(left to right Keith Reynolds, Daniel McGraw, Darren Ho)

Earlier this year on PositiveLite.com, we profiled Totally Outright, a program for young gay men who show promise as future community leaders. Today, in a special series of articles by three graduates of the program, we hope to show how, by investing in these and similar young men, we’re able to ensure that the future of Canada’s gay community will be in good hands.

The uplifting stories of Daniel McGraw, Keith Reynolds and Darren Ho illustrate how, with a minimum of resources but with lots of creativity, it’s possible to create the gay leaders of tomorrow. But the program not only forms future leaders. It also provides participants with the chance to build communication skills, practice outreach techniques and strategize solutions for the numerous challenges faced by gay men.

All three of the young men who tell their stories on PositiveLite.com today have found a place in the gay community beyond the bars and clubs. Both Daniel and Keith now work in gay men’s health while Darren, a university student, has started a project to address the lack of visible presence of LGBTQ people among ethnic communities.

Totally Outright has been running in Vancouver for several years and graduates 20-25 young men annually. Created and evaluated by the Community Based Research Centre (CBRC), it’s delivered by Health Initiative for  Men (HiM), a community organization dedicated to strengthening the health and well-being of gay men through a sex-positive, integrated approach to health. The program has been so successful that a Toronto version was launched this spring by the AIDS Committee of Toronto (ACT). 

Read what Daniel, Keith and Darren have to say and be inspired!

If you are interested in starting a version of Totally Outright in your own community, or just want to understand this program in depth, Health Initiative for Men has provided full background information in CATIE’s Programming Connection.

New research suggests that a disproportionate number of HIV transmissions - perhaps more than half - may originate from people during the acute stage of HIV, which is the first few months after someone is infected. Why? Because HIV replicates very quickly immediately after infection so a person is much more likely to pass on the infection at this stage if they’re having unprotected sex. And they’re more likely to think they’re negative.

Health Initiative for Men (HiM), a gay men’s health organization in Vancouver, has developed an innovative and sexy harm-reduction campaign - Hottest at the Start - to raise awareness about the acute stage of HIV infection among young gay guys - and maybe those who are not so young - who are are having anal sex without condoms.

We featured Hottest at the Start and it’s sexy prevention messaging - including its steamy promotional video - on PositiveLite.com in October 2011. So when Jody Jollimore, program manager at HiM, was in Toronto at the recent Gay Men’s Sexual Health Summit, I caught up with him to learn more about the messaging behind the campaign and why HiM took the approach it did to reach gay guys who are having unprotected sex. You can see this interview in the video clip at the bottom of this post.

Check out the Know Your Risk Calculator  that Jody refers to.

You can find out more about the acute stage of HIV infection on CATIE’s website. 

Video services courtesy of Guy McLoughlin. Images courtesy of Health Initiative for Men.

Two years ago today, I was diagnosed with HIV. Having managed to remain negative throughout the first 28 years of the epidemic, here was I, in my sixties, suddenly finding myself HIV-positive. The diagnosis itself was not unexpected - I had made some decisions to have unprotected sex - but the shame of having to admit that I had seroconverted was difficult for me to reconcile with the self image I had of myself. And with the image others had of me. After all, here I was - an educated, aware gay guy who’d lived through the early years of AIDS, a social worker who’d worked within the gay community for over thirty  years - now having to deal with the shame that I’d allowed myself to become poz.

But I was well-connected in the community and had the support of a wonderful life partner and some great friends. They, along with the excellent care I was receiving from my GP, who is also an HIV primary care physician, enabled me to handle my emotional turmoil. And because I have a natural curiosity, and because I wanted to learn as much as possible about HIV and what it meant to live with it, I began to read voraciously about every aspect of it. I found a great deal of help and useful information at a number of websites, particularly Canada’s CATIE,  Vancouver’s Health Initiative for Men  and the UK’s aidsmap.com. 

Then I found PositiveLite.com. This website was a revelation - a Canadian online HIV magazine by and for people who are either HIV-positive or who are our friends and supporters. Here were women and men, both from Canada and elsewhere, who were writing openly about their lives as poz people. And they were writing not just about living with HIV but about all aspects of their lives, which were as rich and as varied as those who were not living with this chronic illness.

But there was more. They were also writing, from their own lived experience as HIVers, about issues of importance to us all - the best approach to take in the 21st century in preventing the spread of HIV, developments in treatment, about stigma and discrimination, about how to manage disclosure and deal with the increasing criminalization of non-disclosure, about aging with HIV and about how, paradoxically, HIV had changed their lives for the better.

I was so impressed with what I read on PositiveLite.com that last summer I wrote to publisher Brian Finch to tell him so. He was very gracious in his response and asked if I would be interested in providing more specific feedback about the website, which was about to undergo a major redesign. I said I would. Before I knew it, I had an email from PositiveLite.com editor Bob Leahy inviting me to write for the magazine the story of my seroconversion.  I agreed to do so, anonymously. I was not quite ready, at that stage, to have my name, face and the intimate details of my life plastered all over the internet for all to see.

I guess Brian and Bob must have liked what I wrote, because they arranged for my story to be picked up by aidsmap.com. So it was not long before Bob started using his considerable charm in encouraging me to become a regular contributor and to write more about what I was learning. I took some time to say yes, because I’d just retired from my long-time job and was looking for volunteer opportunities that would provide me with the chance to to work with people face-to-face and to make new friends - writing, after all, is a somewhat solitary pursuit. But, in the face of Bob’s persistence, I overcame my hesitance.

So before I knew it, I was actually starting to enjoy sharing my experiences as an HIVer and my increasing knowledge of HIV with PositiveLite.com’s community of readers. Through doing so, I quickly decided that I no longer wanted to remain anonymous. I was ready to stand tall and proud as an openly HIV-positive gay man. For this I have to thank Brian and Bob and the opportunities they provided me to share my thoughts and experiences with others. After all, coming out as a gay guy when I was in my early twenties had been a liberating experience and I reckoned that coming out as poz should be equally as liberating. And so it has proven to be. I now feel a great sense of freedom and liberation living as an openly poz guy.

It was not long before I began to attend HIV community events and do interviews for PositiveLite.com with other people who who had interesting things to say. Then, at the beginning of this year, Bob offered me the position of assistant editor. And now, just three months later, I find myself as publisher. Never in my wildest dreams did I think, on March 15, 2010, the day I received my HIV diagnosis, how having HIV would change my life in a such a positive (pun intended!) way within two short years. 

As he wrote here yesterday, Brian has come to the decision that it’s time for him to pursue some new opportunities and that he’d fulfilled his job of creating PositiveLite.com. Last week, he asked me if I’d consider taking over the position of publisher. How could I say no? I’m in awe of Brian and what he’s created here. He’s a guy who’s lived proudly and openly with HIV for over half his life. He’s a true survivor with a passion for enabling HIVers who may not otherwise feel they have a voice to have the opportunity to be involved in a discussion about what it really means to be HIV-positive today - the rationale behind PositiveLite.com.

I’m both honoured and humbled that Brian has entrusted his creation to me. His are enormous footsteps to tread in, yet I fully intend to ensure that his trust in me is justified.   I can do that only because Brian will be remaining an integral part of PositiveLite.com as our founder and I will continue to benefit from his wisdom and wise counsel. I’m also supported by our knowledgeable and indefatigable editor, Bob Leahy, and by an amazing community of writers and contributors, who are at the heart of PositiveLite.com. Without them, the magazine would not exist.

I have a strong sense that this three-year-old, PositiveLite.com, is poised to continue its progress beyond its early years as it becomes an increasingly important and respected part of Canada’s HIV community. And while we are indeed Canadian, and will continue to reflect the Canadian experience, we remain open to the world - indeed half our readers and many of our writers now come from outside our nation’s borders. We welcome that diversity of experience. Yet we are equally committed to reflect the increasingly diverse face of HIV, both in Canada and elsewhere.

At present, most - but by no means all - of our writers are gay men who write about HIV and their lives from that perspective. This reflects the historical nature of HIV in countries like ours. Gay men still account for the majority of HIVers in Canada, and their experience of HIV will continue to be portrayed in our pages. But the face of HIV is changing, a reality that all of us here at PositiveLite.com are committed to reflecting. Thus, we’re actively engaged in increasing our coverage of HIV as it affects women, First Nations, transpeople, those from countries where HIV is endemic, injection drug users and others. By the same token, by the middle years of this decade it’s estimated that 50% of all HIVers in North America will be aged 50 or older. This reflects the reality that, thanks to anti-viral medications, HIVers are living longer than anyone ever expected only 15 years ago. There are also an increasing number of people who, like me, are seroconverting in later life. These realities will continue to be reflected in our pages even as we continue to tell the stories of younger people infected with and affected by HIV.

We will always remain faithful to our mandate, to be a place for HIVers and our allies to talk about the reality of our lives. Sometimes we will be funny, sometimes angry, sometimes controversial, but always honest.

As I said earlier, you, our readers and writers, are at the heart of what we are all about here at PositiveLite.com. I hope you continue to enjoy, be inspired by and encouraged by what you read here. And if you think you have something to say yourself, then why not consider writing about it here on PositiveLite.com. It may be that you just want to comment on something you’ve read here, in which case I invite you to share it in the comments section at the end of each article (currently an underutilized resource). Or it may be that you want to contribute your own thoughts through submitting a post of your own. In that case, I invite you to contact us through our facebook page, via email to our editor Bob Leahy at This email address is being protected from spambots. You need JavaScript enabled to view it. or by sending me a tweet @John_McCullagh. 

Thank you all for your support. And Happy Reading!

There’s a new approach that’s taking place in HIV prevention and support programs, particularly those focused on gay men, that’s based on supporting us in maintaining good health, particularly good sexual health, by emphasizing our strengths and resilience rather than focusing on risk behaviours and pathologizing our weaknesses and vulnerabilities.

Here on PositiveLite.Com, we’ve featured several programs that utilize this new approach: It’s Hottest at the Start; The Sex You Want;  GPS (Gay Poz Sex); Spunk;  and Totally Outright. 

So I thought it was timely to learn more about the thinking behind this new approach and to understand more about the concepts of risk and resilience that underly it. To help me, I recently sat down with Duncan MacLachlan, the manager of community health programs at the AIDS Committee of Toronto (ACT). 

John McCullagh: Welcome back, Duncan, to PositiveLite.Com. I’d like to start by asking you to describe risk for me. When I think of risk, I usually think of things that could be dangerous, like smoking, for example, or drinking and driving. But it’s more complicated than that, isn’t it?

Duncan MacLachlan: Risk is complicated, John, because it always exists in a context.  It’s often oversimplified. Risk for gay men has, for the most part, been narrowly defined in terms of vulnerabilities. Things like HIV and other STI acquisition, or mental health, issues like depression and anxiety, or substance use. These vulnerabilities are real, of course. They exist because of things like stigmas, trauma and poverty, but they aren’t the whole story. Gay men know this. In the arena of sexual expression, we’re motivated by things like desire, pleasure, intimacy, connection and love not merely the fact that we may be challenged by anxiety or loneliness.

John: I hear you saying that risks don’t exist in a vacuum, they always have a context. That means, I guess, that we should be cautious when judging our own or someone else’s risk behaviours. And yet, that’s not the way, until recently, that we’ve done HIV prevention work. Instead, we’ve said, “This is what you should be doing” - like “Use a condom every time” - which was based on the theory that we’d all make rational choices when faced with risk.

Duncan: Exactly. We all know that our behaviour isn’t always rational. So this idea that we’re free to chose in every situation and that if we’re armed with information we’ll always make “good” decisions is false. Yet, while those of us doing prevention and education work with gay men have moved beyond this simplistic notion a long time ago, it still persists in society at large. It exists in our community as well; the demonizing of bareback sex is an example.

John: Duncan, how would you say we can best overcome the odds and challenges of the risks we face in our lives?

Duncan: Wow, John. That’s a big one! Here’s part of the answer. My studies of psychology teach me that it’s positive reinforcement rather than punishment that motivates us. Again, we all know this intuitively because we’ve experienced them both.  I’m a big believer in love and compassion, both at an individual level and a community level!

John: So tell me a bit about gay men’s resilience. It’s more than just coping isn’t it? 

Duncan: It is. As part of ACT’s current gay men’s resilience campaign, we asked guys what resilience meant to them. What they told us was that it meant bouncing back from a challenge and gaining some aspect of strength from the experience. I think sometimes resilience is coping, but, as you say, it’s often more then that. What’s really interesting is the notion of protective factors - characteristics that counter some of the challenges gay men face, like homophobia. Protective factors can be enhanced. An example Amy Herrick and others have identified in research is shamelessness or sexual creativity.  ACT’s Pig Sex Project (for gay guys who identify as “sex pigs” and who like to have raunchy sex. - Ed.) nurtures these protective factors by providing an environment where guys are affirmed and valued – our slogan is “It’s your choice” - rather than judged for their sexual expression. It’s also an environment where the guys share their strategies for risk reduction with each other because they feel safe to do so.

John: Can you give me some other examples of how we can build resilience.

Duncan: One of the most useful ways of considering the development of resilience programming, or evaluating existing programs and supports for their resilience effectiveness, is a model called the 7 C’s of resilience. These 7 C’s of resilience are: confidence, competence, character, contribution, coping, control, and connection.  People have better health outcomes and a higher quality of life when these things are nurtured and this can be easily measured. At ACT, we are using the 7 C’s of resilience to enhance our capacity to assess the effectiveness of our programming in building resilience.

John: So, Duncan, if I’ve understood you correctly, you’re talking about an asset-based approach to health, focusing on our strengths instead of our weaknesses, on our resilience instead of our deficiencies. That’s very different than talking about condoms, than talking about disease, isn’t it?

Duncan: Yes, although an asset based approach that is rooted in resilience doesn’t mean we don’t talk about condoms or disease. Using condoms might be an important part of many gay men’s resilience.

John: So give me an example of how focusing on our assets, on our strengths, correlates with reducing risk behaviours?

Duncan: Sure. Let’s talk about sex, sexual creativity for example, which is another of the protective factors identified in Amy Herrick’s research. More and more guys are talking about viral load with each other. We now know that having an undetectable viral load reduces risk of transmission. We’re not sure by how much, but it makes a difference. Our willingness to push the boundaries of sexual pleasure enables us to explore the utility of a great variety of cock and ball “accessories” that enhance our ability to stay hard, facilitating condom use.

John: Duncan, you’ve really helped me understand why building on our successes is ten-times more compelling than trying to build on our failures. Because we all want to be successful and healthy. Thank you so much.

Duncan: You’re welcome, John.

Reference: Herrick, A. et al. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav (2011) 15-S25-S29

This is the second of three articles by PositiveLite.com writers on “what undetectable means to me.” Read Bob Leahy’s earlier take on this topic here.  Wayne Bristow will follow later this week.

Three months after I started anti-retroviral therapy (ART), I got a call from my doctor. Even though my next appointment with him was still a week away, he phoned me because he wanted to give me the good news right away. My lab results had just come back showing that my HIV viral load had reached an undetectable level.

He was excited for me and I was excited myself. Why? Because the goal of HIV treatment is to reduce the amount of virus in the blood to a level so low that it cannot be detected by the standard tests. Being “undetectable” confirmed that ART was working for me. HIV had been stopped in its tracks; it’d been defeated in its attempts to damage my immune system. It was a milestone that I celebrated that day and continue to celebrate because my periodic viral load tests still come back undetectable. 

Reaching this status was a personal demonstration in my own life of what everyone had been saying in recent years. That, thanks to ART, HIV is different now. It’s no longer the death sentence it once was but is, instead, a chronic, communicable disease that can be controlled by medication.

This is a big deal as far as I’m concerned. I’m of the generation that was most affected by the AIDS epidemic of the 1980s and early 1990s. The majority of my peers, gay guys  in the prime of their lives, were either dead or dying. At that time, there was no treatment that could have saved them. I was one of the lucky ones in that I didn’t become infected at that time, but to this day I still grieve the loss of those men - my friends, colleagues, loved ones, drinking buddies and sex partners.

Many years later, as the result of some decisions I made that I now regret, I became HIV-positive myself. But, because of the anti-HIV drugs that are now available, I’m not going to die of AIDS like my friends did 15 or 25 years ago. Rather I’m going to live the kind of active, healthy life that they could only have dreamed of. Achieving an undetectable viral load is a marker of that expectation.  

I’m fortunate in that I was diagnosed early, have access to ART and am the patient of a knowledgeable and caring physician. It was he who advised me to go on ART immediately after my diagnosis because he believes that long term outcomes are better if treatment is started early. Everything I’ve subsequently read and learned confirms that belief. On top of that, I tolerate my drugs so well that I could go from one day to another not thinking about HIV at all (except that my role as assistant editor of PositiveLite.com won’t allow me to do that!).

For many others, however, having a chronic illness such as HIV can be exhausting, unpredictable and isolating. Finding good care and treatment may be hard. And having HIV can, all too commonly, be fraught with stigma and discrimination. Meanwhile, other HIVers of my generation are long-term survivors who often suffer significant side effects and damage to their bodies caused by the toxicity of an earlier generation of anti-HIV drugs. So celebrating my own good fortune is tempered by this knowledge.  

That having been said though, having an undetectable viral load provides me with a positive sense of being in good health with good long-term health outcomes. Baring a cure, I anticipate dying with HIV, not of it.

The status of being “undetectable” also gives me a sense of positive self-esteem and emotional well-being. I’m not diseased. What I have is a well-managed, chronic illness. It’s unfortunate, but it’s nothing to be ashamed of. It’s part of the human condition.

This, in turn, has enabled me to feel good about being out of the closet, as it were, with respect to my HIV status. Proudly labelling myself, as I do, an HIV-positive gay man is a profoundly liberating experience. People can see that I’m healthy, enjoying life and contributing to the community through volunteer work (if I hadn’t reached the age of retirement, I’d still be working) and that’s allowed me to become a role model of sorts.

One of the most important outcomes for me of having an undetectable viral load is that it’s lessened the burden of worrying about infecting others when I have sex. A number of recent research studies have demonstrated that, with certain caveats, a person taking HIV treatment with an undetectable viral load in their blood should not be considered sexually infectious. Indeed, Julio Montaner, one of Canada’s and the world’s most respected HIV scientists, has publicly gone so far, in an exclusive interview with PositiveLite.com, to state that he’s “very comfortable that [ART] is at least as protective - or more - than condoms”.  

From this knowledge comes my desire to focus my energies on fighting against the criminalization of HIV non-disclosure. Because those of us who do what we have always been taught to do and wear a condom when we should or if we have an undetectable viral load - or both - don’t pose, in the words of the current law, a “significant risk” of infecting our sexual partners. What we do have, however, is a responsibility to protect our own health while not harming the health of others. That applies whether we’re HIV-positive or HIV-negative or don’t know our status. 

So, to summarize. I realize I’m privileged and don’t represent every HIVer out there, but I rejoice in my “undetectable” status. It allows me to live an active, healthy life with the expectation that, when the time comes, it’ll be old age not HIV that I’ll die of. It gives me a sense of emotional well-being that enables me to be proudly poz and to give back to the communities to which I belong. And it lessens the worry of infecting those with whom I have sex. For all these reasons, I feel blessed to have an undetectable viral load. As I said at the beginning, it’s a status that I celebrate every day.

 

Putting on a two-act play with just a couple of actors on stage is always a bit of a challenge. To be successful, the script has to be compelling and the actors skilled. Luckily for Toronto audiences, the new production of Jeff Baron’s much-produced 1996 play Visiting Mr Green, that opened last night, is a winner.

How could it not be with acting legend Theodore Bikel in the title role? He’s now 87-years-old and made his film debut in 1951 in the African Queen. Born in Austria and classically trained at Britain’s RADA, he’s been a multiple award-winning star of American stage, screen and television for almost 60 years. He’s ably supported by up-and-coming local actor Aidan deSalaiz, already a veteran of the Stratford Shakespeare Festival and a graduate of Stratford’s Birmingham Conservatory for Classical Theatre Training. And how refreshing it is to be able to enjoy a play where a gay character is played by an openly gay actor.

Yes, Visiting Mr Green is a gay-themed play. It’s also a Jewish one, produced here by Toronto’s Harold Green Jewish Theatre Company. The plot is simple. Ross Gardiner, a secular Jew, works on Wall Street where to succeed in his chosen career and climb the corporate ladder - not to mention maintain the love and respect of his casually homophobic father -  he must hide his sexuality. Or so he thinks. His world begins to change however, when, driving too fast in his car, he almost kills an elderly man as he’s crossing the street. Ross is charged with reckless driving and sentenced to do community service in the form of visiting the victim, the lonely and recently widowed Mr Green. At first, neither man wants anything to do with the other but they put up with it since it’s court-ordered.

These men come from two totally different worlds, despite living in cosmopolitan New York. The older man’s life is focused on family and his traditional, deeply-held Jewish values. The younger guy, meantime, is a worldly man-about-town struggling with the heterosexism of his dad and of his chosen profession along with his own internalized homophobia, a struggle immediately recognizable to those of us who’ve been in the same position. Seemingly these guys have nothing in common apart from their Jewish heritage, but, even there, there are differences as one is observant and the other not. Yet, through the course of the play, they come to realize how much they do in fact share and have in common (and no, Mr Green doesn’t turn out to be gay). Their recognition of this at the end of the play touched me deeply.

This is a serious play but also a very funny one. And its theme and Yiddish-based humour make it a very Jewish one too. It’s also a play that’ll resonate with a gay audience. Bikel is perfect as the elderly Jewish guy that we all know, either in real life or through the movies and television while deSalaiz’s Ross is the embodiment of the young, self-confident gay man, despite struggling with being out at work.

Toronto is having a strong theatre season and Visiting Mr Green has a lot of competition for the attention of theatregoers. But this one deserves your entertainment dollar. Go see it! 

Visiting Mr Green plays now through February 18, 2012at Jane Mallett Theatre, St Lawrence Centre for the Arts, 27 Front Street East, Toronto 

For tickets, visit the box office, call 416 366 7723 (toll-free 1 800 708 6754)or book online at www.stlc.com

 Photo credit: Racheal McCaig