PositiveLiving A MAGAZINE FOR PEOPLE LIVING WITH HIV l SUMMER 2014-2015
Is Truvada true blue? • Safe sex options • Ageing with HIV
PositiveLiving THENEWS ISSN 1033-1788
EDITOR Christopher Kelly
David Menadue Menadue, Adrian Ogier, Dr Louise Owen DESIGN Stevie Bee Design ASSOCIATE EDITOR
Positive Living is a publication of the National Association of People With HIV Australia.
Positive Living is published four times a year. Next edition: March 2015 Positive Living is distributed with assistance from
SUBSCRIPTIONS Free subscriptions are available to HIV-positive people living in Australia who prefer to receive Positive Living by mail. To subscribe, visit our website or call 1800 259 666. CONTRIBUTIONS Contributions are welcome. In some cases, payment may be available for material we use. Contact the Editor. ADDRESS CORRESPONDENCE TO:
Positive Living PO Box 917 Newtown NSW 2042 TEL: (02) 8568 0300 FREECALL: 1800 259 666 FAX: (02) 9565 4860 EMAIL: firstname.lastname@example.org WEB: napwha.org.au 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.
Condom PrEP trials present promise claims questioned
In what is being described as “the most significant breakthrough in the battle against HIV in a generation”, PrEP could soon become widely available in the UK through the NHS. Interim analysis from a UK study has shown the preexposure prophylaxis pill, Truvada — a dual combination of tenofovir and emtricitabine — to be highly protective against HIV for gay men at risk of infection. Dr Sheena McCormack, who is heading the study at the Medical Research Council in London, said: “The exciting opportunity this offers is to make the biggest dent in the epidemic of all time.” Yusef Azad, of the UK’s National AIDS Trust, said: “These encouraging results provide powerful evidence that PrEP should be accessible to all who need it as soon as possible.” Dr Rosemary Gillespie, of the Terrence Higgins Trust, echoed the statements and added: “We will now be looking to the NHS to act swiftly to ensure those most at risk of HIV in the UK can access PrEP.” Following the encouraging results — which are consistent with most other PrEP trials — the UK study will be fast-tracked
and participants who have not yet started PreP will now be allowed to do so ahead of schedule. Meanwhile in France, results from the IPERGAY trial — which is establishing the efficacy of taking Truvada before and after sex, rather than daily — have shown a “very significant” reduction in the risk of HIV infection in the group of participants using Truvada as PrEP compared to the placebo group. The results were so convincing that it has been recommended that all trial participants now be offered PrEP. Describing the findings as major, study director Professor Jean-François Delfraissy said: “The results should change international recommendations towards HIV prevention.” Final results of both trials are expected to be presented early in the new year.
A new condom that uses an antiviral gel as added protection against HIV may not be quite the revolutionary product its marketing suggests. The VivaGel condom, developed in Australia and made by pharmaceutical company Starpharma, is the only condom of its kind to incorporate the antiviral compound astodrimer sodium in its lubricant. According to the company’s website blurb, laboratory tests show that it can "inactivate" up to 99.9% of HIV, herpes (HSV) and HPV. However, experts have voiced scepticism. Writing for The Conversation, Bridget Haire, vice president of the Australian Federation of AIDS Organisations (AFAO), said the VivaGel condom is unlikely to offer any more protection than your average condom: “There is no clinical evidence to support the idea that this new product adds any extra protection from HIV.” Indeed, from the very little information that has been published on the product, two studies found women experienced mild vaginal inflammation. “This is troubling,” said Haire, “as inflammation can increase the risk of acquiring HIV.” Also, out of the nine clinical trials listed on Starpharma’s website, none appear to have examined the product for anal use. Furthermore, marketing the condom as “antimicrobial” could have “undesirable effects” said Haire. “In the event of breakage, the false reassurance of the coating may deter a person at risk from seeking post-exposure prophylaxis with anti-HIV drugs.”
Over 50s: a growing HIV demographic There are now more older people living with HIV than ever before. New data shows an estimated 4.2 million people aged 50 years or older were living with HIV in 2013. This means the prevalence of HIV among older people has more than doubled in two
decades. The success of antiretroviral treatment (ART) and a high rate of new infections among older people are cited as the main causes for the increase in numbers. In high-income countries such as Australia, the life expectancy of
an HIV-positive person (on ART and able to maintain viral suppression) is similar to that of an HIV-negative person. A comparable trend is seen in subSaharan Africa where average life expectancy for PLHIV has increased considerably during the
THE EDITORS PAST AND PRESENT Bridget Haire (1994-1998) l Kirsty Machon (1998-2002) l Paul Kidd (2002-2007) l Adrian Ogier (2009-2014) l Christopher Kelly (2014-) PositiveLiving l 2 l SUMMER 2014-2015
past decade. The authors of the data say HIV responses need to address the specific needs of older positive people while more attention needs to focus on HIV prevention for the over 50s. More see page 9
Remember to like us at facebook.com/ positiveliving mag and receive all the latest HIV news.
Something to say? Write to us christopher@ napwha.org.au
‘Mississippi’ Stigma remains ART trial begins widespread A global trial is underway to better understand how administering antiretroviral treatment (ART) to HIV-infected newborns can potentially functionally cure them of the disease. The study — being conducted in the US at the National Institutes of Health — was initiated by the so-called ‘Mississippi baby’ case. After receiving ART 30 hours after birth and remaining on treatment for the next two years, the Mississippi baby appeared to be HIV-free. However, earlier this year the virus had returned to
ACON promotes HIV awareness in Sydney’s Hyde Park ahead of World AIDS Day
detectable levels. Even so, the case gave hope that HIV has an Achilles’ heel. “Even though people were disappointed that the Mississippi baby rebounded, the fact that the child was off antiretrovirals for 27 months was unheard of,” said Dr Yvonne Bryson, co-chair of the trial. “Early treatment of that baby still made a tremendous difference on the amount of virus in the body.” Involving almost 500 babies from eight nations — the United States, Argentina, Brazil, Uganda, Malawi, Zambia, Zimbabwe and South Africa — the trial (called
IMPAACT P1115) will see HIV newborns given intensive ART within 48 hours of birth. After two years of treatment, the children will come off medication for as long as they retain an undetectable viral load. “Our hope is that some of them, or perhaps one of them, will stay in remission or be cured,” said Bryson. “Even if we find that a lot of these babies might have a virus rebound, we’ll learn a lot about how long it’s been gone and also whether or not we would add in a vaccine or another drug to make the remission even more prolonged.”
A recent New Zealand survey exploring reactions to people with HIV makes for depressing reading. The research — conducted by the New Zealand AIDS Foundation — shows stigma is still very much an issue with nearly a quarter of respondents saying they would be uncomfortable being friends with someone HIV. Despite being aware of how HIV is transmitted, 47% of participants said they would be uncomfortable sharing a home with someone living with HIV; 56% said they would feel uncomfortable having food prepared for them by someone living with HIV; while 87% of people were
uncomfortable having sexual contact with someone living with HIV. “HIV stigma is one of the devastating parts of the virus,” said New Zealand AIDS Foundation chief Shaun Robinson. “There are no medications that can ease the effects of social isolation, or being avoided by family or friends or treated as someone to be feared.” The stigma surrounding HIV is spotlighted in a short film, More Than HIV, which aims to tackle discrimination by putting a human face to the virus. “The best way to combat stigma is to show people as people,” said Robinson.
HIV exposed HIV is a cunning bugger. It can lie dormant for years. Not only that, the virus conceals itself in the very cells that help fight off foreign invaders. It quietly lies there cloaked in CD4 cells, in an undetectable state waiting to regenerate. Now new research has discovered a protein thought to be able to expose hidden HIV. Called Ssu72, it appears to interact with another protein called Tat (Trans-activator of transcription). Tat signals to the HIV virus when it is safe to replicate. Researchers at the Salk Institute CD4 cells raise the alarm in California have discovered that to the immune system Ssu72 can bind itself chemically to Tat. It also acts as a sort of jump lead. “Tat is like an engine for HIV replication and Ssu72 revs up the engine,” said a Salk researcher. “If we target this interaction between Ssu72 and Tat, we may be able to stop the replication of HIV.”
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One night in Bangkok
The perfect storm ORIGIN OF HIV TRACED TO THE CONGO
Through the most comprehensive genetic analysis so far, scientists believe they have traced the origins of the AIDS pandemic to Kinshasa — the capital of what is now the Democratic Republic of Congo. The human immunodeficiency virus (HIV) is thought to have originated in southern Cameroon where it probably crossed to humans handling chimpanzee bush meat. However, HIV remained regionalised until it entered Kinshasa in the 1920s. At that time, Kinshasa was the fastest growing city in central Africa: its transport links — which included a modern railway system — allowed large numbers of male migrant workers to converge upon the bustling trading post. This skewed the If the headlines are to be believed Australia is in the grip of an ice pandemic that’s fuelling HIV. Christopher Kelly goes beyond the sensationalism in search of facts. “State government to fight ice scourge”; “Ice and Grindr: danger in the playground”; “Crystal meth linked to HIV rise in Australia”; “Increase in HIV linked to ice”. As you can see, crystal methamphetamine is very much in the news at the moment. Particularly in Melbourne, where findings of a parliamentary inquiry into crystal meth have been released and a drug conference — Ice & Altered Realities — has been held. But how accurate are the headlines? Is ice really behind an increase in HIV diagnoses in Australia? According to one study the answer appears to be yes. Conducted by the Prahran Market Clinic in south-east Melbourne, the study reveals a “convincing significant
gender balance, which in turn led to a roaring sex trade. It’s thought the virus was further spread by doctors injecting patients with unsterilised needles. “It seems a combination of factors in Kinshasa in the early 20th century created a perfect storm for the emergence of HIV, leading to a generalised epidemic with unstoppable momentum that unrolled across sub-Saharan Africa,” said Professor Oliver Pybus, lead author of the study published in the journal Science. The virus stayed confined to the Congo until the 1960s, when it spread to America and around the world. Since the beginning of the epidemic 75 million people have been infected with HIV; while up to 40 million have been killed by the virus.
Faced with an “emergency situation”, Thai authorities organised the first mass HIV testing for young gay men in Bangkok in September. Held in a glitzy downtown ballroom and in partnership with AIDS activist group TestBKK, the ‘Fresh Up’ party aimed to encourage routine testing among gay men. “The event is the new approach to discuss and exchange attitudes about HIV so we can reach our target easier,” said TestBKK campaign coordinator Philip Lim. Over the past decade, HIV has spread rapidly among Thai gay men, especially among those living in large urban areas and international tourist destinations such as Bangkok, Chiang Mai, Phuket,
and Pattaya. And the situation doesn’t seem to be improving: a recent UNAIDS report found gay men account for 41% of all new HIV cases in Thailand. Experts point to a number of factors for the stubbornly high percentage: a booming Thai economy leading to an increase in gay venues; the emergence of hook-up apps; and a growth in crystal meth use. Also, up until recently, when it came to HIV prevention education gay men were completely ignored. But it seems Thai authorities are waking up to the scale of the problem and have embarked on an awareness campaign specifically aimed at young gay men. And in October, Thailand became the first country in Asia to offer treatment to everyone living with HIV.
A new ice age?
association” between crystal meth use and HIV diagnoses among MSM (men who have sex with men). However, the report’s coauthor, Dr Beng Eu, is keen to point out that the study isn’t trying to simplify the link between meth use and HIV as mere cause and effect. “Obviously not all meth use is problematic, and we’re not
suggesting it is,” said Eu. “Rather, we hope the study and its findings will assist doctors to start conversations with patients who might be more likely to be using meth and putting themselves at risk of HIV.” Eu’s study surveyed 211 gay men between 2011 and 2013, 65 of whom were HIV-positive and 146 who were not. Of those HIV-positive, 63.1% reported
Dr Beng Eu: “Not all meth use is problematic, and we’re not suggesting it is.” using crystal meth in the past year. (This compared with 33.6% of respondents who were not HIV-positive.) Also, out of the positive participants, 84% believed their use of ice had led to their HIV status — hence the
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hysterical headlines. Admitting he was surprised at the reaction to the survey, Dr Eu hopes the findings will encourage people to examine their drug use and seek assistance if they feel their behaviour is having a negative impact on their ability to stay healthy with HIV. “Talking about this openly is the first step towards thinking about how to manage the problem,” said Eu. Living Positive Victoria’s vicepresident Richard Keane is also calling for open dialogue. “I feel there is a very hostile environment surrounding the use of crystal meth across the community,” said Keane. “The media sensationalism of the ice ‘pandemic’ particularly around people who are HIV-positive and gay men is not helpful. We must engage with those directly affected. It is within these conversations that some of the answers and a more unified and mature response can be found.” (See page 12)
SAFE SEX For gay men, the mantra “condoms, condoms, condoms” is a very familiar one. And while condoms remain at the forefront of HIV prevention, as Christopher Kelly reports, today there are an increasing number of safe-sex options from which to choose.
hese days, ‘safe sex’ (meaning a very low likelihood of transmission of HIV) isn’t just restricted to condom use alone. Now, it’s a whole different ball game. Hugging the analogy to my chest and running with it, back in the day sex was ping pong. The game was simple enough to understand: there was protected sex and unprotected sex, condom or no condom. The rules were black and white. Today, the game is more complex; think International Rules Football (a hybrid of Aussie Rules and Gaelic Football for anyone interested). “Sex hasn’t been black and white — condoms or no condoms — for quite some time,” said ACON CEO Nicolas Parkhill. ACON has released a list of riskreduction strategies that reasonably constitute safe sex (provided certain parameters are met). They are: condoms, PrEP, sustaining HIV suppression, serosorting, and negotiated safety agreements. The first strategy — our old friend the love glove — remains an effective barrier against the transmission of HIV. Men who use condoms every single time they have anal sex are up to 70% less likely to acquire HIV in their lifetime than men who don’t use them. But in the real world who uses condoms 100% of the time? In the heat of the moment they can be passion killers — once you’ve
finally managed to tear open the packet with your teeth, you’re as stiff as week-old celery. And when you’re not quite — how shall we put it? — compos mentis, it’s easy to throw caution to the wind. So given 30 years of condom promotion has failed to end HIV, surely the more prevention methods in our Bat Belts the better. Which brings us to PrEP. PrEP involves an HIV-negative person taking an anti-HIV drug once a day. If taken as prescribed with strict adherence, PrEP has been shown to reduce the risk of HIV transmission by up to 99%. While many in the HIV sector believe PrEP to be an important new component of an effective combination prevention response, there are others who are concerned it will lead to an explosion of unprotected sex, accompanied by increased rates of sexually transmitted infections (see page 8). “We know from research that
many of the men interested in PrEP already have low rates of condom use,” said Parkhill. “So while it may be counter intuitive, PrEP could reduce the rate of some STIs in these men, as to access PrEP, men will need to see a GP every three months at least which creates more opportunities to offer STI testing and to break the cycle of transmission.” Number three on ACON’s list of risk-reduction strategies is a supressed viral load. According to several large international studies, a positive person on antiretroviral treatment maintaining an undetectable viral load (UVL) reduces the risk of HIV transmission to low to next-to-zero. Earlier this year, interim findings of the PARTNER study (which aimed to assess the risk of transmission between poz-neg couples engaging in condomless sex) showed a transmission rate of 1% a year where couples
engaged in any anal sex, and 4% for anal sex with ejaculation where the HIV-negative partner was receptive. In a nutshell, the positive partners were virtually non-infectious. Fourth on the list: serosorting. This is a strategy that aims to limit condomless sex to people of the same HIV status. In order for this strategy to be effective, men must not only know their own status but also be sure of the status of their partners. “HIVpositive men have been using serosorting for many years,” said Parkhill. “We have always respected gay men’s capacity to manage this complexity, by and large successfully.” However, serosorting in casual sexual encounters is not an effective prevention strategy for HIV-negative men, as ascertaining the current HIVnegative status of even a familiar casual sex partner is inherently unreliable.
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Fifthly, and finally, negotiated safety agreements. This is where two HIV-negative men —having established they share the same serostatus — agree to limit condomless sex to their relationship only. Negotiated safety requires that both parties have an explicit agreement about always practising safe sex outside the relationship. Such a strategy requires transparency and a commitment to revising the agreement should it be broken. “The model of agreement promoted is one where there is an overt agreement to discuss slip ups,” said Parkhill. “Obviously, this is not a great thing to happen, and different couples will take different approaches. We would recommend returning to sex with condoms — or another form of protection — until both partners have reconfirmed HIV-negative status.” There are some who will dismiss condomless sex strategies altogether. Gay men who engage in ‘unprotected’ sex are reckless, dangerous — irresponsible, they say. “We don’t think anyone should be judged or stigmatised,” said Parkhill. “We would make the case that sex on PrEP or effective UVL is protected sex, as is sex with condoms.” But after decades of being told to always wear a condom, isn’t there a risk gay men could find the condomless strategies confusing? After all, it flies in the face of ingrained community norms. “Having a range of choices to protect against [HIV] is — in our view — a benefit,” said Parkhill. “Ensuring we equip men with this information and support them to make informed choices is the key challenge here. Pretending these [strategies] don’t exist would seem to us to be the greater risk.”
25 years of
PositiveLiving It began as a humble newsletter; today Positive Living is a multi-platform publication with an international readership. Adrian Ogier traces PL’s evolution and looks back at the key issues of the day.
In the beginning . . .
Bridget Haire 1994-1998
The combination therapy era In the early 1990s, the PL editorship passed to Bridget Haire, who was employed as an information officer at the Victorian AIDS Council (VAC). Shortly after, she and PLWA Victoria treatment officer Colin Batrouney decided to turn Positive Living into a broadsheet and — in a flash of brilliance — to insert it into the Melbourne Star Observer. The move put HIV out in the community and into the forefront of people's minds. This was part of a plan both to make distribution more cost effective and to emphasise that HIV issues were important to the whole LGBTI community, not just those living with HIV. Inserting Positive Living into gay community newspapers remained the magazine's outreach mainstay from then on. The first insert issue
In 1989 an information officer at PLWA Victoria called David Stephens created a newsletter and called it Positive Living. The magazine started out small — four A4 pages to be precise — but the articles included in the first fledgling issues were consumed with relish by the organisation's small but growing membership: “AZT: is it good or bad?” and “How can you access other meds?” were among the first articles published. There were also stories about anti-discrimination legislation and how to get housing or onto the DSP. David Menadue was PLWA Victoria president at the time and sat on PL’s first editorial committee. He also wrote a column called ‘Mind Space’ about his everyday NOV. 1996 experiences living with HIV. “With the exception of Talkabout, nobody else was doing that at the time,” says Menadue, “and it seemed to be what people wanted to read.” He adds Positive OCT. 1997 Living had to be careful not to be perceived as overtly political: “We reported on ACTUP goings-on but tried not to be too out appeared in November 1994, just after the there. We were all so scared of being depivotal AZT/3TC results had been funded.” presented. This marked the beginning of
the combination therapy era. Eighteen months later came the first reports of the efficacy of triple combination therapy. “Because these results were so significant, it was critical to engage the community,” Haire says. “And so treatment became a key focus of the publication.” With the fiasco of early AZT intervention (the Concorde trial) still very fresh in people’s minds, it was important to present all sides of a treatment story — not just the good results, but other issues like side effects and adherence problems. This holistic approach to information — trying to present the science along with the lived experience — did not go down well with some treatment advocates. “They wanted people with HIV to be told to get on medication now to save their lives,” says Haire. “That wasn’t our role. We wanted to give the information and be part of the conversation.” To maintain reporting integrity, it was important to tell the whole story about a particular drug as fully as possible. However, there were incidents in the early days of people trying to influence how some stories were told. “We didn’t NOV. 1998 have internet access back then, and were dependent on journal articles and conference reports from whatever source,” recalls Haire, “— including pharma reps.” On one memorable occasion, a pharmaceutical representative tried to stop a story about side effects going to press. “She failed,” says Haire. “We published the truth as we understood it.” When Haire and Batrouney moved to the Australian Federation of AIDS Organisations (AFAO) Positive Living went with them and in 1996 the publication became national. The first national issue
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included an interview with an international researcher who urged people not to start treatment with an inferior protease inhibitor — unboosted saquinavir, the first protease inhibitor on the Australian market. “This researcher had been pivotal in the development of this drug and was very clear that it was suboptimal,” says Haire. “This was a highly controversial piece of news. And one that Positive Living broke.”
Kirsty Machon 1998-2002
The challenges of treatment In the late ’90s Kirsty Machon took on the role of editor. During this period, many people were wary of treatment and its long-term toxicities. “Drugs like d4T and the new protease inhibitor class were saving lives . . . but at a cost,” Machon recalls. Positive Living was very much a treatment activist publication and Machon saw it as her job to portray things accurately and give people the facts so that they could make up their own minds. “We also wanted to encourage people to think beyond the negative aspects,” she says, “and consider the new treatments that were coming along.” Positive Living has always prided itself on tackling the issues that people want addressed. Side effects were a major part of people's lives back then, so tips and tricks to deal with them were constantly on offer in the magazine. “We wanted to help people live a little more easily under what were for some pretty difficult circumstances,” Machon says. This was the reason why the regular feature ‘What’s your problem?’ was created. The doctor's advice column proved so popular that it exists to this day (see page 10). Despite being funded by Big Pharma, Positive Living has always fiercely protected
more settled period around its editorial treatment,” says Kidd. independence. Positive Living had always been “We were a treatments publication and up occasionally till this point had focused on side questioned about effects and what drugs were in the the influence of pipeline. “We still dealt with that corporate stuff,” says Kidd, “but we were sponsorship,” says entering a period when treatment Machon, “but the was becoming less of a big deal. pharma sponsors The emphasis was changing to never pressured me to write about any particular drug or to take a particular stand.” Indeed, Machon was invited to SEPT. 2005 attend a pharmaceutical company function in Thailand and to report back on the findings of a drug they were promoting at that time. “I didn't like its side effect profile at all and was quite critical of it in my report in Positive Living,” Machon recounts. During her tenure, Machon was also very careful to position Positive Living to all people living with HIV — regardless of gender or sexuality. For this reason APR. 2006 Machon paid special attention to the issues of positive women and heterosexual lifestyle issues relating to HIV. We had to men. rethink what Positive Living was all about.” The year 2002 marked 20 years of HIV and Kidd produced a special anniversary issue that year. “I spent some time plotting an HIV timeline that ran through the issue,” he recalls, “and people loved it.” In 2003, former editor Kirsty Machon wrote a pretty radical article on the fertility options for positive men. “Heterosexual men living with HIV can feel particularly marginalised,” says Machon. “So, I thought it was fair to devote a feature to Paul Kidd characterises his time as editor their issues, including their right to have as one of transition — not only for the children.” publication but also for people living with It was years before the Swiss Statement HIV generally. “I don't know if we quite or the PARTNER study. However, the knew it at the time, but we were entering a evidence was already convincing that
Paul Kidd 2002-2007
A period of transition
treatment provided protection from transmission. This was the first time that men had been included in the positive procreation debate and the article received supportive feedback from readers, as well as some fairly conservative doctors. “Plus one letter of complaint from someone who took exception to us profiling a sub-population such as straight men,” Machon recalls. During this period, management of PL transferred from AFAO to the National Association of People with HIV (NAPWHA). This was a significant move as the magazine was now back in the hands of people living with HIV.
Adrian Ogier 2009-2014
Lifelong and manageable My first issue of Positive Living talked about how impending changes to same-sex law reform would impact welfare recipients in relationships. It was a subject that would affect many PLHIV around the country so I spent days labouring the copy, and checking figures and quotes. This established one of my two AUTUMN 2011
editorial principles: no matter how complex the issue it should always be written in good, simple English . . . and proofed within an inch of its life. The other was never to print a bad news story unless I could accompany it with something positive. So stories on the risk of heart disease, for example, would usually end with ways you could avoid getting it. The phrase: “Eating well, exercising, drinking less and not smoking” frequented the magazine during my time as editor. Which kind of sums up the period. By now, HIV had become lifelong and manageable. The things that threaten people living with HIV are pretty similar to the ones that threaten any ageing population. PLHIV just happen to be a little more susceptible to some of them. Mental health touches us particularly. One column I introduced called ‘State of Mind’ was an immediate hit. And I suspected it might. The column offered a variety of ways to tackle anxiety and depression. Guest therapists wrote on mindfulness, meditation, yoga breathing, massage, and cognitive behavioural therapy.
Christopher Kelly 2014- The future looks bright Which brings us to the here and now. And the future looks bright: treatments are improving all the time and more people with HIV are living well and living longer. So too, there is an ever-expanding suite of prevention methods available. Among the most exciting is Truvada as PrEP (see page 8). Can it really be true that with strict adherence this little blue pill can reduce the risk of HIV by up to 99%? Independent studies across the globe are indicating so. Indeed, a French study — IPERGAY — suggests Truvada can be effective in protecting against HIV when taken intermittently. Then there are the PARTNER findings. Earlier this year, the European study
found that — providing the positive remain sadly much the same. Stigma is partner is on treatment and maintaining commonplace — the results of a recent an undetectable viral load — survey left me shaking there is almost zero risk of HIV my head in disbelief (see transmission between poz-neg page 3). Let’s hope that couples. Speaking as someone in one day people will a serodiscordant relationship, regard HIV much as the findings are nothing short of they do diabetes. miraculous. As for Positive Living, And while scientists remain in the spirit of the times, cautious of talking up a cure, for it’s gone digital. The some, sustained remission may magazine is available in be not so far away. But although flipbook format via the SUMMER 2014-2015 medical science has made leaps NAPWHA website and bounds since the first issue of Positive (napwha.org.au) and the PL Facebook Living was published a quarter of a page. However, there is a limited print century ago, attitudes towards PLHIV run for subscribers only. Alternatively,
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you can request to personally receive the electronic version of the magazine. If you would like to subscribe to one or the other — or both! — email me: email@example.com. Whatever the platform, you can be sure that Positive Living will continue to inform and support people living with HIV across Australia. So cheers. Here’s to the next 25 years . . .
Depending on who you listen to, Truvada is either a miracle pill potentially capable of ending HIV or a party drug likely to lead to bacchanalian behaviour. Not since “the pill” has one tablet caused such a divide in opinion. The controversy surrounding Truvada (a medicine used to treat people with HIV) began two years ago when the drug was approved as a pre-exposure prophylaxis (PrEP) in the United States — meaning the tablet could be taken as a precaution against contracting HIV. Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles, was among the first to describe Truvada as a "party drug" (the suggestion being people will take it before or after a "big weekend" thinking this will provide protection against condomless sex). PrEP has been shown to reduce the risk of HIV infection by up to 99%. But to achieve such a high level of protection Truvada needs to be taken every day. Damien Rivkin, a clinical psychologist at Sydney’s Albion Street Centre, says such strict adherence is a concern. “PrEP is far more demanding than using condoms. It requires more discipline,” said Rivkin. “It's hard enough to get positive people to take their meds every day. It would be harder to get negative people to take their tablet every day in the off-chance that they might have sex." Earlier this year, America’s Centres for Disease Control issued PrEP guidelines. They state that PrEP is for people at “substantial risk” of HIV infection such as gay men, people who inject drugs, or negative partners in poz/neg relationships (see box). Authorities in San Francisco have since made Truvada available to those eligible, and New York is considering doing the same.
Andrew’s story Andrew is a 37-year-old gay man who has been in a relationship with his HIV-positive partner for the past ten months. “I think my partner always thought we would use condoms but my research
True blue? David Menadue reports on the little pill that’s causing a big fuss.
Opponents of PrEP say its availability will discourage condom use. Yet there is no evidence in the US of PrEP users abandoning condoms en masse. Besides, Australian studies already show increasing numbers of gay men aren't using a condom every time they have sex.
showed me that, as he has an undetectable viral load, my risk of getting HIV from him was low already. When we first had unprotected sex though, I freaked out. I rushed off to get post-exposure prophylaxis (PEP) from the local hospital the next morning. It was clear I wasn't as comfortable with the idea as I originally thought. I was so glad that I did go to the hospital because I met a
Some clinicians are also worried that should PrEP encourage people to have a lot of condomless sex with multiple partners they risk picking up sexually transmitted infections (STIs) such as gonorrhoea or syphilis — which can in turn cause a positive partner's viral
load to rise and increase the chance of HIV transmission. Advocates argue that one of the conditions of PrEP is that individuals are tested regularly for STIs (at least every three months). Someone who acquires an STI will therefore be quickly treated, meaning better outcomes
great clinical nurse who explained the facts about transmission to me, and that I was unlikely to even need PEP because of the low risk. After informing my doctor of my experience, she asked me to consider PrEP. Having done some research online, providing I had a prescription, I learned I could order the generic medication from a Canadian website for $125 a month. My partner and I felt it
was worth paying that for peace of mind — for both of us. Prior to receiving the prescription I agreed to quarterly check-ups with my doctor and signed a waiver acknowledging I understood there may be some extremely small risk of transmission. Since taking PrEP, the effect on our relationship has been very positive. It's probably been a greater relief for my partner who was so worried
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at both an individual and population-wide level. Truvada as PrEP is not available in Australia but it was much discussed at the International AIDS Conference in Melbourne in July of this year where many HIV-experienced Australian doctors supported providing Truvada for people in serodiscordant relationships. (There appeared, however, to be division amongst doctors on the question of whether PrEP should be made available for HIVnegative people engaging in condomless sex with multiple partners.) There are currently a number of PrEP trials underway across the country. Associate Professor Edwina Wright is chief investigator of the VicPrEP study. She says the findings from the study should help inform decisions about the feasibility of a PrEP service in Victoria. "We are looking at the acceptability of PrEP, adherence to it and whether behaviour change occurs while on it,” said Wright. “A recent study from the Kirby Institute suggested that it would only be cost-effective to give serodiscordant couples PrEP. We are hoping our data will prove that it should be extended to other at-risk people." The consensus among HIV organisations in Australia seems to be that PrEP is a valuable additional method of protecting against transmission. ACON’s acting CEO Karen Price said: "While condoms remain the best protection against HIV transmission, having other methods of prevention available to gay men is vital in reducing transmission rates." Of course the Australian conversation has only just begun. But if the American experience is anything to go by, stay tuned for a long and protracted battle to get PrEP approval here.
about the possibility of passing the virus onto me. This has meant we can relax, have more confidence and a more spontaneous sex life. I know how important it is to take it every day and I have only forgotten once. I now have a tablet dispenser for each day of the week. I have my partner to remind me though — if he is having his pills with breakfast, then I know it's time for me to take my little blue pill.”
POSITIVE VOICES PHOTO MICHAEL CASTELLANO
POSITIVE PEOPLE SHARE THEIR EXPERIENCE OF AGEING WITH HIV
“Age doth weary and the years condemn…” For positive people it should read: “HIV doth weary and the years condemn . . .” Long-term survivors such as myself certainly have been wearied by HIV. And it’s not just the virus that has knocked us for six. The drugs, too, have taken their toll. Many of the early drugs were discontinued because of their toxicity. However, we had no choice but to take them and were left to live with the side effects. As a direct result from taking the trial drugs, I suffer from chronic peripheral neuropathy and lipodystrophy. Both conditions are very debilitating, causing extreme pain in the case of the former and depression with the latter as it affects self-esteem. One of the trial medications has also left me with a very rare Long-term neurological condition called survivors such superficial siderosis. Doctors know as myself nothing about this disease; there is no treatment or cure. Sound certainly have familiar? been wearied Another annoying part of by HIV. And ageing with HIV is that I have to factor more doctors’ visits than it’s not just the other people my age. As someone virus that has ageing with HIV, I am constantly knocked us being monitored for toxicity and changes to my liver and kidneys. for six. As well, I suffer from sleep apnoea, which also seems to be a common condition with men with long-term HIV. Heart conditions are amongst the most common ailments. I know this personally. I have atrial fibrillation and may need a pacemaker to remedy the condition. The HIV is also responsible for my high blood pressure. So whilst we long-term survivors are in a good place, and we’re thankful the drugs have kept us alive, there is a huge cost. Is it worth it? You bet it is!
I was diagnosed HIV in 1989, when I was 24. It was hard to I’ve learnt over the years, as I get older, not to blame imagine any future back then. I was told I had four years to everything on HIV. When you’re 75, health wise, things live. There was no treatment; it felt pretty hopeless. When are going to go wrong. You are going to get arthritis; you’re drugs became available they came with lots of side effects. not going to have the energy levels you had when you were They were keeping me alive, but not making me feel any 60 or 50 or 40. better. I didn’t have any quality of life and was quite ill all Although I do think the virus and the drugs exacerbate of the time. One day I’d had enough and stopped taking existing conditions; I do think things accelerate and them. Not long after that we got triple combination explode a bit with HIV. So I’m probably a little bit worse treatment, which brought great hope. off than a healthy 75-year-old. But you must be careful not Between the ages of 24 and 35 I did nothing. When I to blame everything on HIV. got to my mid-30s and realised I was going to have a future The cocktails have done wonders, there’s no doubt after all there was a whole mind shift. I started about it. Although some have been very toxic. One drug volunteering for Living Positive Victoria (LPV) and Positive gave me pancreatitis, another sent me quite barmy. But Women. My life built from there: I started going to TAFE these days, the situation is a lot better — there’s such a and getting a few diplomas. Now I’m a peer support wide choice of drugs. worker at LPV, which is incredibly rewarding. HIV has taught me to be more When you’re empathetic Living with HIV has changed dramatically since and less judgemental of people. I was diagnosed 25 years ago. The progress that has living with HIV, It has taught me to appreciate what I have. been made with science and medication is You get to value things you didn’t notice the stigma, unbelievable. I am just really hopeful for people before — particularly good friends. It the disclosure sounds corny, but I’ve learnt to live for the newly diagnosed that it won’t be so much of a — they’re physical problem for them. moment. I spoke to a recently diagnosed young woman My advice to the young newly diagnosed constants who said after seroconversion HIV hasn’t been an would be to seek out help and support. throughout issue at all. She takes her pill and gets on with life. There are places and people around that your life. So can help you through it. It’s very important Her issue is stigma, and dating, and all that sort of stuff. being positive to talk to others — especially of a similar When you’re living with HIV, the stigma, the has made me age — who are in the same position. disclosure — they’re constants throughout your When I was diagnosed in 1988 I was quite resilient. told I’d be lucky to live three months — six life. So being positive has made me quite resilient. And like a lot of people living with HIV who have at the most. I couldn’t believe I made it aged, I feel like I have already come to terms with death. through that first year. My attitude for many years was, Been there, confronted it. Not scared of it. “Well, look, there’s another day gone.” So I feel Living with HIV has also helped me become wise and unbelievably blessed to be here. non-judgemental. I’m now fortunate to be in a position to People with HIV weren’t meant to live this long. Now help others, to educate and hopefully reduce stigma along people with HIV are being put in aged-care homes. the way. HIV has dramatically altered my life, but I don’t According to the experts, I should never have made it. I know how else my life would’ve been without HIV. think “Gee, I’m still here — I’m 75!”
PositiveLiving l 9 l SUMMER 2014-2015
DOCTOR LOUISE ANSWERS YOUR QUESTIONS
Starting treatment Michelle from Geraldton writes: I’d like to start treatment but I’m a bit worried about side effects, some of my friends have had random ones. What should I expect? And how should I choose between what’s available? When can I expect results? Dr Louise replies: The decision-making around antiretroviral treatment is a complex one that has to take a number of factors into account. The most important thing to note is that being on treatment improves outcomes for individuals and reduces transmissions to others. We are fortunate these days to have a wide choice of HIV treatment options meaning we can usually find a combination that suits each individual. There are three once-daily fixed-dose combination pills available containing multiple medications in one pill. In choosing the combination
for you, the first thing the clinician looks at is what will be most effective based on the genetic profile of the virus. Standard practice now is to order a genotype test of the virus to determine if there are any resistance mutations that would reduce the effectiveness of treatment. For many people who have never been on treatment this test often reveals that the virus is fully susceptible — i.e., any appropriate combination of the medications will work and result in viral suppression. Then we need to look at other considerations when choosing the regimen. Other medications the person may be on have to be taken into account in order to identify potential drug interactions; so too, other medical conditions (such as kidney or liver problems, coinfection with hepatitis B or C); and also lifestyle factors. The most important
what’syourproblem? determinant predicting treatment outcome is that the tablet regimen is taken as strictly directed all the time. This is the crux — we are asking you to take a pill or combination of tablets every day for the rest of your life. There are ways we can help with adherence (alarms, apps and prompts etc.). Nowadays the medications are extremely effective and a decrease in viral load is usually seen within weeks to months. Usually, after a combination is selected, you would have a review a few weeks
— or may occur without any overt symptoms, e.g., a decline in kidney function. Usually your doctor will discuss the common side effects that may be associated or occur with the combination prescribed. Talk to your doctor or nurse about any side effects that you are experiencing. However, for most people on HIV treatment the most common side effect is a robust CD4 count and an undetectable viral load. And that’s no bad thing! Keep your questions under 100 words and email them to firstname.lastname@example.org.
later to check for early side effects. So what side effects can be expected? Any medication can have side effects and these may be obvious early on — such as a rash
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.
SUPERfoods Salad days Well, summer is here and one Australian food blogger couldn’t be happier. “I love this time of year,” says One Hungry Mami. “The weather is warmer, the days are longer and holidays are imminent. Also, it’s stone fruit season!” One Hungry Mami’s blog shares recipes and ideas on whole plant foods. Not that she’s out to convert people: “You must eat the foods that make you feel best,” she says. But who wouldn’t feel great tucking into these two fruit-inspired salads? “The flavours of sweet and savoury really work well together,” says Mami, “and they also add a different texture depending on what you do with them.”
White nectarine and tofu salad SERVES
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2 AS A SIDE OR 1 AS A LIGHT MEAL
1 white nectarine, sliced into wedges 100g firm tofu, sliced into 0.5cm thickness 2 handfuls of rocket 1tbsp red onion, thinly sliced 1/2 lemon, juiced sea salt and freshly crushed pepper to taste
Method 1 Heat up a small frying pan and place nectarine wedges flesh side down. (I used a nonstick frying pan so didn’t need to add oil.) 2 Cook for about 3 mins per side; they should be a little bit caramelised. Remove from heat and now cook tofu on each side. (Again, I didn’t use oil but feel free to if you prefer.) 3 In a medium-sized bowl combine rocket, nectarine, onion and tofu. Pour in lemon juice and seasoning and get your hands in there and give it a gentle but thorough mix so everything is coated evenly. Serve.
Baked apple and pumpkin salad SERVES
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4 AS A SIDE
2 granny smith apples 4 cups of pumpkin chunks 1 tbs balsamic vinegar 1 tbs extra virgin olive oil sea salt and ground pepper
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4 handfuls of rocket 3/4 cup bortoli beans 1/4 cup walnut halves, chopped 2 tbs dried cranberries
Method 1 Pre-heat oven to 180°C. Line a tray with baking paper. Peel and core apples, cut them into thick wedges and place on tray along with pumpkin pieces. Bake in oven for about 30 mins, or until pumpkin is cooked. 2 Once cooked, remove from oven and leave to cool for about 20 mins. In a screw-top jar, add balsamic vinegar, olive oil and seasoning. Shake to emulsify. 3 In a medium-sized bowl, place rocket, beans, walnuts and cranberries. Add the pumpkin and apples and toss gently. Serve. n For more plant-based recipes visit onehungrymami.com
PositiveLiving l 10 l SUMMER 2014-2015
What’s up down under? BY LANCE FEENEY It is a little over a year since the Positive Life NSW president Malcolm Leech died of anal cancer. I’ve been thinking of him and his commitment to the myriad health and social issues faced by people living with HIV. I’ve come to realise that we need to avert other deaths from anal cancer in gay men and people with HIV. Positive Life, along with ACON, is a community partner in SPANC (Study of the Prevention of Anal Cancer). This study is currently running in Sydney and has about 12 months to go. It’s one of the largest studies of human papilloma virus (HPV) in gay men. SPANC follows gay men at five visits over three years and examines the course of HPV disease, which is believed to be the precursor to anal cancer. Anal cancer and cervical cancer in women are caused almost entirely by infection with HPV, a family of more than 100 different viruses that cause everything from common warts to genital warts and cancers. Most sexually active people will acquire at least one type of HPV and just about all HIV-positive gay men have detectable HPV infection. The high-risk HPV type associated most often with anal cancer is HPV16, followed by HPV18. Persistent infection (or reinfection) with high-risk HPV types is an important factor in
HIV-positive gay men have 80-100 times the risk of contracting anal cancer. developing anal cancer. HIVpositive gay men have 80-100 times the risk of contracting anal cancer, and gay men have about 30 times the risk compared to the general population. HIV-positive women have 15 times the risk of anal cancer compared with the general female population. People with lowered immunity and people who smoke are at greater risk of anal cancer, and the risk increases with age. One important factor to note is that in many cases the body will eventually get rid of HPV infection. The average length of any single anal HPV infection is about five months to a year for HIV-negative people. However, HIV-positive people and people with weaker immune systems may take longer to get rid of HPV infection. You can also be
reinfected with HPV. The good news is that if anal cancer is diagnosed very early survival rates are good, but if picked up late, prognosis is poor. There are currently no accepted guidelines for anal cancer screening. This is because there are a number of major concerns about the accuracy of screening tests, the side effects of treatment, and effectiveness or not of treating pre-cancerous lesions. The SPANC study hopes to increase our understanding of these issues. So until the findings from this research become available, the following approaches can be taken to either decrease your chance of developing anal cancer or detecting anal cancer when it is small and has a better prognosis: 1. Stop smoking
2. Get an annual digital anal examination from your GP 3. Get checked for any anal symptoms like a lump, bleeding, sores, or pain If you haven’t already turned off and stopped reading, you may be thinking this information is yet another bad news story in a long line of bad news stories. This may be particularly so if you’re a gay HIV-positive man over 50 who’s lived with HIV for some time, and smokes. We’ve been through a lot, the bad days of AIDS; the evolution of modern treatments and those intolerable side effects; increased rates of inflammatory and agerelated diseases; and scary predictions about neurological impairment — to name a few. It’s no wonder some of us have succumbed to HIV-related fatigue, depression and apathy. Added to this is the fact that gay men have a special relationship with their arses. We are not like straight men, who by preference have an entirely different attitude to their bums. So, if you haven’t been examined down there for some time — hot play sessions aside — visit your doctor for a digital anal examination. Detecting an abnormality, particularly if you’re at high risk of anal cancer, can save your bum and your life. Lance Feeney is the Senior Policy Advisor and advocate at Positive Life NSW and is a member of the NAPWHA PozAction Group.
Annual General Meeting announced The Positive Life NSW Annual General Meeting (AGM) will be held on Wednesday 8 December 2014 at Aerial UTS Function Centre, UTS Building 10, Level 7, 235 Jones Street, Ultimo.
Our Constitution provides that Positive Life NSW Inc. conducts voting for the Board of Directors and nominations for Distinguished Members by postal voting. Therefore,
nominations for the Board have been called and nomination packs have been sent out to full and Distinguished members. The first Notice of AGM and Call for Nominations 2014 pack,
the 2014 Audited Financial Report, the Annual Reports for 2012-2013 and 2013-2014 are all available to view or download from PLNSW website (positivelife.org.au).
Collecting HIV meds from the chemist The Australian Government is changing arrangements for dispensing HIV medications. From 1 July 2015, people living with HIV will be able to access HIV medications from community chemists. First, you will need to check that your chemist stocks HIV medication. Also, find out how the dropping off of the prescription and collecting of HIV treatments will work. In inner city areas, it is likely that you will be able to get HIV medications dispensed on the spot. But, if you live in an area where you’re the only person living with HIV, you’ll probably have to drop off your prescription one day and return to the chemist a few days later to collect your drugs.
In most circumstances, chemists will provide extended hours for dispensing, for example: 8am to 8pm and for some, seven days a week; others may be able to provide a free delivery service. If you decide to go with the free delivery option, be assured that HIV medications are packaged with no apparent branding of the pharmaceuticals contained within. If you have worries about privacy, talk to the pharmacist and let them know your concerns. Most pharmacists are very sensitive to customers’ need for privacy. In the unlikely event that your privacy is breached or compromised, raise the matter with the chief pharmacist. If the issue is not resolved to your satisfaction, you can lodge a complaint with the Privacy Commissioner; the Australian Health Practitioner Regulation Agency; or the NSW Health Care Complaints Commission.
PositiveLifeNSW 414 Elizabeth Street Surry Hills 2010 | ) (02) 9206 2177 or 1800 245 677 | ø positivelife.org.au PositiveLiving l 11 l SUMMER 2014-2015
news LIVING POSITIVE VICTORIA livingpositivevictoria.org.au
Is Tina in town? BY NIC HOLAS In a period in which the media and the community warn of an “epidemic” of crystal methamphetamine use, myth mixes with fear to blur the full picture. It’s vital then that we hear honest accounts of crystal meth use. In the last month, I’ve had the privilege of interviewing and surveying HIV-positive men from Australia and overseas about the different ways crystal meth — or Tina, or ice — affect their lives. I use the word “privilege” because these men have opened up and responded bravely to my questions. Many of them are members of my organisation, The Institute of Many, and this familiarity allowed for an open dialogue. As the world stumbles, bleary-eyed out of the postReagan neo-con era, it seems that finally we’re admitting that the war on drugs has been an abject failure. Criminalising and stigmatising drug users has proven ineffective, and has
Just as we have fought HIV stigma by coming out of the shadows to speak candidly about our lived experience, so too must we create safe, supportive environments for people who use drugs. Nic Holas been grossly imbalanced in the targeting of people from culturally diverse communities and other minorities. “Just say no” as a strategy (or the newer reworked tagline “not even once”) is almost laughable when faced with the complex psychosocial pressures of drug use among gay men — especially those living with HIV. So, how to address this issue with the drug du jour of the gay community? Let us make no bones about it: crystal meth is a pernicious, powerful drug that has the
HOLIDAY BREAK Living Positive Victoria will close for the holiday break from 5pm Friday December 19, 2014 and reopen Monday January 5, 2015. We wish everyone all the best for the season.
capacity to alter the lives of people who interact with it. I have heard bracingly honest accounts of how the drug has affected people to the detriment of their relationships and responsibilities. However, there are many other users for whom crystal is a controllable recreational pursuit that offers immense amounts of pleasure. These people recognise their limits and adhere to them. Some recreational users would, for example, limit Tina to three days at a time; or limit the amount of blasting versus smoking;
and ensure there was ample recovery time built in to play (often with a fully stocked fridge). Also crucial is a network of non-judgemental people who understand Tina’s appeal. This notion is met with some scepticism from men who have required personal or professional intervention in managing their own use. However, it seems those who have a network to discuss their usage feel more inclined to be in control of it. What this points to is the stigma around crystal. I had one participant tell
me they believed their friends would judge them harshly as a “meth head” or “Tina freak”. This attitude seems prevalent in those who have never experienced the drug and those who have emerged from a period of life-altering use. Just as we have fought HIV stigma by coming out of the shadows to speak candidly about our lived experience, so too must we create safe, supportive environments for people who use drugs. So let this be a call for greater honesty, and less baggage. From my research a resource will be created that seeks to authentically depict how our community is managing crystal meth. To my mind, it is the only way we can effect change. Nic Holas has been commissioned by Living Positive Victoria to prepare a report on community attitudes towards the use of crystal meth with participants drawn from his online support group for HIV-positive people, The Institute of Many (TIM).
World AIDS Day Monday December 1, 2014
Happy 21st birthday JOY 94.9!
Happy 21st birthday to our special media partner JOY 94.9. On 1 December, JOY 94.9 will celebrate 21 years on air. This significant milestone is a major achievement, not only as Australia's first and only LGBTIQ community radio station, but also as an organisation that has played a significant role in educating the broader community around HIV/ AIDS awareness. From general programming to special projects such as World AIDS Worldwide and the station's involvement at AIDS 2014, JOY 94.9 continues to deliver on its mission and purpose: to provide a voice for the diverse lesbian, gay, bisexual, transgender, intersex, queer and allied communities; enabling freedom of expression, the breaking down of isolation and the celebration of our culture, achievements and pride. Many happy returns!
World AIDS Day launch
World AIDS Day Memorial Ceremony
HIV and the Law: sexual practice, risk and liability in Victoria
5.30pm for 6pm Positive Living Centre 51 Commercial Road, South Yarra MORE INFO (03) 9863 0444
ACMI 6.30pm MORE INFO VAC (03) 9865 6700
St Paul’s Court in Federation Square 9-10am with Professor Mark Stoove from Burnet Institute. Followed by morning tea at the Yarra Room, Melbourne Town Hall with JOY 94.9 (10.15-11.30am). Call (03) 9863 8733 to RSVP for morning tea
¢ More events check facebook.com/
Suite 1, 111 Coventry Street Southbank 3006 | )03 9863 8733 | ø livingpositivevictoria.org.au PositiveLiving l 12 l SUMMER 2014-2015