positive Living does not necessarily reflect the opinion of NAPWHA except where specifically indicated. Any reference to any person, corporation or group should not be taken to imply anything about the actual conduct, health status or personality of that person, corporation or group. All material in Positive Living is copyright and may not be reproduced in any form without the prior permission of the publishers. n The content of Positive Living is not intended as a substitute for professional advice.

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thenews

UN: on the way to ending AIDS The world is on track to end the AIDS epidemic by 2030, according to a UNAIDS report. “We are on the way to a generation free of AIDS,” said Ban Ki-moon. The UN secretary general made the statement after it was announced that a target to treat 15 million people living with HIV by the end of the year had been “achieved and exceeded”. The milestone was reached due to better access to affordable

Early ART for older PLHIV Delaying uptake of antiretroviral treatment (ART) may have serious consequences for older people living with HIV. According to research, patients aged between 45 and 65 who started ART at CD4 counts below 350 had higher mortality rates compared to people who started treatment when their counts were around 500. “Delaying ART had profoundly deleterious effects,” said investigators. “Delaying ART until CD4 count dropped below 200 increased ten-year mortality from 19 percent to 28 percent.” US researchers from the CFAR Network of Integrated Clinical Systems (CNICS) monitored tenyear mortality rates according to age and CD4 counts at the time of ART initiation in 3,532 PLHIV. The study found a clear relationship between CD4 counts at ART initiation and mortality rates. “The striking increase in tenyear mortality under delayed ART initiation for adults over 45 years stresses the heightened importance of early ART initiation in this group,” the investigators conclude. The findings follow the START study results that showed commencing treatment as close to diagnosis as possible irrespective of CD4 count reduced the risk of illness or death by 50 percent (see page 6).

antiretroviral treatment (ART). In response, people with HIV are living 20 years longer than in 2000. In 2000, when the treatment target was set, fewer than 700,000 PLHIV had access to ART; 15 years ago, drugs cost US$14,000 compared to US$100 today. Between 2000 and 2014, new HIV infections dropped by 35 percent; AIDS-related deaths by 41 percent. In that time, says the report, the global response to HIV

has averted 30 million new infections and almost 8 million AIDSrelated deaths. Eightythree countries — including those with major epidemics such as India, Kenya, Mozambique, South Africa and Zimbabwe — have successfully reversed or halted HIV/AIDS in recent years. Despite the encouraging

news, the report — How AIDS changed everything — warns against complacency, saying more funding and concerted action to reduce stigma is needed to ensure the 2030 goal is met: “Stigma, discrimination and punitive laws continue to affect the people most impacted by HIV and to block their access to HIV services

in every region of the world.” The report also emphasises the urgent need to “scale up” testing (in 2014 only 54 percent of those with HIV knew they were living with the virus). “The world has delivered on halting and reversing the AIDS epidemic,” said Kimoon. “Now we must commit to ending the AIDS epidemic.” According to UNAIDS, there are between 34.3 million to 41.4 million people living with HIV worldwide.

Trade pact will block access to affordable medicines The international medical humanitarian organisation Doctors Without Borders (Médecins Sans Frontières – MSF) has warned that the TransPacific Partnership Agreement (TPP) contains “damaging” provisions that will lock in high drug prices and keep affordable generic medicines out of reach of millions of people — including those living with HIV. TPP is a trade agreement

between America and 11 nations encompassing the AsiaPacific region — including Australia; it accounts for 40 percent of global income. If approved in its current form, the TPP will have “a devastating impact on global health” said MSF. It would lower the standard for which medicines deserve a

patent, extend patent monopolies to existing drugs, and delay the availability of affordable versions of medical products. MSF relies on affordable generic medicines for its programs around the world. The organisation has repeatedly expressed its concerns about the

TPP. “It continues to prioritise the interests of pharmaceutical companies over the health of millions of people,” said Judit Rius Sanjuan, MSF legal policy advisor. “As it stands, the TPP will be the most damaging trade agreement for access to medicines in poor countries, ever.” The US Congress recently granted President Obama fasttrack powers, paving the way for the deal to be sealed.

Stigma drives transmission A European study shows that homophobic cultures are more likely to have higher rates of undiagnosed HIV. Researchers have found that countries that have laws specifically disenfranchising sexual minorities tend to have larger numbers of gay and bisexual men unaware they are HIV-positive. “Our findings,” said Dr Ford Hickson, co-author of the study, “suggest that stigma might increase the rate of new HIV infections.”

A country’s homophobia was assessed by measuring supportive legislation against discriminatory policies. Russia and Ukraine were found to be the most prejudiced countries against LGBTI people, while Sweden topped the list as the most supportive. The study showed clear evidence that stigma was associated with increased HIV risk, with homophobic cultures more likely to have inadequate HIV services, lack

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of HIV knowledge and lower rates of testing. Discriminatory laws, said Hickson, meant men who have sex with men (MSM) “are kept ignorant, under-resourced and poorly skilled when dealing with sex and HIV”. The study — involving 175,000 MSM living in 38 European countries — concluded that HIV prevention strategies can only work if people are able to be open about their sexuality and honest about their sexual history.

thenews

Link between Cuba eradicates cocaine and HIV mother-to-child

Regular cocaine use increases the risk of HIV infection, say scientists. Researchers at the University of California have found that cocaine changes the way CD4 cells work, making them more susceptible to infection. “This study shows that under the same transmission conditions, drug exposure enhances infection through a collective of biological changes,” said UCLA assistant professor of medicine, Dr Dimitrious Vatakis. Vatakis and his team have discovered that cocaine use increases the number of CD4 cells in the body. It is these cells that become infected by the human immunodeficiency virus.

Therefore, the odds of becoming infected increase. While the study sheds interesting light on the link between cocaine use and HIV infection, it was only a small animal model which did not fully

transmission

Cuba has become the first country to eliminate mother-tochild transmission of HIV. The World Health Organisation described the news as “one of the greatest public health achievements possible”. UNAIDS executive director Michel Sidibé said Cuba has shown the world that ending the AIDS epidemic is possible. “We expect Cuba to be the first of many countries coming forward

recreate real-life settings. Research is ongoing to determine how cocaine use might affect HIV transmission in vaginal and anal tissues; how PrEP and PEP can be affected by exposure to cocaine; and how cocaine alters the body’s immune defences.

NZ to trial PrEP

Truvada as PrEP is to be trialled in New Zealand. The New Zealand AIDS Foundation together with the Auckland Sexual Health Service has been given the green light by the Ministry of Health to develop a trial by the end of the year. In studies overseas, Truvada as PrEP — pre-exposure prophylaxis — has proved to be highly effective in reducing the risk of HIV transmission. There are currently three PrEP trials underway in Australia (see page 10).

to seek validation that they have ended their epidemics among children,” he said. Increased access to antiretroviral drugs was a major contributor to Cuba’s accomplishment. It’s estimated that 1.4 million women living with HIV become pregnant per year. Without treatment, there is

up to a 45 percent chance of the virus being transmitted during pregnancy, labour or breastfeeding. That risk dramatically drops to around 1 percent if both the mother and baby are given treatment throughout the stages when HIV infection commonly occurs.

SF: HIV infection rates at all-time low

New HIV infections and HIV-related deaths are at an all-time low in San Francisco, dropping more than 17 percent from 2013 to 2014. In all, there were 302 new HIV diagnoses last year, and 177 deaths. (In 1992, at the height of the AIDS epidemic, San Francisco recorded 2,331 deaths.) Public health officials put the drop in numbers down to the approval of Truvada as PrEP — pre-exposure prophylaxis. Since

the introduction of Truvada in 2012, new infections have dropped in San Francisco by 30 percent. Proof positive, say

officials, of PrEP’s effectiveness as a prevention tool. In addition to PrEP, the wide availability of testing and rapid access to antiretroviral treatment is also driving the drop in numbers. “All of that together,” said city supervisor Scott Wiener — who last year publicly announced he takes Truvada as PrEP — “creates a very strong atmosphere for reducing new infections.”

HIV-positive people may now enter Singapore — but their stay will be limited to a maximum period of three months. Up until recently, Singapore enforced a blanket ban on HIVpositive people entering the country. Now, the short-stay Social Visa Pass is available to all visitors, regardless of HIV status. The ban on HIV-positive people

seeking work permits or permanent residency still remains, however, as “the public health risk posed by long-stayers is not insignificant”, said a health ministry spokesman. While welcoming the repeal of the short-term entry ban, Roy Chan, president of Singapore organisation Action for AIDS, said more needed to be done.

“While things have improved slightly, we cannot forget that many [PLHIV] are still being asked to leave their jobs and are ostracised by friends and family. Many still suffer alone, and have trouble securing jobs and health insurance,” Chan said. “We need a supportive environment that does not discriminate against a person because he or she is HIV infected.”

The Castro, San Francisco’s gay village

Black market for blue pill Singapore opens door to poz tourists People living with HIV in poor socio-economic circumstances are selling their HIV meds to negative people to use as PrEP (pre-exposure prophylaxis). The most common antiretroviral sold is Truvada, with sellers earning up to $100 for a month’s supply. According to a US study, the main reasons for selling

antiretrovirals were because the person needed money for alcohol or drugs (74 percent), or for living expenses (23 percent). Health professionals warn against informal use of PrEP, however. Risks include sporadic supply, lack of regular HIV testing, lack of STI screening, lack of side-effects monitoring, and counterfeit pills.

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thenews

SCALES OF INJUSTICE Upon diagnosis, Michael Johnson was compelled by law to sign a form acknowledging he was living with HIV. As Christopher Kelly reports, two years later, that signature would seal his fate. On 10 October 2013, AfricanAmerican student Michael L. Johnson was hauled out of class and marched from Lindenwood University, in St Charles, Missouri, in handcuffs. Johnson, then 21, had been arrested for failing to disclose he was HIVpositive to sexual partners. In July, Johnson — a gay highschool wrestling champion — was sentenced to 30.5 years’ jail. To put that in context, consider this: in 2014, a Missouri man responsible for the deaths of two people while drunk-driving was sentenced to seven years. The criminal statute Johnson was convicted of violating was originally passed in 1988, at a time when HIV was considered a death sentence. These days, HIV is a chronic, but manageable condition. The drugs to treat it have become so effective that a person can become virtually uninfectious. Despite this, Johnson was convicted of a Class A felony. HIV activists, along with members of the medical and legal community, have expressed outrage at the harsh sentence meted out to Johnson — a sentence normally reserved for murderers. “Punishing Michael Johnson as if he is a murderer because state officials have failed to address a severely outdated, irrational criminal law is not only fundamentally unfair, it is barbaric,” said Mayo Schreiber, of the US Centre for HIV Law and Policy (CHLP). Johnson’s supporters complain that the prosecution and the media portrayed him as a sexual predator whose “HIV semen” placed the community at risk. “He did not seduce these people,” said the executive director of CHLP, Catherine Hanssens. “He was sought out as a sex partner.” The prosecution is also accused

of deliberately exaggerating fears about HIV. “Health officials stood by silently,” said Lauren Fanning, also from the CHLP, “while the prosecutor used ignorance to persuade a jury that Michael Johnson’s HIV is effectively a deadly weapon.” Time and again during the five-day trial the prosecution emphasised that Johnson engaged in anal sex without wearing a condom, completely ignoring the fact that neither had his partners. Which begs the question: why is Johnson solely to blame for having mutually consensual unprotected sex? It also emerged that the man whom Johnson was convicted of recklessly infecting — Dylan King Lemons — continued to engage in consensual unprotected sex with Johnson, even though he believed Johnson had transmitted the virus to him. Another sexual partner of Johnson’s admitted he regularly had bareback sex with “people he barely knew”. None of the men testifying against Johnson were able to prove he was the source of their infection. Nor were they able to prove Johnson’s non-disclosure (Johnson testified he had disclosed his HIV status before engaging in sex with his accusers). It was a case of he said, he said, and — after deliberating for just two and a half hours — the mainly white jury (only one member was black) sided with Johnson’s six accusers (four of whom were white). According to the Centres for Disease Control (CDC), laws “explicitly focused on persons living with HIV” had been established in 33 US states by 2011. Of those, 24 states criminalise non-disclosure, and 25 criminalise behaviours that pose low or negligible risk for HIV transmission.

LEFT Johnson was portrayed by the media as a dangerous sexual predator.

Last year, the CDC released the following statement: “The majority of laws were passed before studies showed that antiretroviral therapy reduces HIV transmission risk and most laws do not account for HIV prevention measures that reduce transmission risk, such as condom use.” Indeed, under Missouri law wearing a condom is not considered a legal defence. The CHLP estimates that more than 200 cases criminalising people living with HIV have been prosecuted since 2008. Such convictions shame and stigmatise people living with HIV — further deterring people from disclosing their positive status. They also serve to deter people from getting tested. Dr Jeffrey Birnbaum is an

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expert on HIV among adolescents. “HIV criminal laws have no positive impact on the spread of HIV,” he said. “Sentencing people living with HIV to prison for having sex will, based on decades of HIV clinical experience, only drive people away from health centres where they can learn their HIV status and get the medical care they need.” Hanssens says Johnson’s conviction reinforces both an ‘ignorance is bliss’ approach to sexual health and personal responsibility, and public hysteria and misconceptions about HIV. “For the conviction to be fair, you have to believe that Mr Johnson’s willing sexual partners are blameless victims who have every right to rely on a potential sex partner’s statements about his

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health status as the sole basis for deciding whether sex poses any risks,” she said. “You also have to believe that his actions are the equivalent of murder.” Clearly no one has died. Indeed, with proper care and treatment, Johnson’s “victims” have every chance of living long and healthy lives. As for Johnson, his hopes of one day wrestling in the Olympics lie in ruins. Instead, he gets to spend the next three decades wrestling with the injustice of it all. “You didn’t think the system would be that bad where it would demonise you for being positive,” Johnson is quoted as saying. “There are two things in my case people hate: they hate men who are gay, and I also think the thing that people don’t understand and hate is HIV.”

For a long while, the most pressing question in the world of HIV has been: when is the best time to start antiretroviral treatment? As David Menadue reports, it seems we now have a decisive answer.

pinion has long been divided over when to start treatment for HIV. On the one side: as soon as possible; on the other: best to wait. Now there can be no doubt. The announcement of the findings of the START study in May this year provides clear evidence of the value of starting treatment while T-cells are still high rather than waiting until they drop to 350 or below and the immune system is weakened. Up until now, global treatment guidelines have skewed conservative, holding back the use of antiretroviral treatment (ART) until there were signs that an individual’s HIV was progressing. Professor Sean Emery, START coordinator from the Kirby Institute in Sydney, said there should now be no hesitation in advising treatment upon diagnosis. “I don't think that clinicians should feel any discomfort recommending people with HIV start treatment as early as they like,” said Emery. “There is no clinical reason to wait until you get to a certain CD4 count to treat anymore.” The study’s findings validate the changes made last year to Australia’s treatment guidelines allowing people with HIV universal access to ART irrespective of CD4 count (the US Department of Health and Human Services recommends the same). It remains to be seen, however, whether the START study will persuade the World Health Organisation to lift its current guidelines recommending ART at CD4 counts of 500 or less. Primarily funded by the US National Institutes of Health,

START (Strategic Timing on AntiRetroviral Treatment) was set up in 2008 to answer a question that needed a definitive answer: is there a real clinical advantage to starting treatment earlier rather than later? More than 4,500 HIV-

markedly after two landmark studies. “In 2011 with the HTPN 052 study, and then the PARTNER study in 2014, the real benefit of being on treatment and getting an undetectable viral load (and hence reducing your risk of

taken antiretroviral treatment before and had to have a CD4 count of at least 500. They had to agree to be randomised into the two arms: immediate treatment or deferred treatment (waiting until CD4 counts dropped to 350

END OF

DISCUSSION positive people helped provide the answer in a study spread over 35 countries — including Australia. Professor Emery found it difficult recruiting Australians at first, as many were reluctant to commit to ART until absolutely necessary. Attitudes changed

transmitting the virus to partners) became clearer,” said Emery. “HIV-positive people started to see the benefits of being uninfectious to others and that changed some attitudes to treatment." START participants had never

or an AIDS-defining illness had developed). In May, the study generated global headlines when it was stopped 18 months ahead of schedule because the clinical benefits of treating earlier were overwhelming: among those who were treated immediately, the risk

of illness or death was cut by half. The Data Safety Monitoring Board found there were 41 AIDS or serious non-AIDS events or death in the treatment arm, compared with 86 events in the deferred arm — a difference of 53 percent. Findings were the same for low-, middle- and highincome countries. “As a result of this trial we now know that treatment at all stages of the disease extends survival and prevents serious complications in people with HIV,” said Emery. With 12 million people on treatment and 30 million infected worldwide, providing ART for everyone with HIV is going to come at a cost. Emery acknowledges there will be financial implications — especially in developing countries. “While efficiencies can be made in how medicines are distributed and drug companies can be lobbied to reduce prices, other innovations need to be looked at,” said Emery, “like reducing the dosages of some drugs — and hence their cost — as we currently think some people are getting higher doses of some drugs than they need for therapeutic benefit.” As for Australia, at AIDS 2014 in Melbourne, every health minister (federal and state) signed up to a Legacy Statement that aims to end HIV by 2020. This can only be achieved through increased testing; increased access to treatment; and increased numbers of those on treatment reaching viral suppression. Informed conversations within the positive community, including GPs, about the value of early treatment will also be needed if we’re to get anywhere near ending HIV in Australia. Finally, the START trial now provides clinicians and positive people alike the evidence that they have long needed: that treating HIV as close to diagnosis is the way to go.

No clinical reason to wait to treat anymore. Professor Sean Emery positiveliving l

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The challenge for the older generation, says Jake Kendall, is — not just to be living longer with HIV— but to be living well with HIV.

Holding back the years ot so long ago, ageing with HIV would’ve been considered an oxymoron. In the early years, it was a rare occurrence; most people lived briefly with HIV before dying from AIDS. These days, effective treatment means people with HIV can expect to live a normal lifespan. But while modern medication works miracles, ageing with HIV brings new complications. And some of those complications are only just being recognised. Research suggests many of the diseases associated with ageing appear to occur at higher rates among older people living with HIV (PLHIV) than in the broader population. Living with multiple medical conditions — such as cardiovascular disease, cancer, osteoporosis, diabetes and dementia — will become the norm as the HIV population ages. Indeed, according to the most detailed analysis of likely future trends in HIV care for an ageing population yet conducted, the proportion of older PLHIV with at least one coexisting condition

will increase from 29 percent in 2010 to 84 percent in 2030. And 28 percent will have three or more additional medical conditions. Although the findings are based on the clinical needs of Dutch PLHIV — three-quarters of whom will be over the age of 50 in 15 years’ time — they are relatable, say the authors, to other Western countries with maturing HIV-positive populations such as Australia. Many of the health problems will be driven by various forms of cardiovascular disease (highblood pressure, high cholesterol, heart attacks and strokes), with 78 percent of older PLHIV having at least one of these conditions by 2030. In addition, the study found 17 percent will have diabetes and 17 percent will have a cancer. But, wait, there’s good news, too! Chances are, as someone living with HIV, your health and wellbeing is being routinely monitored — far more than the average person’s. So if there were signs of anything worrying, your healthcare professional would more than likely pick up on the

symptoms. Early detection often means a greater chance of effective treatment. Speaking of effective treatment, thanks to a new generation of antiretrovirals, many older PLHIV have robust CD4 counts and are able to maintain an undetectable viral load, which we know reduces the risk of illness and infection. Research shows us that older PLHIV have better drug adherence than younger people. And as the START study found (see page 6), treating early reduces the risk of developing non-AIDS events by more than 50 percent. On top of treatment, there are, of course, other ways you can lower the risk of developing agerelated conditions. And, yes — yawn — you’ve no doubt heard all these recommendations before. But there’s a reason for that: they work. First up, if you smoke, stop. Now. No ifs or butts. Minimise alcohol and drug use. At the risk of sounding like your mum: binge drinking leads to high blood pressure, putting you at risk of strokes and heart attacks. Excessive use of amphetamines,

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such as ice and cocaine, can lead to heart disease. Those are the don’ts. The dos: exercise regularly — it gets the blood pumping, reducing the risk of cardiovascular disease. Eat well. Choose a diet with an emphasis on fruits, vegetables, whole grains and beans. Fish and lean meat both get the Heart Foundation Tick of approval. As do ‘healthy fats’ found in olive oil, nuts and avocados. According to the Cancer Council Australia, at least one in three cancer deaths are preventable and the number of cancer deaths could be significantly reduced by adopting a smarter lifestyle. Smoking, of course, is a no-no. Excessive alcohol, inadequate diet, and obesity are also triggers for cancer. As is unprotected exposure to too much sun (“Slip, Slop, Slap” and all that) — although a small amount of rays at the right time are the best natural source of vitamin D. Calcium is key to reducing the risk of developing brittle bones, although calcium on its own is not enough to stave off osteoporosis. Vitamin D (salmon,

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tuna, eggs, cheese) and vitamin K (herbs, green leafy vegies, asparagus, olive oil) also play an important part in protecting your bones. Omega-3s found in oily fish are beneficial to bones, too. Regular exercise (three to five times a week for 30 minutes), adopting a Mediterranean diet (olive oil, vegetables, fish, fresh fruit and wholegrain breads etc.) not smoking (ever), and drinking moderate amounts of alcohol (wine especially) have all been found to help reduce the risk of developing diabetes and dementia. And finally, get out more. Adopt a hobby. Study after study has found people who maintain a social network and engage in activities, not only live longer, but also remain healthier than people who are socially isolated and who do not engage in meaningful pursuits. Many local HIV organisations run support groups and host social events (see page 16). Ageing — HIV or not — is no bed of roses. But if you take heed of some of the above, hopefully, it’ll be a long while before you’re pushing up the daisies . . .

Having young people say “Look, I’m HIV-positive, I’m living with it, and I’m living conﬁdently”, I’m just so pleased there are people willing to take that point of view because it’s going to change the world.

POSITIVE VOICES

David&Sebastian David Menadue and Sebastian Robinson were diagnosed HIV-positive 30 years apart: David in 1984, Sebastian last year. Here, the oldie and the newbie discuss stigma, disclosure, activism and survival.

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POSITIVE VOICES POSITIVE PEOPLE SHARE THEIR EXPERIENCE OF LIVING WITH HIV Sebastian Robinson: Can you describe the social climate in which you were diagnosed? David Menadue: The times were very different. The scaremongering and the vilification really started in the mid-1980s. People such as Fred Nile carrying on about quarantining us, and [AIDS] being the ‘Wrath of God’. “We always said that decriminalising gay sex would lead to all sorts of pandemonium in society and, look, it has” — that kind of talk. It was social disapproval on a whole new level because people were scared of you; they were scared of the virus but just as scared of people with HIV. SR: Do you think that’s changed?

hide HIV from important people in my life — my family, my workmates. And they were people that I really, really valued. But the last thing I wanted was for those people to reject me. The way I coped was hanging about with other positive people — there weren’t many. A whole lot of people wouldn’t get tested. They thought what’s the point? There was no treatment. In terms of my self-esteem, my face and physical looks have been the most important change. I got lipodystrophy — the “AIDS look” some people might say. But the head space, and what I’ve done with my life over the years, I’m very proud of in some ways. What about you? SR: I was diagnosed HIV-positive while I was involved in a play

Achilles’ heel that you’re trying to hide, that’s when— SR: You create the truth, we can define our own reality and my decision to live openly as a positive man is going to be the reality by which I define myself. If I ever have a public profile as an actor, that information has to be mine and not anyone else’s to divulge. I’ve considered the ramifications of being out and gay and successful as an actor and that suddenly became like nothing when I was diagnosed HIV-positive. I thought, OK, I just have to take this on as well. DM: And, in the same way that gay shouldn’t be an issue, being HIV-positive shouldn’t be an issue. At the end of the day, this is about social norms moving on.

with the idea of rejection, but the whole thought process does wash through my head every time. It’s a declaration. What I find pops up occasionally is, because my status is on my apps, sometimes I feel like I’m fetishised. Either people won’t talk to me or they will have a slightly higher interest in speaking to me because I am poz. DM: I’m probably too old to be fetishised, I expect. Sex was incredibly important to me. To keep having that human contact when I was poz was terribly important. I always put myself out there even when I was relatively unwell. It was just something I had to do. For me, that meant I was normal. I refused to get into, “I’m this AIDS patient and I’m staying at

drugs were rolled out during the 1990s, bringing their own toxicities and only having a limited effect in stopping the large number of deaths back then. The ‘protease moment’ in ’96 was the turning point for me and so many other friends. At that time, I had less than 50 T-cells and had had my sixth AIDSdefining illness. I probably couldn’t have survived much longer. From the first day I took the protease inhibitors I felt a great relief taken off my shoulders. My body was thanking me to the point where I became a bit elated or manic. Suddenly, there were all these positive people showing bursts of energy, doing their ironing in the middle of the night and other strange things. Anyway, moving

DM: I think it’s changed enormously but I think for some gay men it’s still a scary thing in terms of sex. I don’t think too many people think casual transmission is a big issue any more — I hope they don’t. Do you? SR: What do you mean by casual transmission? DM: Just touching someone, being in a room with them; kissing them. Just having social contact. SR: I think people understand HIV is sexually transmitted. DM: But they didn’t initially. Doctors had never seen a retrovirus like it before. It was actually called HTLV-III then, it wasn’t called HIV. So I had a test for HTLV-III and they were pretty sure that I was positive for the AIDS virus. But I was 32 and I thought I’m pretty strong and robust. I had 950 T-cells when they did the test. So I thought I was going to be fine. But of course, as the ’80s unfolded, it was clear it wasn’t going to be like that at all. There was a time when I did not think I would make 40. So turning 60 a few years back I had the biggest party — a huge party with about 100 people. SR: Do you think HIV affected your confidence levels or your idea of self? DM: In the ’80s I felt I had to

called The Death of Kings [Death of Kings is set within the Sydney gay scene during the early years of HIV]. It was like life imitating art imitating life — it was all getting a little too method! I was in a state of shock because I was told my diagnosis at the same time as a rapid test came back negative, so I wasn’t expecting a positive result. From the beginning, I knew I needed to be public about my HIV. There are a whole lot of young people that live with HIV but few in the public eye. I thought, I can’t see anyone. Who is that person going to be? I guess it’s me. DM: Being an out, positive man, you’re doing something constructive; you’re making a strong statement and it’s very hard for people to fight that. If you think you’re a victim, if you think you’ve got this weak

SR: When someone questions why I choose to be out as a positive man, when they ask why I would put things at risk by disclosing, that’s the reason why I need to disclose. Because if people feel like I should be protecting myself, then that is absolutely why I need to be vocal — because there shouldn’t be that fear. And that fear only exists because of the way we protect ourselves or keep ourselves silent. DM: Do you feel the need to disclose your status to sex partners? SR: Generally, yes.

home” mentality. I would absolutely tell people I was positive. SR: I was certainly more anxious when I was engaging in sex before I reached an undetectable viral load. DM: So you’re on treatment? SR: Yeah, I started last year and I was undetectable within a matter of weeks. DM: Was that a hard thing, to go on treatment? SR: Not at all. I made sure I was completely informed and I knew it was best to start treatment sooner rather than later.

DM: Is that nerve-wracking? SR: It’s not debilitating but it does play on my mind. I’m not afraid of myself so much, I’m OK

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DM: There were no treatments at all until 1988 and the first one, AZT, was highly problematic. A series of other relatively untried

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on . . . has becoming HIVpositive changed you, Sebastian? SR: Fundamentally I’m the same person, but absolutely. It has, let’s say, broadened my purpose. I’m not saying it’s a good thing, I’m just saying that it’s a thing. It’s not what I asked for or expected, but it is with me forever. So, you either choose to integrate it or ignore it, because the HIV is there whether you like it or not. DM: People like yourself — who are prepared to be open about their status — are helping to normalise HIV in ways that were never possible in my time. Having young people say, “Look, I’m HIV-positive, I’m living with it, and I’m living confidently”, I’m just so pleased there are people willing to take that point of view because it’s going to change the world.

DOCTOR LOUISE ANSWERS YOUR QUESTIONS

what’syourproblem?

Suppressing the virus Deborah from Wagga Wagga writes: I’ve just been diagnosed HIV-positive. There’s lots of talk online about achieving an undetectable viral load — what is that and what does it mean? Dr Louise replies: A viral load is the number of copies of the HIV virus in the blood plasma of someone living with HIV. An undetectable viral load is reported when the number of copies in the blood is 20 copies/ml or less (<20 copies/ml). Recent research suggests that people living with HIV with undetectable viral loads are more likely to maintain higher CD4 counts, meaning a more robust immune system. Becoming undetectable also greatly reduces the risk of onward transmission of HIV. Antiretroviral treatment (ART) is very effective at reducing the

production (or replication) of HIV, raising levels of CD4 cells and slowing disease progression. For this to happen, however, it is essential that the HIV medications are taken every day, strictly as prescribed. HIV treatment consists of a combination of at least three drugs taken daily. Two to four weeks after starting treatment your doctor may order some initial blood tests to check liver and kidney function. A viral load level will be assessed at about six weeks after commencement of treatment. As a guide, the viral load will often drop significantly on the first test; the virus will then, ideally, be fully suppressed — i.e., undetectable — within six months.

Your doctor may be concerned if there is detectable viral load (>200 copies /ml) on at least two

separate occasions four weeks apart, or if there has been failure to suppress the viral load to undetectable by four to six months after initiation of ART. (This rarely happens.) If, however, the viral load is not decreasing as expected, it may be because the medications haven’t been taken regularly or, in some cases, resistance may be present. To ensure there are no drug interactions that could be interfering with the ART, be sure to tell your doctor if you are on other medications. It’s also important to let your clinicians know if you are having trouble remembering to take your HIV meds or you think you may be experiencing

side effects. With effective treatment, most people living with HIV will experience improved immune function which will lead in many cases to near-normal life expectancy. Keep your questions under 100 words and email them to pl@napwha.org.au. n Dr Louise Owen has been working as a sexual health physician in the HIV sector since 1993. Previously a director of VAC’s Centre Clinic in Melbourne, she is currently the director of the Statewide Sexual Health Services in Tasmania. Her advice is not meant to replace or refute that given by your own health practitioner, who is best placed to deal with your individual medical circumstances.

THEPILLBOX

Truvada: why the wait? It’s safe to say, that when it comes to Truvada’s effectiveness as a preventative measure against HIV, the science is well and truly in: studies from around the world repeatedly find that, when taken daily as a preexposure prophylaxis, the little blue pill works as well — if not better — than condoms. So why isn’t PrEP readily available in Australia to those who want it? Although Truvada’s manufacturer, Gilead, has submitted an application to the Therapeutic Goods Administration for the licensing of the drug as PrEP, there is unlikely to be a response until mid-2016. After that, another interminable wait, as Truvada is considered for Medicare subsidisation — assuming Gilead makes a submission to the Pharmaceutical

Benefits Scheme. At present, people wanting to access Truvada as PrEP in Australia need to be enrolled in one of the three trials currently underway, pay up to $13,500 per year for an ‘off label’ prescription, or buy a generic online. For many working in the HIV community sector, providing widespread access to PrEP is a no-brainer and there are growing calls for the licensing process to be fast-tracked. “I really hope the government expedites the response to make PrEP available in Australia,” said Victorian AIDS Council (VAC) CEO Simon Ruth. “Clearly someone has the power; it’s just about figuring out who that person is and putting pressure on them to move this

along as fast as we can.” Indeed, VAC has launched a campaign with that very purpose in mind. As part of the #approvePrEPdownunder campaign, VAC has produced a video which features high-profile members of the HIV community calling for the immediate availability of PrEP. “Coming from community leaders with lived experiences as HIV-positive people spanning over three decades, it’s a moving testament to the fact that, had

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this technology been available, these people would not be living with HIV today,” said VAC CEO Simon Ruth. Living Positive Victoria is among the many community organisations backing the campaign and its CEO, Brent Allan, is among those featured in the film clip. “This video places people living with HIV where they need to be — championing those strategies which we know make a difference in HIV prevention,” he said. David Menadue also appears in the video. He believes PrEP has “an increasingly important role” in HIV prevention. “As the science about its safety becomes even clearer and as society appreciates its value — rather than stigmatising those that use it —

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[PrEP] will have a profound effect on decreasing the numbers of new diagnoses and helping to end HIV.” In an article published on Vice.com, Alan Weedon argues that, without PrEP, efforts to eliminate HIV transmissions in Australia will be severely frustrated. “If Australia honestly wants to have no new HIV transmissions by 2020,” wrote Weedon, “widespread access to PrEP may need to come a lot sooner.” As yet, America is the only country where Truvada is licensed as a pre-exposure prophylaxis — although, following the emphatic findings of the PROUD study, indications are the UK will soon follow suit. In the meantime, Australians most at risk of HIV are being left behind.

Holding the Man is currently screening in cinemas across the country. Speaking to Daniel Brace, screenwriter Tommy Murphy says he hopes the film will help combat stigma surrounding HIV. An Australian classic, Holding the Man is an account of Timothy Conigrave’s 15-year relationship with John Caleo. The best-selling book was published posthumously in 1995, due to Tim’s death from an AIDSrelated illness the year before. It was first dramatised as a play in 2005. Tommy Murphy, who worked on the theatre adaptation and wrote the screenplay, admits at first he was nervous at the prospect of bringing Tim’s words to life. “My nervousness may have been about the fact that I was generationally removed. It’s not immediately my story, nor did I lose anyone close to me in that initial phase of the epidemic,” says Murphy. “I didn’t feel that I was obviously expert in it in any way, or belonged to it. I had to work to break through those barriers — personally and artistically — to be able to bring the story to stage and screen.” Although lacking the firsthand, lived experience of the AIDS crisis, Murphy found the distance to be a creative benefit. “It was a huge asset creatively,” says Murphy. “Learning about my history became a research task. I think there’s a great curiosity, a great yearning to understand the triumphs as well as the tragedy of AIDS history by younger gay people. And I now know that this curiosity extends beyond the gay community as well.” Both uplifting and heartbreaking, the story sits atop the changing political landscape of the 1980s, portraying the fight for gay rights aside the emerging

AIDS epidemic. It’s a story, says Murphy, which connects the LGBTI community. “We share a perspective on things that is more nuanced than sharing politics or even sharing the same story, but there’s a connection that’s undeniable. I swell up with pride that I belong to this community.” Helping bring authenticity to

the screen was director Neil Armfield and consultant Dr Edwina Wright, who started her career at Fairfield Hospital during the period in which the film is set. An authentic presence is certainly felt when film extra and HIV elder David Menadue appears as an AIDS patient in the ward where John is situated (see below).

Scenes such as that bring home the fact that Holding the Man is an historical drama, based on real events that affected many people working within the HIV sector today. “When I look back at my journey,” says Murphy, “I realise how little I knew about HIV/AIDS history. I think by knowing our history, we can see

how far we’ve come and know why today is better than yesterday, and the day before that. I hope [the film] also highlights the stigma that has been a constant of the HIV/AIDS story, because understanding and telling this story will help to encourage conversations and ease the stigma that still exists.”

HOLDING ON TO HISTORY

HOLDING THE MAN: A PERSONAL PERSPECTIVE BY DAVID MENADUE What a relief it was to attend a preview screening of Holding the Man and to find it such a faithful and authentic recreation of what many of us — gay men in particular — experienced with HIV over the last 30 years. The novel has such a treasured status within the community, particularly with HIV-positive people and their friends. The film tells our story through the eyes of gay activist/

playwright/author Timothy Conigrave. With the talents of director Neil Armfield and screenwriter Tommy Murphy it was always likely to be a winner — but I'm so glad it is. As someone who attended the 1979 National Homosexual Conference Workshop in Fitzroy, I remember the noisy rabble-rousing of the young gay contingent led by Tim and Alison Thorne. They kept us older

activists on our toes, just in case we were going to drop the ball on issues such as decriminalisation, sexism and homophobia. I didn’t know Tim’s story until the early 1990s when I was in Ward 4 at Fairfield Hospital with John who was gravely ill. I, too, was in a similarly fragile state, having developed a MAC infection. I remember the Caleo family visiting frequently. But to anyone living with HIV

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at that time, from anywhere in Australia, the film will have resonance: the awful stigma that came with a diagnosis, the potential rejection from family, the constant wondering about who infected who in your relationships; the false hope of supposed good clinical news that turned out to be futile. It is all there. To those younger HIVpositive people who have wondered what the fuss was

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about with AIDS or have tried to imagine what those years were like, I hope Holding the Man will be a revelation. We still have a long way to go to conquer HIV stigma and discrimination in the community. Films such as Holding the Man — our very own Australian story about the AIDS experience — should go some way to building greater understanding in the broader community.

nswnews PositiveLifeNSW

Better understanding ice use Throughout May and June, NUAA (NSW Users and AIDS Association) and Positive Life collaborated on a meth-use survey with the aim of helping to understand who is using meth and how they are using it. Six-hundred people took part, 459 of whom are current meth users. Some of the main findings included: n Ice/meth use is less about

be in all places where sterile syringes are available;

individual ‘addiction’ and more about a social activity; n People mix it up when it comes to how they use ice/ meth, who they use with, and in what circumstances; n Most people use ice/meth less than weekly; n Safe-use messaging needs to

Ice/meth use is less about individual ‘addiction’ and more about a social activity

n People need to know where they can get sterile injecting equipment and resources; n There needs to be better harm-reduction advice about safer ice/meth using for onthe-go use, and safer use in group or social situations.

The choice is yours Informing partners of exposure Contact tracing is informing a previous sexual or drug-using partner(s) that they’ve been in contact with a treatable sexually transmissible or blood-borne infection. These conversations can at times be difficult, but it remains important to inform sexual contacts that they may have been exposed to an STI, HIV or HCV. Positive Life, along with a number of other community and public health agencies, is developing enhanced contact tracing and peer-led services and resources so people newly diagnosed with HIV can tell as many of their contacts and partners safely and confidently about a possible exposure.

On 1 July, people living with HIV were able to access their HIV meds from their local chemist. This means PLHIV have an increased range of options and more convenience when accessing HIV drugs. If preferred, you can still get your meds dispensed from a hospital pharmacy. But now, your local chemist can also dispense your treatment or, alternatively, you can buy online. The choice is yours. To help find a supportive pharmacy, a list of chemists and a handy map are on our website at thechoiceisyours.positivelife.org.au. You will also be able to add your feedback and share your experiences.

What is HAND? HIV can sometimes impact on psychological and neurological functioning. The allencompassing term for this is HIV-associated neurocognitive disorders or HAND). If you have noticed, suspect, or someone close to you has mentioned, changes in your behaviour, please seek advice from a skilled clinician. The sooner you speak to someone

about this and address the symptoms, the better off your mental health will be. Mental health and neurological conditions can be difficult to identify, come to terms with, and are complex, so you need to speak to your doctor or an experienced healthcare provider. Positive Life is currently working on developing information and resources to

address complex HIV neurological conditions or disorders. If you have any concerns or feel you are experiencing difficulties of this nature, we'd suggest you start a conversation with your treating HIV doctor, sooner rather than later. For further support or information on any of the above, please call the number below.

PositiveLifeNSW 414 Elizabeth Street Surry Hills 2010 | ) (02) 9206 2177 or 1800 245 677 | ø positivelife.org.au positiveliving l

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vicnews

Rules of engagement Andrew Eaton shares the process of developing a strategy for Living Positive Victoria to better engage people living with HIV. This past winter, I was asked to work with Living Positive Victoria (LPV) to develop an agencyspecific Community Engagement Strategy. LPV asked me to prepare a document that reflected the diversity of people living with HIV in Victoria; that detailed how LPV was currently succeeding at engaging Victorians living with HIV; and that provided recommendations to improve the organisation’s relationship with the communities it seeks to represent. In order for such a document

to resonate with both the organisation and its membership, I knew that LPV’s Community Engagement Strategy had to be developed directly from community input. This was achieved by scheduling individual and small group consultations with 50 respondents representing five stakeholder groups: people living with HIV, Andrew Eaton members, volunteers, staff, and representatives from tangible direction for the partner organisations. organisation to enhance its Each consultation was an ability to act as an authentic inspiring experience. representative of people living Respondents provided an inwith HIV (PLHIV). depth understanding of LPV, an Respondents agreed that the appreciation for the organisation excelled in six main organisation’s hard work, and areas:

1 engagement of gay men living with HIV; 2 providing short-term wellness interventions; 3 communications; 4 advocating and campaigning for PLHIV; 5 putting a public face to HIV; and 6 leadership within the HIV sector. There were five areas where the organisation could improve: 1 engaging communities other than gay men living with HIV; 2 mediating between PLHIV and other support services; 3 clearly communicating how LPV is distinct from the Victorian AIDS Council and Positive Living Centre; 4 better accessibility of staff and office space; and 5 following through on great ideas. With these responses and the

organisation’s capacity in mind, I made the following recommendations for LPV to improve their community engagement by the end of their current 2014-2017 Strategic Plan: 1 develop service maps and referral pathways; 2 offer culturally-specific peer support; 3 conduct population health research; and 4 offer support outside of current office space and business hours. The complete strategy can be found by calling Living Positive Victoria on (03) 9863 8733 or at livingpositivevictoria. org.au/about/business-plan. Andrew Eaton is a social worker with a focus on the health and wellbeing of people living with HIV. He has worked for communitybased HIV organisations in Canada, Swaziland and Australia.

Shepparton visit

chin wag Hosted by Vanessa Wagner and Nurse Nancy

Chin Wag hits town Chin Wag, hosted by Nurse Nancy (Dr Kath Albury) and Australian superstar Vanessa Wagner (Tobin Saunders), delivers HIV information in an entertaining chat-show format to PLHIV, their friends, family and carers. The show includes a panel of local healthcare workers, experts and service providers. Chin Wags are in high demand and are facilitated on request. THE DATE: Monday 12 October THE VENUE: Multicultural Hub, 506 Elizabeth Street, Melbourne MORE INFO (03) 9863 8733

Living Positive Victoria and our HIV sector partners are heading up to Shepparton in the Hume north-east Victoria, for an evening event focused on living with HIV. It’s a free, accessible, family-friendly event aimed to engage the local community about current issues around HIV. Special guest presenters will speak alongside members of the Positive Speakers’ Bureau about the latest in treatment advances, support and care, community dispensing, as well as new programs and services for people living with HIV, their friends and family. The event will be hosted by Victoria’s new commissioner for gender and sexuality, Rowena Allen (at right). Assistance is available for those wanting to travel from Hume area or nearby to attend.

THE DATE: Thursday 8 October THE VENUE: University of Melbourne Theatre, 49 Graham Street, Shepparton MORE INFO (03) 9863 8733

living positive victoria | Suite 1, 111 Coventry Street Southbank 3006 | )03 9863 8733 | ø livingpositivevictoria.org.au

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qldnews

RAPID launches on Gold Coast QPP’s Brisbane-based RAPID testing initiative has been so successful that the service has been extended to the Gold Coast. Sharna Quigley reports. With the Gold Coast accounting for 11 percent of new HIV diagnoses in Queensland, expanding the RAPID testing program into the region was a no-brainer. “The Gold Coast is the largest centre of HIV notifications outside Brisbane,” said Jime Lemoire, QPP’s RAPID practice manager, “so we’re bringing the clinic down there to increase testing rates among gay men and men who have sex with men (MSM). With efforts to increase testing, we hope to see the rate of new notifications drop over

time on the Gold Coast.” The Gold Coast RAPID service operates out of the Queensland Injectors’ Health Network clinic (QuIHN) in Burleigh Heads. Lemoire says the close partnership with QuIHN has enabled QPP to provide more services to the community at a lower cost. “QuIHN believes in the right to healthcare with respect, dignity and consideration — and those are values shared by RAPID. We are looking forward to this exciting community partnership with QuIHN, as well as our clinical partnership with the Gold Coast Sexual Health Clinic and other medical services,” Lemoire said. RAPID is a non-invasive model of testing where clients are invited to ask questions about HIV but — importantly — do not need to provide details about their sexual or injecting

history. “Peers do not need to conduct a sexual health history,” said Lemoire, “and clients of RAPID report exceptionally high satisfaction rates with our approach.” The peer-led model means that the staff conducting the testing consultations are from the targeted community themselves. This can be beneficial, as many men feel more comfortable sharing with a peer, and less anxious talking about sexual health and risk. One of RAPID’s peer education and

RAPID manager Jime Lemoire

AWARE one-day workshop highly recommended

Qld govt refunds Biala As Toby Longhurst reports, the longestablished Biala Sexual Health Clinic will be a beneficiary of the Palaszczuk government’s maiden budget. In its first budget since winning office in February, Queensland’s Labor government is investing a record $14.2 billion in health. Of that, $13.2 million will be allocated over four years to reinvigorate the Biala clinic in Roma Street. Another $5.3 million allocated to the sexual health strategy will be rolled out in partnership with community organisations, with

funding being provided Bisshop, a fierce to the state’s primary opponent of the HIV organisations: the clinic's de-funding, Queensland AIDS says she is pleased Council (QuAC), HIV that the “extremely Foundation Queensland short-sighted” (HIVFQ) and decision has been Queensland Positive corrected. “Biala People (QPP). played a vital role Biala’s funding was in offering services controversially cut by to travellers, Fiona Bisshop: the Metro North You can measure the people requiring anonymity, and Hospital board in 2013, health of a city by which led to the closure the sexual health of people in need of free treatment,” of the general sexual its inhabitants Dr Bisshop said. health clinic and a “They say that you can measure greatly reduced capacity for the the health of a city by the sexual HIV/AIDS clinic to operate in — health of its inhabitants — let's a move widely slammed by the state's HIV service providers and hope Brisbane can once again measure up to the high standards practitioners. we have had in the past.” HIV specialist Dr Fiona

testing officers, Glen, believes the model is successful because he knows exactly what it’s like to be in the client’s position. “When clients learn that, they feel more at ease, respected and understood,” said Glen. “This really helps in reducing barriers to testing, and even encourages regular testing routines because clients get to know us and we have a down-to-earth relationship with them.” QPP supports a range of testing options, which, Lemoire says, is crucial if Australia is to end new HIV transmissions by 2020. “Diverse approaches must be embraced,” he said, “if we are to increase HIV testing rates to the level required to achieve our ambitious 90-90-90 UN targets.” The RAPID testing service operates Tuesdays and Wednesdays from 2pm until 7pm. For more information visit: rapid.org.au.

AWARE is a one-day workshop that provides information and support to those who have recently been diagnosed with HIV. The workshop covers a variety of topics, from disclosure to treatments — and everything else in between. The feedback from participants is always extremely favourable. “The AWARE program gave me a sense that I would be okay, that I could continue to live my life the way I choose,” said one. “To anyone who is newly diagnosed and has not attended the AWARE Workshop, I would FEEDBACK FROM PARTICIPANTS highly recommend it,” said another. For further information or to register for the next workshop, please contact Jesse Hooper, peer support and communications officer at QPP, on 1800 636 241 or visit qpp.net.au

Was great for meeting other people with similar issues in a space that felt totally safe. It provides invaluable information in an easyto-understand format’

queensland positive people | 21 Manilla Street East Brisbane 4169 | )07 3013 5555 or 1800 636 241 | ø qpp.net.au positiveliving l

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Don’t diminish spinach ON DEALING WITH DISCLOSURE n Don’t make it a big deal and chances are neither will they. n The earlier the better — why waste time on someone who may reject you because of your status?

When it comes to infection-fighting abilities, spinach packs a punch. It’s rich in vitamin C, oozes antioxidants and contains beta-carotene, which enhances the immune system’s defences. Place 250g of thawed frozen spinach, 1 avocado, 1 cup of natural yogurt, ½ cup of mayo, 2 tsp of dried dill, 1 crushed clove of garlic and a pinch of salt into a food processor and give the ingredients a quick blast so you’ve a rustic-looking savoury dip. Place for an hour in the fridge, then serve with pita triangles.

QUOTEUNQUOTE

HIV prevention should be relatively easy — we know how the virus is transmitted — but, because transmission involves intimate behaviours around which taboos and hypocrisy thrive, too many people are exposed needlessly to the risk of infection. Dennis Altman, author and academic

n If you experience a negative reaction, move on and consider yourself lucky to have Eating a handful of nuts every day could significantly lower the dodged an ignoramus. risk of early death, says a Dutch study. Researchers found that

GO NUTS!

people eating at least 10 grams of nuts a day had a 23 percent n However upsetting, lower chance of dying. don’t take rejection Analysing the dietary personally — HIV habits of more than 120,000 men and stigma has nothing women, the ten-year to do with you. study also found that n Make sure you have a those who regularly ate nuts social support system had a 45 percent reduced risk of neurodegenerative disease; so as to share any a 39 percent reduced risk of respiratory disease; and a fears and hesitations. 30 percent reduced risk of diabetes. positiveliving l

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GOFIGURE q

By 2020

PERCENT of Australia’s HIV population will be aged

50+

calendar2015 september 18

Friday

Queensland Positive People presents Planet Positive — a social evening for HIV-positive people, their partners, family and friends. @ Shafston Hotel, East Brisbane. From 6–11pm. ) (07) 3013 5555 for more details.

Tuesday

‘Home is Where the Art Is’ is a presentation of works by artist (and Living Positive Victoria volunteer) Joe Borg and is part of the Melbourne Fringe Festival. @ The Foyer Gallery, Gasworks Arts Park, 21 Graham Street, Albert Park, Melbourne. 5.30–7.30pm.

Thursday

tasCAHRD (Tasmanian Council on AIDS, Hepatitis and Related Diseases) is hosting a coffee afternoon. Kick back, chat and make new friends. From 2pm. @ 319 Liverpool Street, Hobart. )Tracy Wing on (03) 6324 1242 for more details.

october 12

Monday

Chin Wag is a community forum for PLHIV, their friends, family and carers. Hosted by Nurse Nancy (Dr Kath Albury) and Australian superstar Vanessa Wagner (Tobin Saunders), Chin Wag delivers HIV information in an entertaining chat-show format. @ The Multicultural Hub, 506 Elizabeth Street, Melbourne. Time TBA. For more ) (03) 9863 8733

Friday

Positive Life NSW hosts Genesis — a weekend workshop for gay men diagnosed HIV-positive within the last two years. @ ACON, 414 Elizabeth Street, Surry Hills, Sydney. ) (02) 9206 2015 for more details.

Saturday

The WA AIDS Council and NAPWHA hosts a community forum. The event is an opportunity for people living with HIV to reconnect with the community, to have their say on current issues, and to help improve the lives of others. 11am–1pm. @ Northbridge Piazza (upstairs), corner Lake and James Street, Northbridge, Perth. RSVP Ali ) (02) 9482 0000. Queensland Positive People presents a charity cabaret at Imaginations nightclub, 18 Edward Street, Spring Hill, Brisbane. 7pm–midnight. ) (07) 3013 5555 for more details.

november 10

Tuesday

WA AIDS Council marks three decades of the collective response to HIV/AIDS and invites PLHIV, family and friends to acknowledge this milestone and reconnect with all who have played a vital role in HIV/AIDS work. @ West Australia Ballet Centre, 134 Whatley Crescent, Maylands, Perth. RSVP to events@waaids. com or ) (08) 9482 0000.

Thursday

Anwernekenhe 6 — the national Aboriginal and Torres Strait Islander community conference on HIV education, prevention and wellbeing — is being held over three days in Mparntwe (Alice Springs). This year marks the ANA’s 21st anniversary. @ Double Tree Hilton, 82 Barrett Drive. More 2 info@ana.org.au.

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Monday

International Day for Tolerance promotes the advancement of human welfare, freedom and progress everywhere for everyone. The day is an opportunity to encourage tolerance, respect, dialogue and cooperation with your friends, family and colleagues.

Friday

Straight Arrows invites you to glamp it up in Gippsland for Camp Seaside 2015. Held at a 50-acre outdoor adventure park, the event’s focus is to provide inspiring and life-changing experiences through a combination of programs and activities. Kids welcome. @ The Summit, Trafalgar, Victoria. More ) (03) 9863 9414