Subscribe to our RSS feed

The Latest Features and Interviews Stories

  • Unlimited intimacy
  • Talking treatment as prevention with Julio Montaner
  • 30 years of ACT: A conversation with Hazelle Palmer
  • In the beginning
  • HIV in Toronto’s African, Caribbean and Black communities

Features and Interviews

May13

Unlimited intimacy

Monday, 13 May 2013 Written by // Bob Leahy - Editor Categories // Gay Men, Features and Interviews, Health, Sexual Health, Lifestyle, Opinion Pieces, Population Specific , Sex and Sexuality , Bob Leahy

Editor Bob Leahy talks to Tim Dean about his controversial book “Unlimited Intimacy: Reflections on the Subculture of Barebacking” – and about what makes barebackers tick.

Unlimited intimacy

“Seed is a gift, it’s love, it’s acceptance. Taking a man’s cum – in your ass, down your throat, rubbed into your skin, whatever - even if you don’t know his name, is closeness. It’s an act of love and trust.  Even if yawl just met. Both the bottom and the top will walk away smiling . . . and content. Now it’s a sleazy affair that boys get cracked out of their mind for. Like it’s an embarrassing nasty secret thing to want. This is so fucked.”

From HIV-positive bareback blogger Geek Slut, quoted in "Unlimited Intimacy  . .". .

Recently writer Tim Dean gave a presentation on the subculture of barebacking and its mores to an attentive audience of 200 at the Gay Men’s Sexual Health Summit in Toronto.  PositiveLite.com editor Bob Leahy caught up with him afterwards and sat down with him for this frank talk.

Bob Leahy: Tim. Thank you for talking to PositiveLite.com – and welcome to Toronto. I’d like to talk to you about your book first of all.  Tell me, how did you come to write about barebacking? What interested you there?

Tim Dean:  I came to write that book because I was living in the Bay Area of San Francisco and I was going out a lot and having a lot of sex – this was in the late 90s – and what I encountered in public sex environments were lots of guys who wanted me to cum inside of them. There was never a conversation about status, there was never a conversation about condoms, and I realized fairly quickly that this was something new in the history of the epidemic that I needed to think about — to think about what was involved and what had changed.

There is a substantial body of research that went in to the book.  Tell me about your research method.  How did you gather the information - through conventional methods?

I would say they were not very conventional methods. Much of the information was what I gleaned from personal experience, that is, hanging out in sex bars, sex clubs, bathhouses to a lesser extent, and also talking to people. That’s something I do in my life and I was using that material to reflect on. I also got very interested in bareback pornography and was able to use my training as a critic to analyze what is going on in this kind of pornography, what makes it different from other kinds of pornography.

Let’s talk about the bareback porn industry in a minute. Writing the book, you chose very consciously to be non-judgemental, is that right? You could have injected your own views in to it, but you chose to be descriptive.  Why did you do that?

That was a very important decision on my part, influenced by two things. One was to take a kind of anthropological approach to the study of sexual subcultures, where you limit what you can learn if you decide ahead of time whether something is good or bad, positive or negative. The other was a kind of psycho-analytic influence where the suspension of judgment allows thinking to achieve its full potential so that it was very, very important to me not to judge.

And what was the reaction to that approach? In your refusal to judge, did people think it sounded like you were endorsing barebacking?

Yes, some people did. And the fact that I wanted to write about this subculture without judging it and on the other hand saying that I’m also participating in this subculture, the refusal to judge was often understood as a kind of backhanded way of endorsing or excusing what I was doing.  I didn’t see it that way at all.  For me, it was an ethical decision to suspend judgement. Some people got that.  Some people read it differently.

So did it feel comfortable writing from the perspective of a participant in the barebacking culture? It’s kind of brave, I think.

It seemed sort of inevitable, in the sense that a lot of what I found out, I found out by doing it. Certainly in the literature I read at the time on “unsafe/unprotected sex” it was always assumed that somebody else was doing it, it was others who barebacked. It was very important to me to dispel that illusion. I was not going to be closet-y about the fact that I was barebacking. There is still a stigma attached to it and it’s hard to come out as somebody who enjoys bareback sex. But I don’t think we actually get anywhere by pretending we are not doing things . . . 

OK, let’s talk more about this. We haven’t defined barebacking.  Are we talking about people who identify as barebackers, part of a barebacking culture, or people who slip up occasionally - or both?

I used the decision when writing the book to use the term “barebackers” very broadly, to cover both the subculture and also people who may not consider themselves ‘barebackers” but who sometimes or occasionally do have sex without condoms, or want to have sex without condoms. It’s too easy to place the blame on a small subset who are very committed barebackers and I wanted to avoid that by using the term broadly.

I wanted to ask you about the allure of barebacking. There are so many stigmas and potential risks, why do people do it?

I think there are lots of reasons. The first and most obvious is that men often prefer sex without condoms, it feels better . . .

You called it “enhanced genital stimulation”.

Yes. That’s the most obvious reason. Beyond that there are all the meanings that are attached to exchanging semen, to receiving someone else’s cum. I think HIV prevention discourses have not been very good at acknowledging how important semen is to gay men – their own and other peoples’. Sometimes you want lots of guys’ semen inside of you.

Well, you’ve talked a lot about disgust with bodily fluids, and you mentioned spit as an example, but semen must be the same kind of thing, that we have a sort of love/hate relationship with it - in that in some contexts these fluids are very hot and in others they disgust us.

I think that’s true. I think that semen, because of HIV and the epidemic, has become even more loaded with meaning, in becoming dangerous, in becoming dirty . . .

Toxic.

Yes, In becoming toxic it has become potentially hotter. That is, on the one hand we are told we must absolutely keep it outside of our bodies, and on the other hand it becomes something very exciting to get inside.

Well, let me throw out a quote from you on that. I think you said “the fact that sex may be unsafe may be the sexiest thing about it.” Is that true?

I think for a number of people that’s absolutely the case. It’s a mistake to think we don’t like risk. Risk can be very exciting.

I suppose you can think then of public sex. We think public sex is very hot because we might get caught. But are we saying bareback sex is hot because we could get infected with HIV?

In some cases, yes. Your question makes me think of straight couples who like to fuck in the bathroom of a plane. There is a risk involved, it’s not comfortable, maybe the sex isn’t all that gratifying because of the conditions, but there is a risk involved which makes it very exciting. And that translates for some gay men in terms of HIV too.

Is the transgressive thing important in bareback sex too, the chance of something bad happening.

Yes, and also stepping away from being a normal responsible adult in our society, and everything that goes along with that. You know part of the appeal of public sex is that it happens outside the house, it happens in a space where someone can be somebody different. Therefore it’s hot. We are also inundated with safe sex messages and sometimes for that very reason stepping away from that and doing something that is “unsafe”,  that’s ”risky”, can be the hottest thing to do.

The other allure you’ve described is in the title of your book. “Unlimited Intimacy.” That’s important for barebackers, isn’t it?

Yes, I think it is. Men who have a lot of casual sex with a lot of casual partners are not in flight from intimacy but actually searching for a particular kind of intimacy. The phrase “unlimited intimacy” came from a barebacker in an interview I read and that seemed to me to be a perfect way to encapsulate intimacy beyond the couple.

So there is nothing more intimate for some people than exchanging bodily fluids?

Right.

Sometimes we talk about casual sex, but it sounds like what you’re describing is very intense sex.

It’s incredibly intense. It’s very meaningful, completely spiritual. If you are having sex with a bunch of strangers, group sex can be something that feels like communion.

I think you’ve mentioned too in the book that there is very much a sense of belonging.

Sure. It’s about finding and making a community with people you don’t necessarily need to get to know to be part of.

OK I want to find out about barebackers and what is their relationship to risk. I think what you say - and this is probably grossly simplifying – is that this is an equation, where barebackers recognize the risk, but then balance it against the pleasure. Is that what’s going on?

Sure, I think that’s part of it. But one of the other things I want to add that’s going on is that the majority of barebackers do NOT want to infect sero-negative guys. They are not trying to put other people at risk. They are interested in an experience of risk for themselves that is maybe more a risk in fantasy than in actuality in some cases.

So they do care about the possibility of HIV transmission?

Yes.

Do you think people think they don`t care.

I do. It's hard for people to wrap their heads around the fact that people can be barebacking and still wish to reduce transmission. I think it's a mistake to think about barebackers as simply irresponsible hedonists.

Tell me why you’ve been using the word “disgust” a lot lately.

I’ve become very interested in disgust for various reasons.  One, in the world of academic theory I inhabit, people don’t talk about disgust, they talk about shame. Shame is connected to identity.  For me, disgust is connected to acts and in order to have a discourse about sexual acts we need to think about and talk about disgust.  Disgust is really complicated because disgust in the context of food simply pushes you away from food.  Disgust vis-à-vis sex or bodily fluids can draw you to those things. Sometimes sex can be intensified by doing things that you actually feel can be kind of disgusting.

Or that other people find disgusting?

Which is why large amounts of bodily fluids, especially semen, are important in the subculture and within some of the porn. One of the things that interests me is that some people find “sloppy seconds”  disgusting, that is using multiple loads, using cum as lube. But a lot of guys, including straight guys, find it very hot.

And isn’t it a staple of bareback porn? I’m thinking of the porn classic Dawson’s 20 Load Weekend?

Absolutely.

Tim, I think one of the take-home messages I got from listening to you is that if we find an act not to our liking, it becomes morally wrong.

I want to make the distinction between moral disgust and sexual disgust so that we can hold on more tightly to the idea that just because you don’t like something does not make it morally wrong. That seems to me very important.

Is anything morally wrong in sex?

Absolutely.

Give me an example of what is morally wrong in the context of barebacking?

I think coerced sex is morally wrong. I think lying to people is morally wrong. I think treating people badly is morally wrong. The ethics have to do not with the act you are actually doing, but how you treat your partner. To me it’s very important in the book — and in my life — to understand that other people are not objects to be used for one’s gratification. Other people are not sexual commodities. We may play out a fantasy in which I use you as my sexual slave and we both may enjoy that, but within the broader context of our encounter I treat you like a human being with respect, etc.

Let’s talk about the breeding, gift-giving subculture. Some people have played it down and suggested it’s mostly fantasy and that it’s very hard to track down real bug-chasers for research, for instance. Is this really a big part of bareback culture?

It’s certainly a big part of the fantasies that animate the subculture. In that way it seems to me important. I think in the process of writing the book and when I was giving lectures, people wanted to know, “How many gift givers, how many people are there out there doing this?” I don’t think that can be answered because the fact is it’s a very exciting fantasy for a lot of people but how that translates into practice is very, very hard to know.

But are there some people out there who really want to be poz?

I think so, yes. They see being poz as an inevitability, as giving them licence to bareback without worrying.

How do you feel about that?

Well, I think part of the reason I want to talk about fantasy is not so much that I’m psycho-analytically oriented – although I am – but because American culture does not have a very good way of talking about fantasy. Therefore it does not have a very good way of distinguishing between what is a fantasy and what is something you actually want to do. I’ve done some work on this around rape fantasies.  A lot of people have a fantasy about being raped, but that doesn’t mean they want to be raped. It means they want to enact a fantasy; and it seems to me you can make an analogy with guys out there who say they want to become poz.

OK, I want to talk about bareback porn.  It’s very different to mainstream gay porn, isn’t it? It looks different, I’m thinking in particular of Treasure Island Media  (NSFW link) which has a home-made feel. Actors can be overweight, older, not conventionally attractive. Why is that?

I’m very interested in Treasure Island Media and Paul Morris’s whole politics, ethics and aesthetics of making porn. He sees himself as a documentary pornographer, documenting what guys are already up to and therefore the guys in his films should not be some kind of fantasy ideal with perfect bodies.  

They should look like us?

They should look like us. They should look like the guys we are and the guys we meet.  Some people don’t like his porn for that reason.  They say the guys in it are ugly. That’s not my view on it. The range of body types makes it real.  It makes it hot. It’s clear you can be older, overweight, you can be hairy, you can have an imperfect body, you can look like a poz guy – and still be a porn star, still be the subject of sexual pleasure. That’s important.

Do you have any views, Tim, on the role of barebacking porn in encouraging or stimulating bareback behaviour?

People want to be able to draw a very clear line between pornography and behaviour – and I don’t think you can draw that line. I think it’s been proven again and again that watching pornography, of whatever kind, will not simply translate into imitating those behaviours. It’s not that pornography has no influence. Of course it has influence over what we find exciting, what our fantasies are.  But what interests me is that even with this iPhone you are recording this interview on we can go in to the bathroom and make pornography and put it on line . . . .

Want to?  (laughs)

(laughs) So that is to say we can all — and lots of people do – make our own porn and put it on XTube and I think that’s an incredibly interesting development.  We can all be pornographers.  If you don’t like the mainstream porn that’s out there, make your own porn – and I think that’s a great thing.

OK. I want to finally get to the intersection between barebacking and HIV prevention efforts. The language of HIV prevention uses words like “intervention” and “counselling” which essentially relate to efforts to change behaviour, or even stop various behaviours. Is there any scope for the world of counselling and interventions to interact with barebackers or do they have their own rationale for what they do and have made up their minds? Are the two worlds apart?

I think there is space for an intersection. When I wrote the book it was very important for me to not to write about barebacking with the desire to understand it in order to stop it. I do think, though, that what counselling offers is a space to think through what one’s desires are, what one’s fantasies are. I think to the degree that counselling makes a space available to sort through the confusion that all of us have in our minds about sex, desire, desirability – that’s good. But if counselling goes in to a situation with the sole attempt to stop something, then it closes off the space in which people can figure out their lives and what kind of sex they would actually like for themselves.

What we’ve seen here is applying a harm reduction approach to barebacking in terms of talking about techniques that might reduce the risk of transmission.  Does that make sense to you?

Yes, it does. But I don’t think it’s all or nothing.  For a long time it was pitched as “use condoms all the time or you are going to become a crazy reckless barebacker who is going to become poz and spread the virus”. It’s not either/or. Thinking in terms of harm reduction makes much more sense.

That’s likely a good place to end.  Tim, thank you so much for talking to us.  You’ve been incredibly honest and forthright about something that challenges many of us.  This has been so useful. It’s been a real pleasure talking to you.

Thank you, Bob

Tim Dean’s book “Unlimited Intimacy, Reflections on the Subculture of Barebacking” is available on Amazon here. 

Tim Dean is professor of English and director of the Center for the Study of Psychoanalysis and Culture at the University at Buffalo. He is the author or editor of several books, including Beyond Sexuality, also published by the University of Chicago Press.

Apr29

Talking treatment as prevention with Julio Montaner

Monday, 29 April 2013 Written by // Bob Leahy - Editor Categories // As Prevention , Features and Interviews, Research, Health, Sexual Health, Treatment, Living with HIV, Bob Leahy

Bob Leahy sits down and asks the hard questions with treatment as prevention’s foremost proponent, Dr. Julio Montaner, head of the British Columbia Centre for Excellence in HIV/AIDS, while in Vancouver last week.

Talking treatment as prevention with Julio Montaner

Bob Leahy: Thank you for talking to PositiveLite.com, Julio.  The last time we talked was in January 2012 I think.  How have things shifted on the treatment as prevention scene in the last fifteen months.  Are you starting to feel optimistic in terms of what you’d like to see?

Dr. Montaner: Well as you know I have been feeling quite strongly for quite a number of years now that treatment as prevention truly offers an opportunity to fully realize the potential of antiretroviral therapy, first and foremost at the individual level, secondarily to pay a huge dividend when it comes to preventing HIV, TB and a number of other diseases.  For us the challenge was initially to get enough of a data base that the argument could be made compellingly enough so that every level of decision making, from policy makers to community, could rally behind it. In my mind the evidence, particularly when you weigh it against the challenge we are trying to address, was already overwhelming in 2006. Imagine how I feel now!

I think that since HPTN052 came on board that has allowed us to say this is definitive and conclusive evidence, and that we now need to move on to implementation discussions. And in the last eighteen months we have seen a huge political evolution, from Hilary Clinton to President Obama to (UNAIDS) Michel Sidibe progressively increasing the enthusiasm. To me, Michel Sidibe was incredibly valuable in 2010 when he formally endorsed getting to zero through treatment as prevention but I sense that his level of enthusiasm and eagerness today is exponentially greater, which is a great sign.

Bob: But in Canada, how do you feel about this.  Have we made progress at all here in the last fifteen months?

You know British Columbia has been unique in the sense that I have been able to galvanize political support based on the evidence exclusively and the return on investment, if you want to put it that way. The Province has been 100% behind us. Unfortunately I have to say that I have been disappointed that the same attitude has not really panned out across the country. There has been a whole lot of intellectual discourse, and it’s incredibly frustrating, you know, when you show data regarding the evolution of the epidemic in British Columbia and you juxtapose that against what is happening in Manitoba and Saskatchewan, for instance, where HIV rates are continuing to rise - and it begs the question what else can I do to make my point?

I point my finger directly at the federal government. I think it is Stephen Harper’s fault and the health ministers’ fault all the way from Tony Clement to Leona Aglukkaq, and PHAC’s fault too because they are unable to release themselves from their political masters to say “we have a crisis, we know how to address it, let’s do it”. In an area where the only answer I get is "this is a matter for provincial jurisdiction" then that allows for all kinds of anarchy to occur and basically we are left without a national HIV strategy.

So how about your provincial partners?  Have you been able to make headway with them or are they still looking for more data?

Well that`s the problem. We have had very good conversations with individual leaders all across the country but they have not materialized in to an executive order to move forward  and my frustration is that the lack of attention by the federal government to this issue makes it possible for the chaos to continue.

I know CATIE is trying to foster a dialogue by hosting national consultations on this issue and also convening a treatment as prevention-themed conference in September. Do you regard these as positive steps?

In my opinion, anything that will create a forum for this kind of discussion to take place is a very well received opportunity. I am a little bit frustrated about the fact that in the CATIE consultation last year there was lot of discussion but I would have hoped it would be the ideal forum that people would rally around the idea and say we want more, we want better, we want  targeted outcomes – and it didn’t happen.

OK. Let me ask you something else.  In the room today (at the TasP conference) you could get the impression that Canada, instead of being a leader in treatment as prevention as we once seemed to be, may be falling far behind other nations. How would you characterize our position now in the world?

Well you heard today about the progress we have together made with China.  I was instrumental in working with the CDC in China, managing to inform their new policy which came about even before HPTN 052, and we have made phenomenal progress there. I’ve been working with colleagues of mine in Rwanda and their work has been incredible, with plans to expand and with a clear national policy, much like China.  It's absolutely brilliant.  And then there’s New York City and San Francisco and Washington D.C. The list goes on and on.

So how does that make you feel?

Well I think individually I feel incredibly pleased and gratified I have been able to do this in my province and be able to export that to willing parties around the world. But it breaks my heart that I haven’t been able to do the same thing for the rest of my country.

Well, why haven’t the other provinces taken treatment as prevention up? What’s behind all that?

I can tell you what have been the keys to our success as opposed to why there is as yet no similar success elsewhere in Canada. Firstly, for us it has been important to have a focussed program; at the BCCFE we have one item in front of us and it’s HIV. Secondly, we have a very aggressive data generation mechanism; we monitor everything and based on that data we can go to politicians and say "this is the evidence about what is happening in your own backyard and you need to do something about it". Thirdly we are very strong advocates, we work with community and with partners to create the urgency that is needed for politicians to feel not only is this what should be done but has to be done. 

Why is this not happening elsewhere in the country? Well, I think we (nationally) need to get our act together. We need to make this something that the politicians cannot walk away from – and I think the elements . . . when you see the state of the epidemic in the aboriginal community and the MSM community, we need to make this a priority.

OK. Now I have to ask you about the issue of MSM and the fact that your numbers of new infections in B.C. have not declined in that population. Why can’t you get the same results there?

Some have argued that treatment as prevention may not work in MSM.  I think that is absolutely wrong. The biology says it does work, it works on the virus no matter where it is. If it works in injection drug users it will work for everyone else. 

So here’s the situation. Treatment as prevention works in serodiscordant couples.  New infection rates among MSM – older MSM – are coming down. The problem is that the rate in young MSM is going up. Because of stigma and discrimination and all the issues around sexuality they come out poorly equipped to protect themselves. They make choices which put them at risk because the environment is not prepared to welcome them in a supportive manner. So they get infected before we can get to them.

So how do we change that piece?

It’s a very tall order to ask a clinician to change that piece, but I have two answers for you. The first one is that if we offer treatment to everyone we possibly can, we make the world a safer pace for gay youth to come out.  Even if nothing else changes, that will help.  Of course that’s insufficient. The second one is systemic change where we access youth before youth come out. Now you ask how difficult that is in places like Abbotsford or Hope or even Vancouver where talking about sexuality in schools is problematic. Beyond that talking about homosexuality, in some school districts, is impossible. We need to change that, because if we cannot have those conversations early on and show that we are supportive of gay youth even before they identify themselves then we will always be trying to protect them after they have got infected.

OK. I want to ask about the role of people with HIV in advocating for treatment as prevention. I’ve had a feeling that the community is absent, somewhat, from the discussion and that the discussion when it occurs tends to be driven top down, as opposed to from the bottom-up, and bottom-up is the way direction has come from historically. Do you agree that there is an advocacy gap there and that is something we need to look at?

Look Bob, I’ll be very frank with you. In my early career working with HIV  - and I’ve been doing this since the eighties – I was there when the community was against us because they didn’t feel we were doing enough, when we were pushed because we didn’t have the answers, they just weren’t available.  I was there when we finally merged and worked together after 1996 to make treatments available faster, to get the regulatory process changed, to get services to the community. But the community has lost its focus. We’ve moved to solve a lot of the problems you have but the sense of urgency to help us solve the next problem is almost no longer there. All the people in the community have different issues. What is missing is that unifying focus that says “Julio, we want you to work with us to end the epidemic.” So I am a lonely ranger here, trying to push for the end of the epidemic.

Well, personally, you know I’ve changed my mind on treatment as prevention. I’m in favour now. And the argument I’ve found most persuasive is that starting treatment early is undeniably good for us.

The reason I started doing this work is not that I had an eureka moment that treatment could prevent transmission.  It was not my priority. This was about my patients, my number one motivation.

I don’t think everyone understands that. I think some people feel that people like yourself have a public health agenda first and foremost.

No. And that is the number one problem.

OK. One more question and that is about the expansion of testing towards more universal testing. I know some jurisdictions have an issue with expanding testing to what we’ve regarded as low risk groups and the issue they have is a cost-benefit one – the cost doesn’t justify the small number of new infections you are likely to bring to light.  How would you respond to that?

Well I met with the Deputy Minister of Health here and said I wanted to do normalized testing, offering testing for everyone who has ever been sexually active in this province.  He said, “Oh no, Julio, here we go again. We cannot afford it”.  I said “you cannot not afford it.” He said “people are going to reject it, they are going to refuse.” I said “Let’s pilot it. We’ll offer testing to people at no risk, either self-perceived or perceived by their physician, who don’t have any conditions that make you suspect they could be HIV-infected and so when they come  to emergency or admittance at three local hospitals with totally different demographics, we offer them an HIV test." We did 10,000 or so tests and found consistently five per thousand came back with HIV-positive results. My colleagues in Argentina did the same thing in acute care hospitals in Buenos Aires – and five per thousand came back positive. CDC in Atlanta says that if you only get one positive per thousand tests it pays for itself.

So that’s your answer. The return on investment is fabulous because you are doing two things – those people change their behaviours, they recognize that they need care and they render themselves no longer infectious. It’s a no brainer.

Julio, you are very persuasive, I must admit.  Thank you so much for talking to us at PositiveLite.com again and thank you too for welcoming us to Vancouver for a great conference.

My pleasure, Bob 

Photo by Bob Leahy.

Read my conference report here.

Apr18

30 years of ACT: A conversation with Hazelle Palmer

Thursday, 18 April 2013 Written by // John McCullagh - Publisher Categories // Activism, Events, Features and Interviews, Living with HIV, John McCullagh

As the AIDS Committee of Toronto, Canada’s largest AIDS service organization, turns 30-years-old, the agency’s executive director talks with PositiveLite.com about its past, present and future.

30 years of ACT: A conversation with Hazelle Palmer

The AIDS Committee of Toronto (ACT) was founded thirty years ago, in 1983. In this video interview, the agency’s executive director Hazelle Palmer reflects back on the organization’s beginnings, how it has changed over the years as HIV and AIDS have changed and how ACT will continue to make a difference in people’s lives in 2013 and beyond.

Apr09

In the beginning

Tuesday, 09 April 2013 Written by // Bob Leahy - Editor Categories // CATIE, Features and Interviews, Health, Bob Leahy

Bob Leahy talks to one of CATIE’s founders, Sean Hosein, now its Science and Medicine Editor, about the early days of the organization.

In the beginning

Almost everyone in Canada – and I dare say in many other counties too - who has an interest in HIV and Hepatitis C treatment and more will be familiar with the work of CATIE.  But for those who aren’t, here, from their website, is a description of what they are famous for: 

“CATIE is Canada’s source for up-to-date, unbiased information about HIV and hepatitis C, connecting people living with HIV or hepatitis C, at-risk communities, healthcare providers and community organizations with the knowledge, resources and expertise to reduce transmission and improve quality of life.’

CATIE has been around for more than twenty years, growing  larger and evolving over the years as the nature of the epidemic  has changed also. From very small beginnings it has grown to a respected and far-reaching organization with almost forty people on the staff.  But who knows how and why it started, or what it was like in those early days?

To get the answers, PositiveLite.com editor Bob Leahy talked to someone who was there - Sean Hosein, one of CATIE’s founders, now serving as its Science and Medicine Editor.

*****************************

Bob Leahy. Hi Sean.  Tell me how you first became involved with learning about HIV

Sean:  I came of age in the early 80’s and I was fascinated by what was then being called the “gay plague” by the media.  They were making ridiculous statements in the media, utterly ridiculous stuff.  The reports were sensationalist, very scary and they didn’t make sense in some ways, making outrageous claims based on a limited set of data. 

I was going to school at the time, first in high school and later to university, and I would go to the university library and it was easy in the first seven years of the epidemic to learn about the disease in that all the medical reports that came in the medical journals were very, very descriptive.  And in the early years too, before scientists were certain, there were all these crazy ideas about how people became infected, and it made for fascinating reading.

At the same time – the mid to late 80s – we had a lesbian and gay rights movement that had developed, particularly here in Toronto, and some of the men and women who were involved with that also began to see a need for an AIDS organization, because people were dying and not much was being done.  (I won’t go in to details why that was – that’s been covered well by the movie “And the Band Played On”, the play “Angels in America” and the recent documentaries about AIDS activism in New York and San Francisco.)  So I got together with some like-minded people, and my part was to supply information - these were incredible people fighting for their lives and I would help them; I was a patient advocate for a while and then I saw a need to help educate both doctors and patients about this rapidly moving field.  So we produced a bulletin that we would give out to doctors and patients in Toronto.

When was that and how did that happen exactly?

Well, in 1985 or so I was writing in a newspaper called Rites – a lesbian and gay newsprint magazine that doesn’t exist anymore -  about discoveries and possible avenues in HIV-related research at the time. And the people who formed AIDS Action Now! (AAN!) around that time were my friends. I didn’t go to the initial founding meeting of AAN! but I did join a few months after - that was in 1988 - and I joined the Steering Committee where I sat for several years. In 1989 I started to produce something for AAN! which we initially called “AIDS Update” but we later called it “TreatmentUpdate” and it was Canada’s first bilingual publication about treatments for HIV.

The cover of the first issue of "AIDS Update", editor Sean Hosein.

We sent it to doctors here and in Quebec, to people around the country. I just reported what was going on in the medical journals in different fields related to research about how HIV caused problems for the immune system and the discovery and testing of treatments for HIV. And it became clear that a lot was happening, there was a tremendous amount of research, but there weren’t enough clinical trials of drugs. So we advocated for getting drugs that looked promising in early clinical trials in other countries, in to Canada and available on a compassionate basis for people with HIV who were very ill. We advocated for setting up a clinical trials network that would test these promising drugs and also for a knowledge broker organization that would help distribute the knowledge about these emerging treatments to people.

Things were done in a very haphazard manner, though, back then because we rushed from one emergency to another, all done with volunteer labour.  We naively felt that there would be a cure after a few years. You didn’t know who was going to get infected and die. The late George Smith, a brilliant intellectual, gay rights activist and co-founder of AAN! and CATIE said that it was like living in London during the Second World War, during the Blitz, so you were on adrenalin all the time. It was at once exciting but there was a lot of danger in the sense that your friends could die at any time from some mysterious cause. We have lost so many brilliant and kind people to this damned virus.

So those were the AIDS Action Now! days. I’m guessing that we’re at the point in the story where CATIE – or what was to become CATIE - was about to be formed?

Correct. The people who had the core idea for CATIE back then were Alan Cornwall – he was a lawyer, George Smith a researcher at the University of Toronto, the women’s health activist Linda Gardner and myself. They mentored me a lot. I was also helped by many doctors both in the community and at hospitals.

What did you do about money?

In 1990 with funding from the Trillium Foundation (an Ontario-based charity) we got a grant to establish the organization we now call CATIE.  It only had one staff member at the time, the project director who is now a professor at York University; his name is Eric Mykhalovskiy. I was working with CATIE right at the beginning as a volunteer.

Those days were really chaotic. We worked then mostly in the city of Toronto but then as the epidemic grew and grew we realized there was a need to expand our services to other provinces. I wrote a grant proposal that the federal government kindly funded to expand TreatmentUpdate’s distribution and reach across the country and to pay for translation.

The Federal government funded us for several years and as they and everybody were seeing we were having an impact, helping people with the information they needed and so on, our funding increased over the years.

I was initially on the board of CATIE but I had to step down after a few years before I could become a staff member.

Where did CATIE’s interest in prevention come from?

Although we were initially a treatment organization, CATIE always had an interest in prevention in that it encouraged safer sex but that was not our primary focus back in 1990. At that time, funders were primarily interested in prevention work and we had to argue that providing treatment information was a form of prevention. However, as the epidemic changed and we saw the Lazarus effect with people coming back to health, we took on more health-related issues for people living with HIV.

CATIE had always been looking at health issues from a holistic perspective, not just treatment-related things, so it was not a stretch to explore information about other sexually transmitted infections that facilitate the transmission of HIV. These infections include germs like herpes, gonorrhea, syphilis and so on. However, our focus was on improving the health of people living with HIV. We also did a lot of capacity building work with AIDS Service organizations which helped us to understand how prevention and treatment really work together. In the mid-2000s people began to raise questions about the ability of HAART to reduce infectiousness. At first these were very dry discussions. We officially expanded our mandate to include all aspects of HIV prevention and treatment in 2008. It was very good timing for us because the biomedical science of HIV transmission, prevention and testing was about to explode and we already had a solid foundation in knowledge exchange through our work in treatment.  

We had always done limited work on Hepatitis C and this was officially added to our mandate a few years ago as well.

Through all this – at least in those early years, Sean – you had a very personal connection to HIV, didn’t you?

I was lucky in that I came of age when safer sex had been invented and so I was able to protect myself but my partner was older than me. So we always suspected he was infected, but we took precautions and then when the test became available we did get tested.  He was positive. And you know it’s one thing to guess that you’re infected and another to see it in black and white. It was very devastating for him initially. You must remember that back in the dark ages of the 1980s there was no effective treatment and studies from that era found that people would die a few years after the diagnosis. Despite that grim forecast, we did all the things we could to keep his immune system going well and we did a very good job of that until the last six months of his life. He passed away in November, 1994. It’s devastating to lose your spouse. We were together for ten years. I am deeply grateful to the many doctors, scientists and friends who helped me with George’s care.

Did that impact the passion you have your work?

I think his death just encouraged me to work harder. There are still many people living with HIV, there are long-term health issues that they will face. Also, as you noted earlier, our mandate has grown so for me there is no shortage of things to do!

Our work today, which has expanded into the spread of HIV, hepatitis C and sexually transmitted infections; these are all important.  I get letters and emails all the time from people, people living with HIV, hepatitis C or STIs, who talk about some article I wrote and how much a difference it made in their health and it’s really moving and wonderful to know that not only am I making a difference in somebody’s life, but so are all the other people who work at CATIE – who do work in translation, editing, producing and maintaining our website, distributing our publications and so on — to make that information accessible. Our executive director Laurie Edmiston and my boss Timothy Rogers encourage constant learning and have helped to maintain a nurturing and stable environment so that myself and others can thrive at CATIE. We also have many doctors, nurses, pharmacists and scientists across Canada and around the world who provide their expertise in reviewing our work and for that we’re very grateful.

What does it feel like to be one of the founders?  Does it give you pride?

Having helped found this organization that once occupied a tiny office at 517 College Street (Toronto) that could barely hold a desk and a filing cabinet, a computer and a printer, go through many changes and growth and now reaching its full potential is really wonderful to see.

Now I’m so proud to see how far the organization has come.

Photo of Sean Hosein courtesy Matthew Watson. 

Mar21

HIV in Toronto’s African, Caribbean and Black communities

Thursday, 21 March 2013 Written by // John McCullagh - Publisher Categories // African, Caribbean and Black, Features and Interviews, Health, Living with HIV, Population Specific , Sex and Sexuality , John McCullagh

John McCullagh talks on video with Shannon Ryan, the executive director of the Black Coalition for AIDS Prevention, about HIV prevention and support among Toronto’s African, Caribbean and Black communities.

HIV in Toronto’s African, Caribbean and Black communities

Canada’s African, Caribbean and Black (ACB) communities are disproportionately affected by HIV. Large and diverse, they comprise both people born in Canada as well as immigrants and refugees from a broad range of countries, often countries where HIV is endemic. It is also a community where, uniquely, HIV predominantly affects those who are heterosexual. 

It was to address the specific needs of these communities that Toronto’s Black Coalition for AIDS Prevention (Black CAP) was founded in 1989. In the words of Shannon Ryan, Black CAP’s executive director, there was “a need to carve out our own niche, to create our own space and to create programming that was delivered from an approach of ‘by us and for us’...We need services that are delivered from our own perspective, in terms of how our communities look, how our communities talk and how our communities approach sex and sexuality and HIV”.  

I recently sat down with Shannon and asked him to discuss the work of Black CAP and the communities it serves. Shannon’s passion for his job and his compassion for those he works with shone through in the interview as he talked about what his agency is doing to address the lived realities of ACB people living with and affected by HIV. 

Watch the video of our interview below and be inspired!

Mar13

The man called newfiebear

Wednesday, 13 March 2013 Written by // Bob Leahy - Editor Categories // Dating, Social Media, Gay Men, Features and Interviews, Health, Sexual Health, Lifestyle, Living with HIV, Media, Population Specific , Sex and Sexuality , Bob Leahy

Tom aka newfiebear has made it his mission to improve gay men’s sexual health via his own home-spun website, newfiebear.net. Today the friendly Newfoundler sits down over coffee with Editor Bob Leahy to discuss his work - and his life.

The man called newfiebear

From Wikepedia: “Newfie (also Newf or sometimes Newfy) is a colloquial term used in Canada for someone who is from Newfoundland.”

I’m sitting with Tom, better known as newfiebear, over a coffee at the Second Cup on Toronto’s main drag, Yonge Street. The place is pretty crowded, and I’m wondering what eavesdroppers might think of a conversation potentially full of references to gay sex. But Tom’s an open man, seemingly with few secrets.  And that includes his HIV status.  “Do ask, do tell” is his approach to life – and to sex. So there seem few worries about the folks just feet from us hearing.

Tom, who I think probably is more comfortable with newfiebear, the handle on his various profiles and the man behind newfiebear.net     – more on that later – is a tall, friendly, 48-year old. He looks younger.  Professing to be shy, he hides it well, smiles easily and laughs a lot. He’s the kind of heart-on-your-sleeve guy you feel instantly at home with. I like him at once.

His story?  He moved to Toronto from Newfoundland 14 years ago and in 2004 became HIV-positive. He took it badly and turned to substance use and after a really bad experience tried to commit suicide. After a spell in rehab, he turned things around and started to educate himself and learn everything he could about HIV, volunteered at different AIDS Service Organizations, ending up at the AIDS Committee of Toronto (ACT).

Through all this “I developed a website for men who have sex with men – I don’t like labels” he says “to help stop people from contracting HIV and STIs. I’m from the bear community and I wanted to have a website for gay men like myself and especially for the bear community where if someone is looking for sexual health information, community support or is living with HIV or if someone is having a hard time with substance, it’s all in one place. So there is lots of information on the site and also community support links, mostly for downtown Toronto, but the information I post about – there are links to a lot of information sites like TheBody.com and PositiveLite.com -  is global. I also have an email where people can ask me any questions at   This email address is being protected from spambots. You need JavaScript enabled to view it. .  I get a lot of global visitors. I get about 1,500 hits to my main page each week.”

Newfiebear.net’s home page gives more clues to Tom’s welcoming personality. “Good day” it says under a photo of the Newfoundland landscape with a cuddly looking bear in the corner. “Thanks for visiting NewfieBear.net“ with a chatty reminder to put your clocks forward this past weekend. “This site is a free information base for all men who have sex with men regarding sexual health, community support, living with HIV and external Information inks . There are also some links regarding sexually adventurous men who are into some kinky sexual acts.” Clearly this newfiebear has a wild side!

His page for people living with HIV comes with a multitude of links – about smoking, about disclosure, about STIs but also comes with this delightful header: “WARNING. There are people in the world that will try and prevent you from spreading your wings. Be strong and move forward. Believe in yourself!”

Tom is a graduate of GPS (Gay Poz Sex) of which he speaks enthusiastically and about which we have written here. GPS is  a confidential, group-based, peer-led program that supports HIV-positive gay and bisexual men in making choices related to their sexual, mental and physical health. Says Tom “It’s an excellent course, I would recommend it to anybody who is HIV-positive.  It’s not just about condoms, but all the different aspects of sex, your fears, substance use, harm reduction, etc."

I asked Tom how GPS helped him personally. “It actually helped me on my own quest for personal self care. I also wanted to have more sex.”

“Did It work?”

“Oh yes, I actually had more sex. It opened up more communication.”  Tom launches in to how it helped him develop his recipe for sexual compatibility, starting with the three-minute coffee chat . “It’s now five”  he says with a grin, talking about his preferred way of screening potential mates that hinges on his “do ask, do tell” policy. So if you want to get frisky with newfiebear these days, expect to be asked not only about your status, but your STI history and more. “Don’t get me wrong” he says on his website. “Online hookups work for some individuals.  All I am saying is my experiences chatting with guys online are a lot different and are much more successful face to face.”

Following GPS, Tom participated in a new program G=MC2, (Gay Men Creating Community) a gay men’s validation series of workshops.  It's a six week program “all about how we can validate ourselves and others.” Again he says “it changed me for the better”.

Tom also has a thing about smoking and his website links to the UK GMFA Quit Smoking page for gay men and Tom's own video page features newfiebear talking about what stopping smoking has done for him, including increasing his sex drive. (He raises an arm in the video to illustrate improved erections). Since quitting cold turkey not long ago, after almost a lifetime of heavy smoking and six failed cessation attempts (“it was very hard at first” he says) he has started a small support group for people in the process of quitting who meet once a week. “There are five people in the group and three of us – myself and two other guys – have not had a cigarette for 61 days. What helps us is that we talk about our triggers and how we overcome them.”

Our conversation keeps returning to sex. Tom isn’t shy to talk about his own sexual strategies. He serosorts, in other words preferring to have sex with poz guys. “Ever since the legal issues about disclosure came out, I’m kind of worried about that.  I don’t want to deal with that.” He’s not a fan of barebacking though. “I’m actually using the second generation female condom. It gives you the sensation of barebacking. I’m HIV and I don’t want to catch anything else. Being HIV is enough.”

I asked newfiebear if disclosing to guys results in rejection sometimes.

“Oh yes, lots of times. It’s their choice, it happens. You are going to get to kiss a lot of frogs before you meet your prince. And I’m still going through the frogs.  But you have to be proactive. Sometimes I feel bad about it, but I have techniques for dealing with it.  I’ll go to High Park and walk around and talk to the squirrels.”

The conversation is drawing to a close, and I have to go. Our neighbouring tables seem either unaware or unphased by the frank discussion we’ve been having. Or perhaps they hear talk about barebacking, improved erections and female condoms everyday here.

In any event, one thing is clear as we say goodbye; sharing is what newfiebear is all about, and it's his passion, whether over coffee in downtown Toronto or globally, via the world-wide web. 

Check out his website here

Follow newfiebear on twitter at @NewfieBear_net.

MarketPlace