I do love Dr. Robert Frascino, aka Dr. Bob.

Dr. Bob is sex-positive, HIV positive and out about it, wonderfully frank and funny as he educates people on The Body about HIV transmission and prevention. His writing makes people feel comfortable to ask what can be deemed strange but true questions.

The ongoing theme in these questions is fear and the ongoing answer is to educate yourself, directly delivered by the good Doctor. HIV is not as readily transmitted as herpes or human papillomavirus (HPV), but it’s good to know the transmission “formula” when making sexual decisions, particularly with a partner whose HIV status is unknown to you.  Dr. Bob offers encouragement around testing when he thinks it’s applicable and encouragement to learn more about HIV for future liaisons.

He also catches amazing fly balls. One section he writes lists the questions as “I’m Positive I’m Positive.” People throw him anger and accusations of stupidity. It is the Internet after all, where anonymity can prompt people to, shall we say, abandon their manners.  There was the poster who’d been seen by multiple HIV specialists who all confirmed he was not infected with HIV, yet accused Dr. Bob et al. of incompetence, and insisted he should have access to HIV meds. This poster isn’t the only one with great fear.  

Dr. Bob’s messages are clear: know your risks. Know your status. Get care when needed. HIV is a fearful disease to be sure. But the fear it creates can be bigger than the risk of getting it. Dr. Bob tries to keep it all level. And living with HIV himself, he’s aware of the wonder of life. Gotta love him.

- Janet

Positive women are having multiple healthy children and enjoying the joys and challenges of parenting. But being an HIV+ mom and dealing with questions from people who might not know about HIV can be stressful. Questions around breastfeeding alone can be tricky for women who haven’t disclosed to everyone in their community and wish to maintain their confidentiality.

Having a newborn for the first time or the fourth time is an adjustment. Want a confidential space to talk about your pregnancy ups and downs? Those first months of sleeplessness? How to maintain privacy for you and your baby? This June 14, we’ll be offering a support group for women who are pregnant or have had a baby in the past two couple of years.  Share your thoughts, worries, successes and delights with other women. Know you’re not alone.

The group is a partnership of Oak Tree Clinic, YouthCO and Positve Women’s Network. Lunch will be served, and it’s all free of charge if you’re a member of PWN, YouthCO or Oak Tree.

Pregnancy and New Mom Support group
June 14, 12 Noon to 1:30 PM
PWN’s Meeting Room: 103-1033 Davie Street
Please RSVP in advance to Dulce at Oak Tree: 604-875-2250. Bring your belly, bring your babe! If you need a childcare subsidy, please contact Dulce for more information.

 - Janet

It was great to be at the Canadian Association for HIV Research conference in Saskatoon earlier this month. Lots of interesting stuff unrolled at CAHR, but one plenary session in particular lit me up. It looked backwards at the origins of HIV and forwards at what we can do to bring an end to AIDS. 

Friday morning was bright and sunny in Saskatoon, but a dark hotel room housed a crowd to hear Doctors Mike Worobey and Mark Tyndall. Worobey’s work is dedicated to exploring the origins of HIV, a puzzle that hasn’t been solved, nor its findings fully agreed upon. Understanding how HIV has evolved could lead to new developments- perhaps a vaccine (although Worobey admitted he isn’t hopeful for that, given HIV’s mutation rate), or at least microbicide options. Tyndall cast his eyes forward, stressing the power we do and don’t have to limit the spread of HIV.

Worobey presented an overview- variations of SIV (simian immunodeficiency virus), the precursor to HIV, have led scientists to believe that it’s been around for at least 100,000 years. Based on the analysis of the diversity of HIV in samples recovered from around 1960, Worobey suggested that SIV made the jump to humans as early as the turn of the twentieth century. (He cited Beatrice Hahn’s work on the “how.”)

Although HIV had established itself in humans, it didn’t affect a large population until industrialization took off between 1894 and 1956. With new roads connecting emerging cities and development of business in Central Africa, people moved around a lot more, had more sexual partners, and therefore facilitated the spread of HIV.  Worobey emphasized that human behaviour has spread HIV, and human behaviour can stop it too- HIV is not as infectious as the flu, for example, and behaviour modification with the prevention tools we already have could turn the tide.

Ok, done.

But obviously it’s not that easy.

Dr. Mark Tyndall envisioned a world after AIDS, providing a timeline that went forwards rather than back. He too stressed the importance of our behaviour in the spread of HIV, but he took a social sciences perspective, emphasizing that the playing field isn’t even when making behavioural decisions.  Disparities such as gender, poverty, racism, mental health, governmental negligence and governmental ignorance all play their parts in making HIV prevention a challenge on the individual level where it counts.

In order to turn the tide on HIV, Tyndall argued, we need some significant change. We need to convince those with power on a big scale, like governments, that they need to support change through harm reduction policy and programming. We need to convince those with power on an individual scale, like the man in the moment with a condom available to him, to use it. We need better education on HIV, government support for harm reduction programs like needle exchanges, condom distribution, drug treatment and social programs that address the underlying determinants of health. As societies, we need to change gender disparities so girls and women have more power.  Not so easily done, he admitted. But humanly possible.

What fired me up was this doctor’s inclusion of a wide range of realities that affect health. Health is so much more than our physical bodies, and Tyndall acknowledged that in his call for social change. Yes, there’s a lot of work ahead and it’s international in scope. But looking at the work, breaking it down into pieces, and taking on what we can with passion and conviction is an effort we can all make. As PWN’s vision states, Action and Leadership on Women and HIV/AIDS. Every step has to count.

- Janet 

Understanding the complexities of HIV transmission is an ongoing study. Why, for example, does a group of female sex workers who have unprotected sex on a regular basis avoid infection? There’s something about their immunity that offers them protection, but what is it? This is just one line of research on the risk factors and scenarios that lead to transmission. The more understanding we have, the more potential to improve on existing prevention tools and develop more options. A new finding can add another piece to the puzzle.

Women’s vulnerability to HIV infection during vaginal intercourse is more pronounced than men’s. Not only do women have more vulnerable areas of exposure in the vagina and cervix, but in the case of unprotected sex, the exposure to potentially infectious semen lasts longer than a male partner’s exposure to vaginal secretions. One of the theories about women’s vulnerability has been that microscopic tears that can be created in the vagina during intercourse provide entry points for HIV. (This always prompts me to praise the benefits of lube.)

But new research indicates that women don’t have to experience any kind of tearing for HIV to gain entry. Inside the vagina there’s a layer of cells that is designed to keep out infection. These cells are bonded together to create a protective wall between infection and the cells underneath. HIV is able to latch onto this protective layer of cells and break the bonds apart. Once there is space between these protective cells, HIV can slip through and infect the cells underneath. (Medicine.net provides a more scientific explanation than mine!).

On an individual level, this certainly underlines the importance of using condoms for penetrative sex. On a public health level, further findings uncovering these parts of HIV transmission could help in the development of prevention tools like vaccines and microbicides. Either way, I’m hoping we’re a tiny step closer.

- Janet

It’s week two, and I still have Olympic fever. I’ll admit I still have some mixed feelings about the Olympics, but I’m not alone in that. Politics aside, I love to watch the actual sporting events, see the nuances of expression on the athletes’ faces as they anticipate, compete, and then react to their own performances. There’s elation, disappointment, glory, rage. Amazing.

Aside from the competitions, I’ve also got my eye on Pride House, a public space for queer athletes and their supporters to gather. There has never been an official space for queer athletes at any other Olympics, and organizers of Pride House at the 2010 Winter Olympics are hoping it will be a statement about the outlook of British Columbia and of Canada in general. It’s an amazing thing to have a space that defies homophobia in sport.

Pride House acknowledges that there are queer athletes at the games, even if they don’t want to come out. It’s understandable- these athletes, have spent their lives dedicated to their sport, and the Olympics are one of the goals they’ve set for themselves. To talk about their sexuality in a largely homophobic arena could spell doom. Coaches could desert them. Teammates could turn on them. Future deals in endorsements could go sour. Everything they’ve known about their lives so far could be compromised by coming out and being honest about their sexuality.

I’d like to think things can be changed. Hockey, one of the most macho (and Canadian) sports of all has seemed to have softening moments. When Brendan Burke, son of Maple Leafs GM Brian Burke came out (and people certainly reacted to it), his father was supportive. While acknowledging his son would not have an easy road, particularly in the field of sports, Burke vowed to support him. Since Brendan’s sudden death earlier this month in a car crash, his father has said he’ll continue to fight homophobia in sport and carry on his son’s work.

Some folks may argue that sports isn’t about sexuality, it’s about competition. But it is about sexuality if you have to hide who you are to play. It is about sexuality if the outcome of your event is influenced by how people perceive your sexuality. And homophobic commentators during these Olympics Games (for all our liberality, Canadians did it too) have certainly proven that sexuality is an issue in sport. Coming out in such an outwardly heterosexual world is an act of courage. It carves a space for others to do so too.

Homophobia and AIDS phobia are linked. Both inhibit people from being honest about who they are and the complexities of their lives. In a world fascinated with celebrities of all kinds, sports heroes don’t escape scrutiny. We want to know what they wear and how they like their lattes. But if they share who they love, and it’s not the heterosexual norm, that’s a different story. I want that ending to change and I think Pride House is an indication that slowly, we’re moving in that direction. Let the enlightenment begin.

- Janet

Right around the time this post goes online, the Olympic torch will be running by my house.  I’ll be standing on the corner with my camera and pretending that’s not my dog barking in the window, driven insane by all the “trespassers”.    I don’t know what these two weeks will hold for me and my family, but for many people – especially athletes and visitors – the Olympics will be one big party.  If you’re not somebody who regularly participates in international sporting events, you might not know that there’s an awful lot of hanky-panky and partying that goes on.

Unfortunately, when people are visiting another place, feeling excited and euphoric, with easy access to alcohol, drugs and parties, they don’t always set themselves the same boundaries as they would at home.  The numbers show that the incidence of sexual assault and violence against women increases at international sporting events like this one.  With more people engaging in risk activities (like heavy drinking and having unprotected vaginal or anal sex), many end up bringing home a not-so-nice souvenir in the form of a sexually transmitted infection (STI).  That’s why the Vancouver health promotion and harm reduction community has banded together to present Safe Games 2010 – a visitor’s one-stop on-line shop for information on staying safe and partying responsibly during the Games.

In addition to providing online information and links to local agencies (including PWN), Safe Games will be visible at events and in the media, distributing Safe Games kits, including condoms, lube and information about how and where visitors can get help if they find themselves in a pinch.  Condoms have been distributed at every Olympic Games since Barcelona 1992.  70,000 condoms were quickly used up at the 2000 Olympics in Sydney and another 20,000 had to be brought in.  100,000 were distributed at Salt Lake City 2002, 130,000 at Athens 2004 and Beijing authorities distributed a whopping 400,000 (100,000 of them for athletes).  I am sure not everybody guages the worth of a city by how many condoms they can distribute when they host the Olympics … but I do.  The visibility of a safer sex message and availability of condoms at large, high-profile sporting events has the power to reduce HIV transmission and save lives.

Another initiative I’ve been following is Safe Vibe.  A campaign by WAVAW (Women Against Violence Against Women), Safe Vibe aims to build a movement to keep predators out of bars.  Check it out.  For more on HIV and Sport, see the last issue of our newsletter The Positive Side.  And to all you visitors to this beautiful city – happy (responsible) hanky-panky, and sorry about the barking dog!

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

“Our gender (as transgender and transsexual people) is … invalidated, insulted, and hated. We are denied personhood because our gender is not heteronormative enough: Proper men do not want to become women, and proper women do not become men….”  writes Lisa, of Questioning Transphobia.  

Lisa’s words well describe the discrimination that many trans women face: the message that they’re not "right" in a fundamental way, or so says mainstream society. When it comes to women-specific services, the discrimination against trans women can be particularly pronounced, and many trans women are left without services because they aren’t "women enough."

There’s a history of struggle when it comes to including all women in women-focussed services, and the feminist movement overall. It’s not just trans issues- race, class, sexual identity and ability have also been conflicts in determining what the issues are for "all" women. (There are many debates on this, but for a piece on the intersection of race, class, sexuality and trans issues, check out this one on conflict at the Michigan Womyn’s Music Festival). The issue that’s brought up in relation to including trans women is the idea that trans women were brought up as males, and theoretically carry a world view of male privilege. The ringing question is, how can trans women understand what it’s like to deal with the oppression of being a girl/ woman when they were brought up as males? It’s an argument that has been used to bar trans women from events and services.

Vancouverite Kimberly Nixon famously took on the issue when she challenged the Rape Relief Collective’s refusal to allow her to become a counsellor because they felt she didn’t have the necessary life experience. She took her Human Rights complaint  all the way to the Supreme Court of Canada. She eventually lost, but did contribute to the awareness of trans issues among women’s groups and services across the country, creating a lot of discussion about discrimination and inclusion.

Ongoing and ever present discrimination can contribute to risk behaviours when it comes to HIV and other STIs.  Not only do people eschew safer sex, making themselves vulnerable to infection, they also turn to alcohol and drugs as a coping strategy. HIV+ Janice Rodriguez writes candidly about discrimination, violence, and fleeing to the streets after too much brutality at home.

While trans women face daily discrimination, there is cause for some triumph in the form of two new resources in the Lower Mainland. The first is particularly sweet: Lu’s Pharmacy for Women has now opened its doors a little wider to include trans women. When Lu’s opened last summer, they wouldn’t serve trans women. There was reaction to this locally, and in web communities all over the world. The Vancouver Women’s Health Collective recently confirmed that Lu’s has changed this policy. We’re very happy to hear it. 

Additional good news in the community is that Vision Quest Recovery Society will be operating Hart House, a recovery centre for trans women. Amidst the growing chaos resulting from budget cuts to many organizations, it’s great to hear of something going in the right direction. 

Positive Women’s Network is trans-inclusive- all positive women are welcome here. We’re glad to have additional resources in the community and hope this is another step in breaking down barriers that exist for trans women. 

- Janet

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

I want to like Obama as much as the next progressive-minded person, but it seems to me he’s dropped the ball big time on some pretty key campaign promises—troops out of Afghanistan and healthcare reform including reduced cost, improved quality and full access.  So, it was a pleasant surprise this holiday season when Mr. President delivered two nice big packages to the AIDS service movement.  While these two major changes directly affect US law, they both have a significant effect for people living with HIV worldwide, as well as for international prevention efforts.

On December 18th, congress voted to lift the ban on Federal funding for needle exchange programs, while the new laws allowing people with HIV to enter the US came into effect on January 4th.  The lifting of the travel ban has had lots of attention in the media and blogosphere; the lifting of the federal ban on needle exchange funding, not so much.  Of course, we enthusiastically applaud both moves, but I have been anxious to learn what these changes will look like in practice—what effect do they have in the US and around the world?  Where’s the “fine print”?  Is there a catch?  I found some answers, both good and not-so-good.

The lifting of the travel ban means that an HIV test will no longer be part of the medical examination that is required of people applying for residency in the United States.  It also means that somebody applying for a visa or attempting to cross the border cannot be turned away simply because they have HIV.  You could say it’s a good ol’ fashioned case of American DADT—they won’t ask and you don’t have to tell.  But what about those visitors who are already flagged in the system as HIV positive, who have already applied for visas and been denied, or who have been banned while trying to cross the border?  It is possible these people will have to take additional steps to apply to have their entry ban waived or overridden.  It is also possible that border guards will take issue with HIV positive foreigners trying to enter without meds for fear they are somehow trying to take advantage of the stellar American healthcare system (!?!) and get meds there.  This could be a problem for all the healthy HIV positive people out there who aren’t taking meds.  It remains to be seen how exactly things will pan out.

On to US needle exchanges … Basically, it has been left to state governments to fund (or not fund) these harm reduction programs which have been proven time and again (even here in Vancouver) to curb the spread of both HIV and HepC.  They also play a vital role in connecting injection drug users with the healthcare and support services that open the door to recovery from addiction.  While many states have chosen to (mostly under)fund syringe programs, more conservative states (including states like Florida and Nevada, who badly need them!) have opted out.  There has been no possibility of federal funding, since it was banned in 1988.  Now the possibility is there, but here’s the potential catch … no funding has been promised.  Let’s see if any becomes available.  Meanwhile, the ban had a significant influence on international AIDS prevention programming, because guess who holds the purse strings for many of the AIDS prevention efforts around the world?  You got it, USAID.  Hopefully this new “acceptance” of needle exchanges by the US government will mean other governments have more freedom to direct US funding to harm reduction programs.  As always, time will tell.

-Miriam

One of our favourite online information sources is The Body – The Complete HIV/AIDS Resource.  They have an excellent high-traffic Ask the Experts forum where twelve HIV specialists (many of them doctors) answer the public’s questions.  A recent thread got me thinking about the notion of risk.  Dr. Robert Frascino (Dr. Bob) calls it the QTND – question that never dies – what’s the risk of getting or passing on HIV by giving or receiving oral sex?  “Sometimes I wish there were a universal factsheet” writes Confused London Boy, “[…] saying when and in what situation a condom should be used”.  “Where is the line?”

Dr. Bob responds to CLB the same way we always respond, reiterating that the risk of HIV transmission via oral sex is very low, but not completely non-existent.  He also clearly outlines a few of the other risk factors, which can increase the risk of transmission: the presence of other STIs, oral trauma or gingivitis, the viral load of the HIV positive partner and whether they are on treatment, etc.  There is no line; “in reality what exists is more of a zone”.  Some people choose to take a “no avoidable risk” approach and always use a condom or dental dam for oral sex with an HIV positive partner.  Some don’t.

One angry answer-seeker had written to Dr. Bob on Christmas day, claiming that he contracted HIV from oral sex and demanding that Dr. Bob retract his assertion that oral sex is a low risk activity “and take a more strident stance that Oral Sex [sic] is a significant risk”.  (It turns out this man actually hasn’t taken an HIV test “yet”, but he’s pretty sure the scratchy throat he’s feeling is caused by HIV …)  Dr. Bob basically says, no, because that would be lying, and defends himself for consistently presenting the risk as it stands statistically (very low), providing as much information as possible about risk factors, considerations, etc.  But he considers it a decision for each individual to make with their sex partners.

There have been a handful of studies on this issue, summarized in 2007 by researchers from Imperial College in London. (Dr. Bob describes these studies here.)  The results all indicate very low risk (with six out of ten studies reporting no HIV transmission via oral sex), but the researchers agree that it is extremely difficult to tell whether somebody really did get HIV from oral sex, because most people don’t engage in oral sex only.  Among the handful of people who make the on-line claim that they contracted HIV from oral sex, it is completely possible that some of them really did.  These people might be one in a million, making up that tiny little statistical probability that makes us say “very low risk”.  For them though, becoming infected with HIV is not “one in a million” … it’s 100%.  You either have HIV or you don’t and if you do it’s a big thing to live and deal with.  But this is exactly the dilemma that intrigues me about statistical probabilities and the notion of risk.  Statistical probability is a scientific measurement of risk, but it is definitely not an adequate indicator of personal impact.

We take risks every day, some smaller, some greater—driving a car, crossing the street, skiing, eating in a restaurant.  The trick is to be informed, avoid unnecessary risks and take precautions when it makes sense.  This navigating of risks is something that each person must do for herself.  As professionals, we can inform you of the facts—the statistical risk and other factors—and we can even strongly caution you against high risk activities, such as sharing needles and having unprotected vaginal or anal sex with somebody you cannot guarantee is STI-free.  But ultimately, you decide what your risk threshold is.  Of course, it’s also important to consider whether something is putting other people at risk …

To make your own decision about oral sex, definitely take a look at The Body’s oral sex chapter and search for “oral sex” on our You Should Know website, dedicated to the sexual health of women after 40.  And remember that there are other, more common STIs that are transmitted by oral sex, including Chlamydia, Gonorrhea, both types of Herpes and Syphilis.  The risk of getting or passing on one of these diseases is greatly reduced by using a condom or dental dam when giving or receiving oral sex.

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

Many years ago I read an essay about women in Vietnam working to rebuild connections and communities after the Americans pulled out. Someone criticized their efforts, saying they were as useless as water. But the women responded that water is a great force: just look what it can to do stone over time. I may not have the quote perfectly cited, but it captures the idea that has stuck with me all these year. I believe in the power of every woman. Even what looks like the smallest gesture is connected to other gestures and actions, and has the capacity to make great change.

We need some great change here at the start of a new year and new decade. Late last year, the World Health Organization reported that HIV is the leading cause of death in women aged 15-44. One of the primary routes of infection is unsafe intercourse. Microbicide research has taken another hit, so a prevention tool that women could use is still beyond science and well beyond widespread distribution worldwide. Unfortunately, challenges to women are widespread, worldwide and kept up daily. As blogger Melissa McEwan says, we live in a culture that perpetuates sexual violence and the myth that women are at fault for it. This attitude is available everywhere – just look around. And seeing that many people still don’t know about safer sex, our work is cut out for us.

I can see some of the challenges, but not all. But I’m not disheartened, because I also see people who are making a difference every day. How did I find out about Melissa McEwan’s blog? Through an email forwarded to me by women (thanks Dalya, thanks Melissa). Even a simple keystroke to send a message on can help shift things.

Happy New Beginnings. Happy change.

- Janet

 This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.