My name is Josh Kruger and I’m HIV-positive. The details of my seroconversion are irrelevant. Whether I was a needle drug user, the son of an HIV-positive mother, less than consistent with my condom use, or a medical professional exposed inadvertently to the virus, at the end of the day, I’m HIV-positive. Regardless of the reason or the background, I am living daily with the same virus other HIV-positive individuals do for many of these same reasons. 

That is perhaps the most interesting part about HIV. There is a culpability and a responsibility involved with it that does not exist with other chronic medical conditions. Have you ever asked a diabetic how he got it? Or, perhaps, asked someone with hypertension how long he had it and if he knew who gave it to him? Of course not, and it’s wrong to equate HIV with these conditions just as it’s wrong of me to act as though men should ignore my status and feel absolutely comfortable dating or having sex with me.

From a practical and medical standpoint, HIV is comparable to diabetes, and many would argue it is easier to live with HIV than diabetes – medically. Psychologically and socially, however, HIV is not on par with these and for us to lie to ourselves and our community and ignore the overarching moral and philosophical question surrounding HIV does a great disservice and impedes honest discussion.

This is most apparent in online profiles, the easiest and most accessible way to peer into the id of the modern homosexual. “Clean and want to stay that way.” This is a common and rather boringly typical statement in a profile you’d find on any app or website, one I myself thoughtlessly uttered once or twice in the past. But consider for a moment the logical implication of saying this. If being HIV-negative is clean, then conversely, as an HIV-positive man, I am dirty. And, I obviously deserve what I have because had I not acted recklessly or stupidly or taken unnecessary risk, I’d not be saddled with this tarnish and grime flowing through my bloodstream.

Obviously, I did not “want to stay that way” enough, you might think. But regardless of how fastidious about hygiene I may be, regardless of the fact that I volunteer or that I am a good man and a good neighbor or that I vote in every election or that I pay my taxes or that I’m an uncle to a lovely five-year-old boy, I am inherently unclean and therefore untouchable.

With the smug self-satisfaction of, so far, having avoided the virus, one can summarily dismiss and marginalize an entire population of human beings. And it’s happening. Yet, sometimes the negative reaction about being positive comes from the same individual barebacking “other neg guys” and who loves Gay Bingo, but he’ll delete my email without having read it because I’m one of “those.” The other. The unclean, irresponsible black sheep, the drunk uncle at Thanksgiving who has the inconvenient ability to remind people of failure.

I’m entirely too realistic and the issue too profound to think about during the search for sex or dates these days. And, what’s most intriguing is that some men will have sex with me so long as the topic isn’t even broached. Act like HIV does not exist, and the pool of sexual partners – including HIV-negative men – increases ten times over. But mention HIV the least bit in conversation or online, and you’ve become the asexual advocate.

And, no matter how physically strong or robust I am, no matter how healthy or professionally ambitious, once HIV is brought up, I’ll always be a cliché, a sick AIDS case, the walking embodiment of God’s divine judgment (I rather like that one, actually.)

But what’s perhaps most surprising about becoming HIV-positive is the amount of men who suddenly become HIV-positive the minute you are. That is, men in person and online – who for years insisted they were HIV-negative – are now quietly reaching out or implying that, perhaps, they were not as honest as they could be.

Why would they lie or conceal their status? Perhaps it’s the same reason I paused when I was asked to write this. Even now, I’m afraid. What exactly am I afraid of?

Well, I don’t date or have sex with anyone who isn’t aware of my status. Those I truly love in this world were all made aware of it the minute it happened. Legal protections are in place to ensure that I am not hurt financially or professionally because of my status. So, what is the reason I and these other men have such trepidation surrounding public affirmation, this second coming out, so to speak?

Your online profile – the one where you talk about being “clean” – might have something to do with it.

Publication of this piece earlier appeared in Josh’s own blog here and   in Philadelphia Magazine’s G Philly Blog on April 25, 2012 found here. 

The CBC this week reported Health Canada will allow men to donate blood if they haven't had sex with a man in the last five years, a change in policy that will go into effect in the coming weeks. Here is a statement from the Canadian AIDS Society received May 22. 

Ottawa, ON – The Canadian AIDS Society (CAS) acknowledges that Health Canada today approved a change to the blood donor deferral period currently imposed on men who have sex with men (MSM) from indefinite to five years from last MSM activity.

The Canadian AIDS Society has, along with other LGBT groups and patient groups, worked to support a proposal from Canadian Blood Services to Health Canada in December 2012 to change the MSM policy on blood donation. The proposal also calls for regular reviews based on scientific data to be collected.

CAS has been an active partner with Canadian Blood Services and others, working for many years to support the five-year time-based deferral as an incremental step towards a behaviour-based screening model for blood donation. Monique Doolittle-Romas, Chief Executive Officer of CAS said, “While a five-year deferral is still too long, we see it as an important step in the right direction. Ultimately, though, we’d like to see a model based on a donor’s behaviour rather than one based on sexual orientation and gender.”

With this important shift in the blood donation policy, CAS believes that there will be an opportunity to gather further evidence to create an even shorter time frame for the deferral in the future. However, Health Canada must continue their support through an increased commitment to research in this area.

“Protecting the safety of the blood supply in Canada has always been and will always be an important issue for the Canadian AIDS Society,” Doolittle-Romas reiterated

The title quote was written by George Bernard Shaw in ‘Saint Joan’ in 1923 but if ever a saying is timeless it’s this one.

The reason I’m dragging it out of the cliché locker is because I feel I have to take issue with a couple of articles that have appeared on PositiveLite.com recently.  

They are IS HIV TRANSMISSION POSSIBLE WHEN VIRAL LOAD IN THE BLOOD IS UNDETECTABLE? from CATIE and INFECTIOUSNESS coming from Aidsmap.com

I respect the work that people in HIV organisations put in to the struggle to control the virus and I appreciate the time and effort put in by writers who do their best to provide us with information – we’d be in a sorry state without them. I also know the perils of one article writer criticising another but I genuinely mean no disrespect. These two articles are pretty representative of what you will find all over the net and therefore my problem is more with the genre than the individual articles themselves.

The CATIE article addresses a question which is in the back of everybody’s mind. It’s crucial, both for positive and negative sex partners. The title suggests that the question will be answered but unfortunately that’s anything but the case. The first paragraph sums up what viral load actually is but hardly gives hard and fast rules which we can hang our hats on. It talks about the viral load being measured in the bodily fluids of a positive person. Surely it’s not. It’s measured in the blood and only very rarely in semen, saliva etc.

“Research shows that successful HIV treatment can reduce the viral load to “undetectable” levels and this can reduce the risk of HIV transmission. However, HIV transmission may be possible when the viral load is undetectable…The risk of HIV transmission when taking antiretroviral treatment may increase if sexually transmitted infections (STIs) are present…This risk may also be higher for anal sex than for vaginal sex.”

What do they mean, ‘can’ and ‘may’? We’re thirty years into the history of the virus. We should be hearing ‘does’ and ‘will’, not bet-hedging to cover all possibilities!

The following is something we’re all very aware of but what does a statement like this actually tell us?

“Viral load tests used in Canada cannot detect HIV in the blood if there are less than 40–50 copies/ml. Therefore, an undetectable viral load means the amount of virus in the blood is too low to detect, it does not mean that there is no virus present.”

First of all, we know the testing procedures are still limited but surely we’re entitled to ask why? Secondly, what the hell are we supposed to take from such a statement? Getting everybody to undetectable status is the universal aim but is pretty pointless if we don’t know how much of the virus has escaped detection because the procedures are lacking. Of course ‘undetectable’ suggests ‘less infectious’ but thirty years into the disease and its treatment and we still don’t know whether that’s entirely true. Until other bodily fluids are routinely tested we’re no closer to an answer and even then, the virus may be hiding in bone marrow, organs and brain tissue. Testing every susceptible piece of the body may never be possible but telling us we’re undetectable but maybe still dangerous, tells us almost nothing; we deserve better.

Another pretty meaningless statement is:

“Research shows that a lower amount of virus in the blood is usually associated with a lower risk of transmitting HIV to others, and a higher viral load is associated with a higher risk.”

Duh! And by the way, what research? We probably all accept the truth of this statement but what research proves that? Far too often the words ‘Research shows…’ are thrown at us in the expectation that we’ll accept that as gospel. Very often research is so small-scale and out of date that it is barely relevant. It is wrong to assume that the reader can’t cope with references to the exact piece of research and it should be expected that research is looked at with a critical eye but very often, ‘research shows…’ will back up a multitude of assumptions.

CATIE quotes HPTN 052 research to back up theories that a lower viral load reduces risk but that research was conducted amongst tiny groups of sero-discordant heterosexual partners in Africa and Thailand. The research is ongoing but trials to measure the same risk reduction when it comes to homosexual, anal sex…well you can whistle for that one! A lot of people hang a lot of credence on HPTN 052 but for HIV+ gay people, it suggests absolutely nothing and proves even less. To be fair, the CATIE article does point this out and even questions the relevance of the research but still draws conclusions that say we can reasonably assume that the same applies to anal sex. Uhm sorry, no it doesn’t!

When a paragraph begins with:

“Successful antiretroviral treatment can lower the viral load in the blood and other bodily fluids to undetectable levels and this can reduce the risk of sexual HIV transmission...Antiretroviral treatment may be much less effective than 96% when these conditions are not met.”

You know that it means very little. We want to know that in the majority of cases, ‘it will’!

More woolly information follows:

“A higher level of HIV in the semen, vaginal fluid, and rectal fluid may increase the risk of transmission when the blood viral load is undetectable. However, it is unclear how often this happens and how significant it is in terms of HIV transmission. Research shows it may be more common if a person has an STI, but can also happen in the absence of STIs.”

There they are again: ‘may’ and ‘can’, plus a ‘research shows’ and an ‘unclear’. How exactly is this useful information? The fact is that the research in all areas of HIV is still shockingly lacking and in the meantime we have to put up with guesswork. That's not good enough in 2013. If there’s no more money for  extensive and indisputable research; or no plans are on the table; or government and scientific bodies are standing in the way; or moral objections are blocking funds it’s the responsibility of HIV sites and organisations to say so and tell their readers the truth. “We just don’t know and this is why we don’t know,” is far more acceptable than ‘cans and maybes’. At least then we know where we stand.

Doesn’t this next sentence just sum it up?

“Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.”

Pitiful, really! Are we going to have to take to the streets again to demand efficient and relevant research which will end up saving the state millions in health care and why aren’t our large HIV organisations leading the charge?

The second article comes from aidsmap.com, which is generally regarded (just like CATIE) as a reliable and up-to-date source of information. The introduction is as follows:

“Aidsmap.com reports about 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. Whether or not this level of HIV in semen is associated with transmission is unknown.”

Now I thought this was interesting and went in search of this new research. It stemmed from a University of California study into the effect of the herpes virus on HIV transmission (read more here.) It involved 46 people, split between so-called HIV transmitters and non-transmitters and could hardly be called ‘large scale’. The Aidsmap article refers to 114 men in the study but even that’s hardly a significant research group. The point is that Aidsmap presents this as fact, based on ‘a US study’ when in fact it’s a little more complex than that and to state that 10% of men on HART have low levels of HIV in their semen seems pretty conclusive, yet it is based on a small study concentrating on the Herpes virus. Again, the statement may be true; it may be relevant and important but we need more evidence to back up global statements like that. (Editorial comment. PositiveLite.com says: even more important is whether such low levels of virus have any significance, i.e the ability to result in transmission. Is in fact the semen issue a complete red herring? We suspect yes, given the transmission history -  or lack of it -  in people with undetectable viral load in their blood.)

PositiveLite.com has quite rightly questioned the accuracy of aidsmap's references to the HPTN052 research, which is trundled out yet again yet proves practically nothing for gay men.  (Editorial comment; PositiveLite.com has since received acknowledgement from aidsmap that the aidsmap information was incorrect and that a retraction (apology?)  will be issued shortly. The moral is, as Dave says, question EVERYTHING you read.)

The article then goes on to say:

“But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load”.

What rare case reports? How many? Why isn’t this being investigated right now, on a large scale, to actually establish some facts? It’s almost as if HIV organisations and sites have become so accustomed to writing generalised pieces that repeat the same old suspicions and assumptions, that it has become a new truth of its own. Why aren’t they screaming out for new research and not settling for worn out cliché responses?

It goes on:

“Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.”

‘May’! Why don’t we know for sure?

Finally, statistics are rolled out:

“They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load…A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.”

Okay, let’s assume that the study involved 114 men and not 46. 36% of 114 is 41. Is it really valid to come to wide-reaching conclusions based on the results of 41 people? The urethral bacteria numbers are even less relevant: 5 people out of 114!

The point is that readers take headlines and believe them to be true, when in fact they’re often based on such small-scale studies that they barely merit a mention. Of course, all these studies may be revealing vital information and should be reported but if one (small) study suggests a trend then it should be replicated on a wide scale across the HIV community in order to establish whether it is more than just a medical soundbite. It’s the responsibility of authors and their organisations to look at these things more critically and if necessary make readers aware of the scale and validity of studies, statistics and suppositions.

The reader also needs to question anything that’s not clear, or seems to be stated as fact when it’s not proven. The problem is that life’s just too short to take the time to do that. So the promulgation of half-truths and loaded headlines becomes the easy way out, eventually leading to mistrust and suspicion.

This article of mine may seem like an attack on two highly regarded HIV information sources; it’s not meant to be. I have used them as examples of what we see every day in articles and discussions throughout the HIV community. We really do deserve better than to be fed meaningless conclusions based on ‘maybes’ and ‘possibilities’ but it’s not the fault of the authors. News has to be reported, no matter how tenuous the facts.

Unfortunately, it looks like the HIV community has to start demanding again. Demanding proper, well, funded and large scale research at home and abroad. The World Health Organisation has a responsibility (and the finances), as does the pharmaceutical industry and every other research or research-funding facility across the globe, including the major philanthropists like Bill Gates etc.

I’m fed up with endless arguments as to whether an undetectable status is safe or not, or whether TASP, PrEP, PEP and various other acronyms are the way forward, or whether the viral load in your blood reflects the true levels in your body. Just how safe is condomless sex between sero-positive people on HART? The questions are endless but I would like answers and soon. Some people and organisations are dragging their feet in providing them. It’s a question of having the political will to do the necessary research and damn well prove things once and for all and if the ‘climate’ makes it difficult to instigate the discussion and find the evidence, then we’ll just have to scream and shout until that changes. If it doesn’t happen then confusion drives apathy and stigma grows.

When you next read an article about the latest theory concerning HIV treatment and transmission; count up the number of ‘statistics, if’s, may’s, possibly’s and researches show’ and ask yourself if you are being presented with new facts and are you learning anything new. If the answer is negative then you may well be being short-changed!

I’m fully aware that some people will be irritated by this article but then I hope they’ll respond and widen the discussion. If I’m talking out of my backside, I hope you will say so  - but you’re going to have to prove it! 

March 15, 2013 - 11:30 pm

Met a guy last night online who was visiting LA for the weekend. We meet up this evening and found we had more than just a simple mutual attraction. He's newly POZ (just six months) so when he got an eyefull of the tattoo he was a bit confused but being in the medical field he quickly connected the dots. His reaction, like many, was supportive yet I got the distinct feeling it wasn't for him. Coming from a more traditional background I think being openly gay and now POZ was more than enough for him to deal with though he did have a nice tribal tattoo.  I wonder if the tattoo would have been an issue for him if we wanted something more serious or maybe he would want one as well ... there's a thought.  

March 17, 2013 - 12:30 am 

We decided to meet up late this evening but because I presently have roommates and like my privacy we chose a more ‘interesting’ venue to hang out at, the local gay bathhouse.  To be honest I have avoided the bathhouses for many years as they no longer hold much appeal. But lacking a place, seeing how he had never been to one before and me desiring to gauge the reaction of people to the tattoo in a sexually charged environment, the bathhouse on a late Saturday evening was the perfect place. 

We did the grand tour of the smallest bathhouse in LA and while he was filling his eyes with the sights - bathhouses by nature defy description so I will not attempt - I was focused on the patrons and their reactions … which was nothing.  That said, we were never approached, nor did we approach anyone to get any sort of reaction.  After a thorough once over of the place we retired to our room and later headed out to West Hollywood. 

March 17, 2013, 2:30 am 

We arrived at one of my old haunts, the now remodelled Mickey’s bar for after hours but instead of dancing we found ourselves on the patio talking.  He attended small high school where he was openly gay, a handsome guy who was into weightlifting at the time and had the respect of his fellow classmates.  Now in his early 30’s he was having to quickly come to terms with being HIV+, something he was having issues accepting and this caused him difficulties disclosing.

Knowing he came from a small southern community I asked if he had told anyone of his family he was positive, something I have yet to do.  Upon his diagnose he called his siblings and told them, “I am HIV+, I need you to go on the web tonight and learn about it because when I call you tomorrow I am going to need your support!” and hung up.  He called back the next evening and when they answered the verdict was unanimous “you are not going to die!”  I have to be honest, this was one of the most simple yet powerful disclosure stories I have ever heard.  

March 17, 2013 - 4:30 am 

We spoke some more and being the night was still felt young to us we decided to retire to LA's largest bathhouse to round out the evening.  If I was going to get a reaction to the tattoo I imagined it would be at this location. Though it was late, there were still lots of people awake and looking to connect. We got a room on the ground floor and made a quick tour of this location; it had changed a bit since my last visit years earlier but the general layout remained the same, with a basement, ground floor and upstairs. 

My guest had a mind to get a third to join us, so we set out on a search. There was no shortage of guys and though we made several attempts, whether being a couple was too intimidating or the tattoo worried the players or the general luck of the evening, we were unsuccessful. Neither approached nor shunned, without actually interviewing someone I couldn't say for certain what was the root issue, if any. So much for testing the tattoo at the bathhouses. 

March 24, 2013 - 10:00 pm 

Yet another in my series of my trips to the Korean spa with the tattoo, one guy struck up a conversation about it saying it looked like the Olympic symbol (it does have three semi concentric rings), I corrected him saying it was actually a biohazard symbol and left it at that.  I was not particularly interested in informing him of my status as this was still the Korean spa and I didn't feel entirely comfortable just announcing my status randomly, sort of defeats the idea of limiting disclosure.  However if he pressed me I would have willingly explained why I was wearing the tattoo as it’s purpose is to promote discussion and it definitely empowers me to disclose. 

March 26, 11:45 pm 

Sitting in the spa at the gym before closing, just myself and another guy (seen him before never talked to him), when out of the blue he commented on the tattoo saying it looked like a gay symbol. (In fact the biohazard tatt is rainbow coloured so it serves to ID me as gay to the observant).  In context this was the day of the US Supreme Court hearing the arguments regarding the Defense Of Marriage Act (DOMA) and the following day they were scheduled to hear Proposition 8 arguments and he was curious how I felt about it as well as the possible outcome.  This was fascinating, as the tattoo appears to get people talking about things that are close to my heart other than just my status. This was a great and most unanticipated result. 

March 30, 2013 9:00 pm 

Arrived late to the Korean spa. I had problems applying the tattoo that evening; the skin seems oddly irritated but I ignored this and off to the spa I went. Only ten minutes into my visit I notice the tattoo, a thin sheet of acetate glued to my skin, was bubbling up. Argh! I pressed hard to get it to adhere and thought it would just stick ... it didn't.  The temporary tattoo that I usually wore for three to five days without any issues was coming unglued.  By the time I was done with my 70 minute session it had peeled up to the point that once I returned to my locker to change I needed to remove it.  It appears my skin has built up an allergic reaction causing the temporary tattoo to not only bubble up but actually cause physical pain to the application site.

So no more temporary tats, the universe has spoken! 

April 1, 2103 10:45 pm 

In the shower at the gym the following evening, a sexy young black guy is one shower over and is clearly looking for some action. Never been one for public play but without the tattoo I felt oddly more naked than I already was ... interesting that the tattoo appears to work for me both as a shield as well as a warning. 

April 6, 11:30 am 

Finally I made contact with Jill Jordan, a highly respected and innovative tattoo artist! Set an appointment with her for April 14th at 1:00 pm. My gym buddy Alonso is so excited he also wants to meet Jill (he has a tattoo of his own in mind). 

April 7, 2013 9:00 pm 

I meet up with my first former bf David while he was visiting LA and being that he was one of the inner circle of people who knew I was poz I wasted no time telling him about my desire to get the biohazard tattoo. Why open with the tattoo? David and I have also had a very deep connection on a spiritual level and I wanted to hear him ask "what is your intention?" 

I gave him my canned answer - it will make it easier to disclose, show solidarity to the HIV+ community, etc., yet I was merely buying time to really look deeper and see if I could find an even more tangible answer. This was always the way with us because of our connection and frankly it's quite refreshing to speak about life in terms of spirit and action.  Oddly I rarely avail myself of such opportunities anymore ... makes me wonder why. 

We had both been through some serious life events, broken relationships, health and financial issues, yet we seemed to be better off for it all.  By the end of the evening I was feeling very comfortable with David again and was ready to give him a better answer with regards to my intent of getting the tattoo. 

First, I wasn't branding my soul, only the body. It reminds me to be mindful of the infection but not overwhelmed by it. A few years ago I might have found such a reminder very disturbing, a constant reflection of a mistake I made and was unable to undo. But now much, like knowing I will die, I am coming to terms with it. The tattoo reminds me my life and time on this earth is precious as well as short and to embrace life at every opportunity. 

Second, the tattoo is a method of communication of not just my HIV status or that I am gay (the rainbow flag has many people identifying as a gay symbol) but purely as an art form with a language all its own.  I trust many will appreciate it on many levels but haters will hate and how I deal with such situations will be a measure of my own growth.  Most reactions have been good and I predict that though this seems like a bold act now it will be passé in 10 years but no less important to me! 

Lastly, it memorializes the freedom of my mind if not body from HIV (my spirit has always been free and I am beginning to appreciate that more and more). David applauded my intention and asked me to meditate further on this act. II told him I would and let him know what conclusions I reached. 

April 10, 10:00 pm 

Over the following days I considered what David and I talked about and we shared more messages over FaceBook when it dawned upon us - damn this tattoo really does get people talking. That’s when it hit me this was an immerging aspect, not just to communicate to other people but to get people talking - about HIV, about gay issues, breaking down the barriers we put up in our daily lives.  I am not so naïve to think this tattoo will change the world but getting people talking is a great start! 

Late at night, I research and write by myself so I can avoid confronting the fact that I am alone, typically until I pass out from exhaustion. Gradually through the evening, as sources for my stories and colleagues I’m collaborating with over long-term projects go to bed themselves, I’m left alone at my computer, occasionally Googling a fact that I’m curious about; tonight, I learned about the history of Prussia.

Thoughts randomly piece themselves together until a great idea hits me, I write it down, and then my aimless reading continues. Sometimes, I’m chasing a lead and poring over ethics complaints and campaign finance disclosure forms. Other times, I’m refreshing my knowledge of American or military history. And, tonight, I purposefully watched the digital clock on my computer until 12:00 AM hit to reach another year of sobriety from alcohol; today, May 6, is the day that I decided years ago that I was finally done with drinking. 

At one point in my life, I had a good job serving my community, a good partner whose boundless compassion and understanding was remarkable, a quaint suburban home, and a good network of friends with reputable backgrounds and even more respectable jobs. Yet, during that very same period of my life, and for years prior, I had generally functioned as an alcoholic.

Somehow, I had always managed to apologize away the missteps, the rare flashes of rage, and the endless sadness, literally bouts of uncontrollable sobbing, that inevitably ensued when I became drunk. At some inexact point years ago, however, the functioning component of my alcoholism started to disintegrate and more of my work was sloppy, more dinners with my husband were missed, more hangovers caused more missed trains, and, eventually, I lost the very thing that I so desperately wanted my entire life: love.

Jung said that we do not wish to hear someone say “I love you” but, instead, “I understand you.” And, for me, this is a truth that I have found only once in my life and that was because it was coupled with love. Sometimes, I will hear someone inexperienced with long-term relationships wax poetically about the perfect nature of his newest adventure; candidly, I indulge myself in these sophomoric romps to, feel, at least for a short while, capricious and giddy. Indeed, there is a fleeting joy in being, for all intents and purposes, idiotically infatuated. But, the one thing that I rarely hear and have never uttered in years is the sincere, and quiet, appreciation of imperfection inherent in love and understanding between two human beings: the pensive tics, the bedhead cowlicks, the sometimes terrible sense of humor, the earnest goodwill found in whomever you truly love.

These imperfections are the essence of the love that we truly seek, whether we know this or not is irrelevant because it is true. And, at one point in my life, I had this love. Though, being an alcoholic, and a particularly nasty, narcissistic one at that, I threw that all away in exchange for doing whatever I wanted to do. This is, indeed, the surest way to destroy a relationship.

Let no maudlin drunk or repentant (at least today) sinner convince you otherwise: we do things as human beings not because we are compelled by nature or illness but, instead, because we choose to do these things.

We cheat on our wives because we are lustful and, for some reason, decide to not have a candid conversation about a non-monogamous yet loving relationship. We steal from public coffers because we desire greater wealth and material instead of appreciating the things we have and choosing to live within our means. We belittle others because we have the power to do so and can feel better about ourselves in the process, and there is no complexity in our motivation anymore than there is complexity in the fact that we must sleep every night as it is our biological function. Whether or not we choose to resist these motivations, to instead cultivate the noblest components we are endowed with is entirely our decision. We are not powerless nor are we weak. On the contrary, we are empowered to deliberately make decisions that have inevitable consequences, be they good or bad.

And this is the most frightening part of being human.

If we are not compelled by force to behave in a terrible way, then we have chosen to deliberately defy our ethics and the better parts of our innate characters and have opted, instead, to give in to the most repugnant and damaging aspects of our animal nature. We become drunkards, drug addicts, narcissists, mean-spirited misanthropes, or, as is typical, whiny, weak-kneed explainers who would rather use these very tools of manipulation, drink for instance, to excuse away our behavior disingenuously rather than confront the fact that our characters are, at least for some of us, inherently predisposed toward unethical acts. This predisposition is not immutable; we can change how we behave and how we cope with life in order to focus our energies in more socially acceptable and rewarding ways. Some folks call this cognitive behavioral therapy; others call it Alcoholics Anonymous. Personally, I call it ethics.

As the years go by and the length of time between the last time I was drunk and “now” continues to increase, I realize that I know very little considering I have experienced so much. Oddly, my knowledge seems to have an inverse proportional relationship to my age and experience; and, this is unnerving. For if part of getting older is recognizing that you are fully responsible for your mistakes, then you must logically realize that you are where you are because of, mostly, your own actions combined with a small number of lucky encounters.

These small chances, these opportunities presented by chance, fate, or God himself, are often hard to identify, but they exist and your actions in response propel your own trajectory down one of many different paths presented to you.

Personally, I chose an unhappy path for a very long period of time, a path that unfairly involved others to a tragic degree. And, I cannot change this, nor can I possibly ever find redemption for these actions and words. Rather, I can simply try harder and hope that those opportunities I once had will present themselves again only in a more recognizable fashion with, I assume, a different set of characters. Hopefully, I will recognize these opportunities more perceptively than I did when I was an active drunk, otherwise I am destined to repeat my mistakes and the idea of happiness, of that love, will always be the dream that I put off every evening, opting instead to read about history or write about politics until I fall asleep.

Today, I am still sober. And, I am still putting off going to bed. Even so, it is much easier being alone sober than it is drunkenly sobbing. And, for that, I am glad I made the choice to continue my sobriety today. I expect that this will continue for some time; after all, you get quite used to not drinking and, interestingly enough, are sort of puzzled after a while why people drink at all, or why you did it in the first place. Then again, there is no puzzle to it.

We do these things because we want to do them.

This article first appeared on Josh's own blog here.

“I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. “ 

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). I won’t deny it. I’ve been feeling very conflicted about starting PrEP.  

Why do I have access to Truvada when the majority of people who need antiretroviral medication to stay alive don’t have access? I got my hands on this bottle relatively easily. The social injustice is not lost on me. I don’t have relatively easy access to this medication because I deserve it more than anyone else.

So what HAVE I done to deserve access to PrEP? Well, a lot of it is sheer luck, actually.

•    Nearly every time I see the news, I am amazed at how lucky I am. I was born in Canada. Talk about winning the lottery. Out of 7 billion people, I am one of only 34 million people living in Canada. Trust me, it’s a great place to live!

•    I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. This provides me with ongoing access to the latest information.

•    I make a good living. I can access healthcare relatively easily and generally for free or at a cost that has little impact on my standard of living.

•    I have a doctor. He’s young (My age. That’s young. Shut up.), gay, and sees a lot of people living with HIV in his practice. So talking to him about my sex life and about PrEP was not difficult. He keeps up to date on research. After a good discussion, he agreed to prescribe PrEP.

•    Not only do I live in Canada, but I live in Québec, the only province to have a universal public drug plan. As long as the drugs my doctor prescribes are on the provincial drug formulary, I am covered for most of the cost. I pay $500 into the drug plan annually, and PrEP will cost me less than $1,000/year on top of that. And if I ever need other drugs for any reason, I will not pay for them. Because $992/year ($82.66/month to be precise) is the most I would have to pay for all my drugs combined.

I’m not trying to be disingenuous. I know that beyond being lucky and privileged, I have access to PrEP because I’ve taken some very concrete steps as well. I did lots of introspection. I tried to reduce my risk as much as possible through other means. I did a lot of research. I actively sought out access. I make sure I’m very diligent about taking my pills.

I always have been very diligent about that. I take all my antibiotics when I need them. I take vitamins daily. When I was on antidepressants, I never missed a dose in 1.5 years. I follow advice from medical professionals to the letter. Case in point: I’ve needed physiotherapy twice. Both times, the conversation during my second visit went something like this:

Physiotherapist: Wow, you’re made remarkable progress in one week. I’ve never seen anyone progress so quickly with this type of injury. Which exercises did you do?

Me: All of them, like you showed me.

PT: You did ALL the exercise I gave you?! How often?

Me: Every day, like you told me.

PT: You did ALL your exercise EVERY day?! How many times a day?

Me: Twice, like you told me.

PT: You did ALL your exercises, EVERY day, TWICE a day?! I’ve never seen this in all my years of practice! No wonder you’re doing so well!

*SLAP* You’re at risk of HIV!

I might make jokes, but I don’t take this lightly.

Every morning when I wake up it’s the first thing I think about. That might stop after a while. But two weeks into taking PrEP, it’s the same thing. I wake up, and as I ponder about whether I want to go back to sleep again for a little longer, I can’t do it. I immediately think: when I get up I have to take my Truvada pill. Because I’m at risk of HIV.

Each and every time I open the cupboard and grab the bottle, I think: how is it possible that I am so lucky to have such easy access to this medication when millions of people who need it to stay alive don’t have access?

Who needs a coffee? I get a slap in my face every morning. Two of them in fact.

*SLAP* You’re at risk of HIV and STIs!

*SLAP* You’re one of the lucky few who has access to this medication and to this prevention option!

I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. I’m not there yet by any stretch. But at least I get some measure of comfort from knowing that I’m putting chances on my side by reducing my risk as much as I can in my current situation. Doing my best to stay healthy seems like the right thing to do to honour those who don’t have access to this drug.

About the author: Marc-André LeBlanc has worked in the community-based HIV/AIDS movement for 20 years.He does community engagement, capacity-building and policy work related to biomedical HIV prevention research, both in Canada and globally. He is a co-founder of International Rectal Microbicide Advocates (IRMA), serves as secretary on their steering committee, has authored two reports on the global state of rectal microbicide efforts, and leads IRMA’s global efforts to ensure the safety of sexual lubricants. Marc-André loves movies. He got a film studies degree while working full-time, just for the sheer fun of it. He is now leading advocacy efforts to get ice cream and popcorn recognised as new basic food groups in Canada’s Food Guide

This article originally appeared on My PrEP Experience here.