The city-dwellers among us — and even those who might live outside the city but head to the land of tall buildings on a regular basis — take elevators for granted. We get on, we know what floor we're going to and press the corresponding button and we're off! It is a handy way to get to the upper floors of a building without arriving out of breath. But how closely do you actually look at the elevators you ride? 

It might be because I live in a city that is a strange mix of cultures and traditions, but the elevators here in Montréal can tell a story about a building that can often be quite different from the story told by elevators in a neighbouring building. I'm talking about the numbering of the floors, of course, which really varies widely here. 

Many buildings start with a ground floor (rez-de-chaussée), which will be represented as either G or RC on most elevator panels, but also sometimes 1. That can be a little perturbing in a context in which the next floor up can either be 1 or 2. There's the strange thing I noticed when I first moved here many years ago: the first floor is often one floor up from the ground floor. It's certainly a good motivation to look at the floor indication when boarding an elevator in a building for the first time, just to be able to be sure which floor to return to for the egress. 

The next highly noticeable thing you might see here, if the building is tall enough, is the thirteenth floor. In many buildings, one leaps directly from 12 to 14, presumably because of the superstitions (triskaidekaphobia) of the builder or owner of the building. Not so true here. Many buildings have thirteenth floors and nobody bats an eye at them. I'm not sure that I've seen a thirteenth floor in English Canada. 

Then there are approaches that make the triskaidekaphobia look tame. The number 4 being so very unlucky in Chinese culture that every 4 is eliminated from the elevator pad: no 4, 14, 24, etc. I'm not sure what they do after the floor numbered 39, but I am sure it is likely an inaccurate assessment of how high up you might be. 

Just one more observation that I have to add, a sign of the times There's something that made me reticent to pull out my phone to take a picture of the elevator keypad as I was thinking about this story. Especially, but not only, when there were other people on the elevator I think that thing is an irrational fear of being thought to be doing something wrong, like snapping photos of people you don't know or of machinery that might be the target of….well, you're either with us, or you're with the people who take pictures of things. All of which to say that the photos you see were lifted shamelessly from the web. 

Do you dare to take your own photos of your elevator keypad to prove me right or wrong in my triskaidekaphobia theory? If you're brave enough, I challenge you to share them with PositiveLite.com  on Facebook. Until then, could you press 5 for me?

You know that thing that ardent ornithologists do? You know, writing down their sightings of each different variety of bird they have laid eyes on, where and when. This post is not about that. It's not about looking, and it's not about birds.

No, when I was a fresh-faced young gay, just out of the closet, I briefly kept a little list of the men I had slept with. No euphemisms: I had had sex with them, usually with very little sleeping involved. My WASPy prudishness caught up with me a few months in and I stopped with the list after a few entries where I didn't have names, but only situations or the make and model of the car that picked me up… Who am I kidding?! It was probably only the colour of the car, which pretty much exhausts my knowledge of cars! 

Even with this abrupt end and the short experience of my list, I was already up to about fifty entries when I stopped. Such a shame I didn't keep it up, as it might have been a very interesting sociological artifact by now. This came to mind in a conversation recently, as I also discussed filling out an online "How gay are you?" quiz with a friend. My friend got to the question about how many different men he had had sex with and he said, "There were only three spaces, so I put 999." I, much more modestly, put 500 at the time.

Now are you seeing how my list might have been interesting to revisit after a lifetime of encounters? 

You might actually be wondering aloud why I should be so proud of being such a slut, whore, whatever, and thinking smugly that you now know why I turned out HIV-positive. I have two answers to share on that topic. First, it isn't that I'm necessarily proud; it's that I refuse to be ashamed. Second, as I frequently assert in meetings with public health types in the context of my work, it really doesn't matter how many partners you have, it matters what you do with them. So clearly, I am on the sex positive side of this debate. 

The other thing that I feel the need to express is about the source and timing of my HIV infection. I don't know, and I have a smidgen — but not really more — of intellectual curiosity about the answers to those questions. They do not preoccupy me. 

I am a gay man who started having sex before we knew about HIV. This is not in any way to suggest that I was or wasn't infected before we knew, or that that would really matter. I was as human afterward as anyone who might be infected today. We aren't machines making cold rational decisions based on available data, we are humans who sometimes don't think about what they are doing or just need some human contact at the moment, or don't always make decisions about our pleasure based on fear of risks. 

When we found out about HIV with my sex life already underway, there was some adaptation around the equipment or the acts, but not around the attitude. I think that changed for those coming of age and coming out post-HIV, at least until recently, which only makes it more of a shame that I didn't maintain my life list. 

I could have written my autobiography as a thesis.

It seems these days that one can't read an article about HIV prevention without running into references to the "Test and Treat" approach and its possibilities of ending the HIV pandemic. I'm not going to examine the whole of that issue here, but I hope to open a can of worms at one end of it. That end is the beginning: testing and what we might do to revolutionize the accessibility of testing to those who might have been exposed to a chance of HIV transmission.

Our cousins in France (as we like to refer to them here in Québec), at the Warning, are now raising the once (and still?) taboo issue of home testing for HIV. I think it's worth exploring the possible advantages and disadvantages of that approach and whether it might be helpful in some way to add it to our basket of testing options.

No jurisdiction currently allows testing without the involvement of health care professionals. There are some openings to the involvement of community health workers, notably in France, where an exception has been made to allow for community-based testing efforts, particularly in the gay community. This doesn't mean, however, that it is impossible to obtain your own rapid testing kit: a colleague of mine managed to order two test kits that were delivered in the mail from Malaysia, and you can't miss the internet ads that offer rapid test kits. (Ediitor's note: see video below illustrating use of one such test.) The problem is that they are not currently legal, not even for self-use.

This official illegality leads to another concern: quality control. If these tests were legal to obtain, there would likely be some government oversight with respect to the quality of the tests. HIV tests generally require a high degree of sensitivity and specificity. These criteria can be explained in this simplistic fashion: sensitivity is the percentage of tests that will come back positive when HIV is present and specificity is the percentage of tests that will come back negative when HIV is not present. False positives and false negatives can cause big problems, so these measures of quality control are ongoing for the test kits that are used in the health care system. Clearly, this monitoring does not take place for products that are not approved for use.

One hurdle to get past in allowing home testing is ensuring that people understand the nature of the rapid test. It isn't rapid because you can use it the day after your exposure; it is rapid because it can give results quickly when testing after the traditional window period. The rapid tests measure antibodies, which take time to develop in the body. There are other options that can give results sooner after an exposure if that is a concern, such as fourth generation ELISA tests which include tests for certain other proteins that develop more quickly than HIV antibodies. These, however, are a little more technically complicated and not available in the form of easy-to-use test kits. This is all information that can be explained to anyone with a great degree of comprehension, so it shouldn't be a reason for forbidding home use of the rapid test.

Indeed, there are other forms of medical testing that are made available to people to use at home. Diabetics monitor their blood sugar levels with great regularity, and on the 'diagnostic' side of things, women have been able to obtain and use home pregnancy tests for quite some time. These things do have regulation, and therefore some degree of assurance of quality that ought to be applicable to HIV home tests, too.

Because of the stigmatization of HIV infection, we have set up some very strict guidelines regarding pre- and post-test counselling. Concerns include ensuring that people understand the nature and impact of the test before agreeing to it as well as ensuring that a test result is not disconnected from appropriate interventions — counselling and information regarding the person's personal practices in the case of a negative result and that plus connection to care in the case of a positive result. This is a little harder to envisage in the case of a self-administered test. Even if the test is technically appropriate (sufficient sensitivity and specificity), who will help the person to manage personal reactions to the result? Is there a risk of people concluding that they are somehow protected from HIV if they are negative after repeated exposures? What about the emotional crisis that might follow a positive result? There is already movement toward simplifying or streamlining some of these requirements, particularly for those who have previously tested, and that should help to speed up the process for many.

It's often easy for those of us on this side of a positive diagnosis (the positive side) to conclude that HIV has become a manageable chronic condition and not the drama that we once thought it was, but the home testing issue is no longer about us. It is about people with widely varying degrees of exposure to information about HIV and the impact of living with (or managing) HIV, and if a rule is to change it has to take into consideration the disparities of understanding in the whole population.

One possibility for opening the door without completely removing it from its hinges would be to make the home tests available to people we hope to test frequently (i.e.: those who have frequent and ongoing exposure to the risk of HIV transmission) by prescription, at least in the form of a pilot project. This approach would ensure that the initial information and counselling would be complete, that connections to care were already in place for future use, and might offer the possibility of lightening the burden on the health care system while simultaneously stepping up regular testing.

Keeping control of the door might be necessary for reasons other than just understanding the science of HIV testing, however. Some of our biggest problems in HIV, persisting after the development of effective treatment options, are human rights problems. What could be the human rights implications of home HIV testing? Think about employment discrimination or other forms of social exclusion. If home HIV tests were to be available over the counter or off the shelf, what would stop people from using them on others over whom they exercise some form of control? As a society, we have not been particularly effective and certainly not proactive at righting the wrongs of prohibited discrimination, so I have very little confidence that we could prevent home HIV test kits from being misused to discriminate and exclude if they were widely available.

This is the issue that really puts the brakes on home tests for me, even if I have been led to a place where I would be ready to accept home tests by prescription for frequent testers. I work with some brilliant people who have really helped to shape and re-shape my own opinions about this topic, and I like to think that my attitude is evolving.

I think we are ready to have this debate and we ought to get to it.

Post-script:

My colleague kindly allowed me to purchase one of his tests and helped me film myself testing. I thought it was important to do this to show that it could be done, it could be done with humour (particularly when the result is not in doubt!) and that undetectable viral load in the blood is not undetectable antibodies on an HIV antibody test. Since the usual “how-to” videos tend to show negative results, I also wanted to show what a positive result would look like. I’m itching to use the photo as my Facebook profile picture (after PositiveLite publishes this article, of course!)

So . . . first the test - then the test results!

Well, since a certain "Pierre Poutine" has been in the news of late, I have finally decided it is time to give in to Bob's persistent exhortations to write about this gooey delight we know as poutine

I say "we know" rather loosely, because I suspect I am about to introduce you to some incarnations of poutine that do not resemble the dish you might love to "dis". Oh yes, there are many forms of poutine, and I suspect that the ones seen beyond the borders of Québec are but pale imitations of what they might be. This is a story of what might be.

Yes, every small greasy spoon and hamburger joint here has its version of poutine that follows a pretty basic recipe: fries, gravy and some kind of cheese (curd if you're going to be authentic, grated if you're not). But you have to step over to the specialists if you are to appreciate the variety that can be poutine.

One such specialist is La Banquise. A staple of the Plateau Mont-Royal (one of the coolest neighbourhoods on the planet, we are told), La Banquise offers no fewer than 28 versions of poutine on its menu, often drawing a crowd such that you will need to wait in line to get in. Believe me, it is worth the wait, as the poutine taquise (with guacamole, sour cream and fresh chopped tomatoes) will attest.

I recently discovered a new kid on the block, at least one that had recently opened a branch on a block more easily accessible to yours truly. Poutineville bills itself as "poutine reinvented" and you will see why when you visit their lovely website. My recent visit led me to bring out my creative side to make my own poutine from the checklist menu, while my companion chose from the pre-set selections. A little mix-up gave me the form of potatoes he had ordered, and vice-versa, but I have to say that I thoroughly enjoyed my creation of "patates écrasées" with chicken, brie and a lovely wine sauce. Oh yes, this experience took poutine up a notch.

Higher up the old cuisine chain would be the higher-end restaurants and their forays into poutine. Le Canard Libéré and Au Pied de Cochon serve classic-looking poutines, but the fries are cooked in duck fat, making them particularly special. There was even a rumour once of the chef of Toqué! having put together a lovely poutine featuring foie gras, but you won't find this on their regular menu. Not even the little sister of Toqué!, the Brasserie T! in a box on the sidewalk next to Place des Arts lists poutine, despite many dishes accompanied by fries.

Still further up the chain, an experiment by award-winning chef Martin Juneau of La Montée de lait. I haven't tried this and it looks like the restaurant may indeed be closed, but I have managed to capture a still photo of his "poutine jenga" and a link to a short video of him explaining his creation to Urbania magazine.  Even if you don't speak French, I dare you to watch his short video and then tell me you wouldn't want to have a taste of whatever he wants to dish out.

So the question, my friends, ends up being not "Is poutine worthy of my appetite?", but "Is my appetite worthy of poutine as it can be?"

Call me Old School. But Old School with some curriculum updates and nuances, not some kind of 3Rs situation (not that Reading, Arithmetic and Writing spells anything other than RAW, but I digress). I said this at the ACCM meeting I wrote about last time and I'll say it here: the first time I saw the "I Party / I Bareback / I'm Positive / I'm Responsible" poster, long before the anti-criminalization demonstration, I found it very personally confronting.

I'm a gay man of a certain age, as we say here in Québec. I was here when my community was developing the "condom every time" message and people we knew and loved were dying. I think it's important to point out that the condom message came from our community and was not imposed on us from public health: in many places, notably south of the border, the government didn't really care about a bunch of social undesirables dying and our community mobilized to address this epidemic on its own. Public health was late to the party.

I have long thought that the "condom every time" message was needlessly narrow. What about diversifying our sources of sexual pleasure? Not every act requires a condom to protect it, and focusing exclusively on the act that does sends another message that is counter-productive to prevention in a macro sense: only one thing counts; the rest is not really sex.

Yes, we have learned a lot of things in recent years, like the impact of a controlled and undetectable viral load on infectiousness, or the rarity of reinfection between people who are already seropositive. (I had a little trouble with that last phrase because I think I personally still need a little more convincing on that.) Our community (or part of it) has developed strategies for prevention that are sophisticated and rooted in scientific developments, just as members of queer communities have learned to adapt to survive through the centuries. It is for each of us to determine our level of comfort with these in terms of what we are individually willing to do.

There are some lines I cannot bring myself to cross in spite of evidence that might prove my fears unfounded. This is not to say I ought to apply my own values to others, but mine should be respected when they apply to my own actions.

This brings me to another realization I have had over the years, and how I continue to be reminded of its truth. We live in bubbles. We live in circles of people who have access to the same information we do, who think like we do and whose values mirror our own. Meeting someone outside our bubble is often shocking in its impact.

I had the occasion, based on some news stories, to have the discussion about criminalization of HIV with members of my family a couple of years ago. I was shocked and appalled at not being able to sway the point of view of two of my siblings, they seeing criminal prosecution for non-disclosure as reasonable. Same family, totally different bubbles.

So let's get back to the poster. When I saw it the first time, I had my "OMG why are we saying that out loud" moment. Then I had my "logical deconstruction of the message" reaction, adding information to which I have access within my bubble, just as the creators of the poster do. Then I had my "cautious public administrator" reaction, realizing that there would be people seeing this poster who do not have access to the same information, at least not as readily as the rest of us, and that those people would be outraged. Then I had my "appreciator of art meets activism" reaction which saw the intention to spark discussion and debate. Reactions aplenty.

Then I had my irreverent reaction and made my own version of the poster (just couldn't help myself!).

I am left thinking that yes, I get it. But what is this poster doing to lead the people who do not understand the message or its underpinnings — even those within our own community — to the sources of information which would give them the possibility of understanding and appreciating the message? When I can't see that action, I have to question the advisability, if not the arrogance, of circulating a message that is obscure and provocative to those outside our particular bubble.

It happened at the demonstration against HIV criminalization outside the Palais de Justice in Montréal the day before the recent Supreme Court of Canada hearing in R v Mabior and R v DC. Some people associated with local ASO AIDS Community Care Montreal (ACCM) were holding a couple of the posters from the recent AIDS Action Now! Poster campaign, namely the "Fuck Positive Women" poster and the "I Party / I Bareback / I'm Positive / I'm Responsible" poster. This last one was the spark for what would follow.

Then it really happened on Facebook, as a photo of the two posters and their carriers was posted to the ACCM page and was denounced in the comments. More comments with different perspectives and similar ones ensued and within about a day there were 87 of them. (There are currently only 82 comments, as some authors decided to remove theirs. You can read them here).

The next thing that happened was that ACCM, one of Montréal's older ASOs, stepped up and made it possible for people to talk about the issues: What did the poster mean? Was the organization encouraging people to bareback? Can we talk to each other without hurling insults? Okay, that last question was mine.

ACCM invited interested community members to a forum on 16 February to talk about it and close to 40 answered the call (I confess that I forgot to count!). ACCM brought in a facilitator and did some prep work: mining the comment thread for the issues that were raised such that those present could identify their choices of topics to discuss in the three-hour meeting. There was additional space for topics from those present. After some opening statements from those who wanted to make opening statements, we wandered among the sheets of enumerated issues and 'voted' (3 stickers each to place next to the issues we wanted).

Four issues were identified (I'm paraphrasing from an aging memory here):

1 – Are people capable of deconstructing and understanding the message of the poster?

2 – What does it mean to "be responsible"?

3 – Is Facebook the appropriate place for this discussion?

4 – What has changed between "then" and "now" in HIV?

The discussion was respectful and conducted in true Montréal style, switching back and forth between English and French. I'm not sure that any opinions were definitively changed, but there were certainly minds opened to other perspectives and an agreement that this dialogue needed to continue.

I think there were a number of winners here. The artist behind the poster, Mikiki, has truly succeeded in provoking debate. Facebook and its oh-so-many users have managed to demonstrate that it works, at least to some extent, in revving up a debate. ACCM has demonstrated its ability to take a controversy that at first seemed scary and uncontrolled and turn it into a productive discussion that got people talking and listening to each other.

Bravo all.