One of the greatest joys I have is getting behind the wheel of Mei Lin. She’s a great little Mazda 3 Sport that has a helluva kick to her. (Her real name has been changed to protect her reputation).
I swear if I ever get pulled over by the Police and they ask me about my driving, I will turn to them, look them straight in the eye, and say “Zoom zoom!!” The sad times are when I have to return her. She’s the lady that I love riding but don’t really want to keep. Sure I have taken her, and a few of her sisters, home to mom, but none of them are truly mine.
What has led me to be the little automonympho that I am? Zipcar. I love Zipcar.
I am a public transit person and have been my whole life. I had actually sworn off the idea of driving in my youth as something that only taxi-drivers and other manual labour people had to do. But me, someone of high esteem, does not drive, but is driven. Oh, the allure of getting into the back of a cab and having a sudden on-set of English accentism as I am caromed through the streets of our fair city, just because.
I was so proud of my anti-driving stance that I pooh-poohed those who did drive and subjected them to long drives out of their way to meet me - in places without parking. Just to show them how awful they are. Actually, I was just scared.
As a child I got to ride in the front seat, with my two of my brothers in the back. I remember a time when we were in the car at a mechanic's shop and my dad was talking to some of his friends outside, working on another vehicle. Sitting in the front seat gave me a clear view of the handle (Ed: the gear shift) with all the little letters. I turned it to ‘D’ for ‘Daniel’! How harmless could that be? My brothers are yelling at me – “the car is moving! " I told them it was their imagination but as men came screaming towards while we inched closer to the vehicle parked ten feet away with men underneath it, it became clear that the D stood for something else. Disaster.
At sixteen I got my learner’s permit. You don’t actually need to drive a car to get that, just take a test. And I’m great at tests. Like a little show-dog, I’m great in the arena prancing around in my little circle in front of all the judges; just don’t ask me to do something in real life on the fly!
One summer I was working at a horse ranch as maintenance. When you look back over your life and remember certain things, this still shocks me today as a job I held for a few weeks! Seriously – I am asking you not to laugh; it’s just too funny when I remember it! Since I was seventeen and the other guy was sixteen, which made me the senior in our crew, the keys to the beat up old Dodge pick-up were mine. In those few weeks I hit two trees, a tree stump, a staff member, ran over someone’s foot and left it in neutral at the top of the hill – so I was pretty amazing. It was when I almost hit one of the young campers that somehow my assistant got a new promotion.
From then on, I vowed that I had completed my lifetime’s work in the field of transportation and was willing to leave that up to the Sulu’s and Chekov’s of this world. We Spock’s must move to bigger and better things.
It wasn’t until the past few years, that there were even thoughts of driving again. Lululemon has a manifesto – a collection of quotes and sayings that sum up their corporate ideology and mode for living. On it there is one motto that resonates with me “Do one thing each day that scares you”. Now I am not sure if I fully live this, but there were many things that I have allowed fear to stop me from ever trying. It is frustrating, and expensive to constantly take cabs, even though I love the decadence of it. But what if I were able to do it myself? Now that would be something. I could go camping when I wanted to, or to Ottawa or Montreal on a whim, if I chose. So I decided to take lessons.
My first time in the car, I had an anxiety attack. I actually started in classwork first, and had a series of anxiety attacks there too. I don’t know, maybe I’m just afraid my half-Asian side will kick in and express itself in stereotypical driving clichés. Anyway, I drove like an old lady! I took my time.
After several months I was ready to take my driving test. I failed. The second time was a success and when I called my friends and family to let them know, I believe there was a hint of trepidation in their congratulatory sentiments.
Zipcar gave me a viable option for getting on the road in short order. One of the things I never thought would happen was my love of speed. The freedom of the wheels opened up new doors. I started offering to guest teach outside of my little bubble of the world. I’m not exactly a great explorer – I don’t really see myself moving off to Europe for the summer or backpacking through Brazil - but now, maybe one or two evenings a month I can drive myself out to another city and teach there [I love you Moksha Yoga Peterborough!]. It’s my mini-adventure – exploring new worlds and new opportunities - to boldly go where this little city dweller has never gone before.
What’s the other exciting part? Cruising the mean streets of Toronto with my best friend in tow, pumping the music and trolling for bears and cougars. That’s right y’all! We go hunting at night! And how do we celebrate a hunting feast? Late night ice cream on hot waffles. Oh yeah. That’s just how we roll! Jai!
This article by Keith Alcorn first appeared on aidmsap.com here.
Global analysis of HIV treatment cascades – the proportions of people diagnosed with HIV, in care, on treatment and virally suppressed – shows that some of the world’s richest countries are still far short of achieving the UNAIDS 90-90-90 target, research from Imperial College London shows. Progress is worst in Eastern Europe, where most countries lag behind average performance in sub-Saharan Africa on every indicator.
The findings were presented by Jacob Levi at the Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) in Vancouver, Canada – described by numerous speakers this week as the '90-90-90' conference.
The 90-90-90 target set by UNAIDS aims to diagnose 90% of all people with HIV, provide antiretroviral therapy for 90% of those diagnosed and achieve undetectable HIV RNA for 90% of those on treatment, by 2020. This ambitious target translates into undetectable viral load in 73% of all people living with HIV.
How far are countries from achieving these targets? In some cases fairly close, but in others, the gap is enormous.
Research conducted by a team from Imperial College, London, and the Cantonal Hospital of St. Gallen, Switzerland, updating a previous survey presented at the 2014 Congress on Drug Therapy in HIV Infection in Glasgow, shows that Switzerland, Australia and the United Kingdom have the highest proportion of people living with HIV with undetectable viral load. In each of these countries, over 60% of the estimated population of people living with HIV have undetectable viral load, compared with 30% in the United States. (Editor’s note . . and 35% in British Columbia, the Canadian province were complete data is available; Canada as a whole joins Denmark, Rwanda, Belgium, Cuba, Columbia, Ukraine, Kyrgyzstan and Vietnam in not having full data.)
Worldwide, 36.9 million people are estimated to be living with HIV of whom 53% are diagnosed, 13.4 million people short of the 90% target, the researchers calculated, drawing on recent data from UNAIDS. Forty-one per cent are on treatment, 14.9 million people short of the target, and 32% are virally suppressed, 15.3 million people short of the target. Approximately 2 million people each year are becoming infected at current rates of transmission.
Breaking this down to look at national treatment cascades from 11 countries with full treatment cascade data and 9 countries with partial data (where data for some steps in the cascade may be missing, or total numbers of people are not reported), the research group found enormous variations at each stage of the treatment cascade. They sought to identify 'breakpoints' in the cascade – steps where more than 10% of people were lost.
Monitoring and comparison of treatment cascades will be an important tool for benchmarking national and regional performance, and for accountability, speakers at the conference agreed."
The proportion of the estimated population of people living with HIV who had been diagnosed varied from 86% in the United States and Australia to 71% in Canada, 51% in sub-Saharan Africa, 45% in Colombia and 44% in Ukraine. Many countries were identified as having breakpoints in HIV diagnosis, indicating the global importance of improving rates of HIV diagnosis.
Retention and linkage to care are difficult to compare due to lack of data in some countries and a lack of a common definitions of linkage and retention in care.
Estimates of the proportion of people receiving antiretroviral therapy were calculated from government drug purchases and pharmacy records, and showed that treatment is a particular vulnerability in the treatment cascade for Australia, Denmark, Brazil, and most prominently, the United States, where just 37% of people are estimated to be on treatment, despite one of the highest rates of HIV diagnosis in the world. (Editor’s note: Canada - or B.C. - is at 51%). Treatment rates are abysmal in Eastern Europe, where just 29% of people are on treatment in Estonia despite a diagnosis rate of close to 90%, and just 11% of people are receiving treatment in Russia.
UNAIDS aims to move countries towards achieving viral suppression in 73% of all people living with HIV by 2020. Switzerland, Australia, the United Kingdom, Denmark and the Netherlands are well on their way to achieving this target; in each case, easily attainable improvements in the rate of diagnosis or treatment initiation should allow these countries to reach the goal.
Other countries that perform well in some areas are still lagging far behind when it comes to viral suppression. France reports that only 52% of people living with HIV are virally suppressed (compared to 61% in the United Kingdom and 52% in Rwanda), while 35% in British Columbia, Canada, 32% in sub-Saharan Africa and 30% in the United States are virally suppressed. Once again, rates of viral suppression are extremely low in Eastern Europe.
Monitoring and comparison of treatment cascades will be an important tool for benchmarking national and regional performance, and for accountability, speakers at the conference agreed.
Levi J et al. Can the UNAIDS 90-90-90 target be achieved? Analysis of 12 national level HIV treatment cascades.Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Vancouver, abstract MOAD0102, 2015.
With early and ongoing treatment, people diagnosed today with HIV can expect to live a near-normal lifespan. But to enjoy good health into old age, they need to look after their overall health and well-being – including their physical, mental and sexual health.
One health risk for gay men with HIV is other sexually transmitted infections (STIs), such as syphilis, chlamydia, and gonorrhea. Although there are treatments for bacterial STIs, being infected with HIV and another STI is very hard on the body:
Yes. But recent research by Dr. Ann Burchell, Director of the OHTN Cohort Study, suggests that HIV-positive men who have sex with men are more likely to be co-infected with other STIs than women and heterosexual men with HIV.
Bacterial STIs are more infectious than HIV. They spread during unprotected anal or oral sex. Unlike HIV, which has a low risk of transmission during oral sex, bacterial STIs spread easily through oral sex.
Bacterial STIs are on the rise in Ontario. Since the early 2000s, gonorrhea has increased by 3%, chlamydia by 7%, and syphilis by 16% per year on average in the province. These STIs are more prevalent among HIV-positive gay men. In the OHTN Cohort Study, which tracks thousands of people in Ontario living with HIV, 21% of HIV-positive men who had sex with men also tested positive for syphilis at some point between 2000 and 2009. In Ontario, rates of new diagnoses of these STIs are significantly higher in gay men with HIV than in the general population.
Gay men who are living with HIV can protect themselves from the negative consequences of other STIs by getting tested more often and getting treated right away.
More gay men with HIV are going for STI testing. In the OHTN Cohort Study, the proportion of gay men with HIV being tested for syphilis rose from 2.7% in 2000 to 54.6% in 2009, and testing for chlamydia and gonorrhea rose from 18.6% in 2008 to 32.4% in 2011. However, even with these increases, not all men at risk are getting tested, and we are still not testing to guidelines. When Dr. Burchell looked at men who reported five or more sex partners in the previous three months, 22% were not tested for syphilis and 42% were not tested for chlamydia or gonorrhea in the subsequent 12 months. This falls far short of recommended annual testing for all sexually active gay, bisexual, and other men who have sex with men.
The best thing that gay men with HIV can do to protect their sexual health is to test regularly for other STIs: at least once a year and more often if they are having unprotected anal or oral sex with multiple or anonymous partners.
You don’t have to see your doctor for an STI test. Sexual health clinics across the province – including the Hassle Free Clinic in Toronto – offer drop-in testing.
To find a sexual health clinic near you, call the AIDS & Sexual Health Infoline at 1-800-668-2437 or visit www.sexualhealthontario.ca.
See Ann Burchell’s papers on:
This article previously appeared on the OHTN's website here.