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

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

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

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

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

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

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

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

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

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

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

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

Post-script:

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

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

We’re born naked… and the rest is drag.” — RuPaul

When I was nine years old, I took my parents’ album of the Broadway musical “Damn Yankees” and memorized every syllable of Gwen Verdon’s show stopper, “Who’s Got the Pain When They Do the Mambo?” Once I was satisfied with my lip-synching and choreography (I decided that a mambo was a dance in which young boys gyrated and flung themselves on and off the living room sofa), the number was ready for public display.

The premiere was a simple affair, exclusive and unannounced. Mrs. May from across the street had stopped in for afternoon coffee, and opportunity knocked when Mother busied herself in the kitchen for a few minutes.

 Not a smart move, Mother, leaving Mark alone with the company.

“Mrs. May, would you like to see me do a song?” The unsuspecting woman gave a polite “yes, that sounds nice” and before Mother could run interference I had turned on the stereo and dropped the needle at the precise moment where Gwen breaks into song.

Mrs. May stared and stared, her hands folded neatly in her lap, as I brought out every sashay, twist and thrust in my dancing arsenal. My moves may have been imperfect but I vocalized brilliantly, thanks to Gwen. As I struck my final pose, arms reaching for the heavens, frozen and triumphant, I saw mother standing in the doorway, holding a plate of cookies and breathing heavily through her nostrils.

Future performances would be limited to my bedroom, where I could conjure an audience cheering with acclamation and mothers wouldn’t put you on restriction.

It is that boy, the cheerful but feminine performer, that I always feared would creep out of me as I navigated young adulthood as a gay man. I worked to shed his characteristics, to replace every soft gesture with a wooden one, to embrace the gym and tank tops and Levi jeans with the same fervor I once had for my beloved Broadway musicals, with mixed success.

And then, a lifetime later, as I worked for an AIDS agency in Atlanta in the 90’s, destiny called. An upcoming drag contest to benefit our agency was suffering from poor participation, and my boss asked if I would consider entering.

Being a drag queen, even for a night, terrified and delighted me. But the performer in me won out, wouldn’t you know, and Anita Mann was born. I created an interactive video rendition of Donna Summer’s “This Time I Know It’s for Real,” (even then, long before this blog, I was toying with the possibilities of video) and won the contest.

 Soon I was performing with “the camp drag queens of the south,” The Armorettes, who hosted a Sunday night show to raise funds for AIDS organizations. Over the years they have raised over $1 million, and their show was a sellout every week. But my own phobic notions lingered.

I didn’t want to be known as a drag queen (“It’s comedy! I’m a performer!” I would insist). I never appeared anywhere in drag but on that stage – I would always get dressed at the show, and was often out of drag for the final curtain call, in a bid to display whatever masculine credentials I had to offer.

I would hear other gay men make disparaging remarks about drag and I withered, unable to admit I was playing to a packed room every Sunday.

The nexus of shame and shamelessness is a complicated one. Each week I put on full display the very things about myself that I had worked so hard to reject – my femininity, my silly pursuit of acceptance through laughter and applause. And just as I gained confidence in what I was doing and why, I would lose a potential boyfriend when he learned of my weekend talents.

As a growing drug addiction encroached on my free time, I abandoned Anita Mann to its demands. For many years thereafter, Anita’s dress and wig would be relegated to a duffel bag hidden in the back of the hallway closet. I had found a vocation in drugs that offered twice the shame and every bit of the need to keep quiet about it.

It took a few years in recovery from my addiction before Anita would make her comeback. Armed with a TV set and a sense of the absurd, Anita performed at a benefit for those of us in recovery, in what may have been her finest hour. Her rendition of “Don’t Get Around Much Anymore” grows more insane by the moment, and perfectly embodied my interest in multi-media performance.

And yes, I am aware that I speak of her in the third person. Maybe it is because I view her as a character I have created, and perhaps it is the remnants of shame, and of my need to keep her at a distance.

It’s strange, how those things about which we have drawn the most shame are also able to liberate us, not to mention help others. My HIV status. My drug addiction. My drag personality. As I have embraced each of these, I’ve found self-acceptance and a way to carry a message of hope, and even joy, to others.

Anita Mann limits her performances these days to recovery-related engagements. It seems fitting that these two aspects of my life, both once secretive, have found their place together. Anita has a voice now as well, doing a sort of recovery stand-up and even singing live when the occasion permits. Anyone in recovery might enjoy watching the highlights of her recent stint at the Crystal Meth Anonymous conference in Atlanta, which includes her bittersweet rendition of “Happiness is…”

Meanwhile, I still struggle with the need to project as much masculinity as I can muster. I swagger more than I sashay. I sport a beard when possible. And I work to maintain a strict gym regimen.

It’s important for me to stay in shape if I expect to fit in that dress.

This article first appeared in Mark S. King’s own blog My Fabulous Disease.

The Song 'It Does Get Better', written by Georgey Payne (below right) , is set to be a positive message to anyone who experiences the struggles that can come with being different.

Georgey herself was moved to action by the experiences of a young gay friend: "I noticed one night he was worried about going home after working an evening, and when I asked him what was wrong he told me he was being bullied at school. I then listened while he explained everything that had been happening, and just remember feeling so sad at what he was having to go through. Being a songwriter, the best way I could think of to help raise money and awareness to prevent this kind of thing happening to others was to write a song. I then asked the most talented UK lesbian artists I know for their help by getting together to record it for charity, and they all said yes - without hesitation."

The L Project is focused on raising awareness and money in the UK. "If the song sells beyond the UK, that would be fantastic. If I jumped back now to age 13 and had heard a song like this, knowing I was gay, but had remained silent, I would have felt so happy, and realised it's not just me, and that I actually had a life waiting for me where I belong" says Georgey. "Our aim is to reach as many people as possible with the release of this single, young, old, friends and family of those affected, it doesn't matter who you are, we all have a chance to help make difference. Our charities help prevent young gay people from being bullied - that's the focus of the L Project," says project partner Sofia Antonia Milone.

All the artists, promoters, sponsors, supporters and anyone else involved with The L Project came together because they are passionate about giving hope that it gets better to LGBT youth. As a result every single penny made from the sales of this single, including all royalties are being donated to charitiy.

Participating artists who worked on the charity single are Scottish legend, Horse, Georgey Payne & Emma Kavanagh (Greymatter), Sofia Antonia Milone (GeEkgiRL), Sandra MacBeth, Amber Taylor-Groves (HeadsHearts), Mel Sanson (Kenelis), Nina McCann, O'Hooley & Tidow, Lorna Thomas, Leanna Goring, Juey, Jess Gardham, Amy Sutton (Neon Choir), Nicky Mitchell, and Ella Chambers.

The benefiting charities are Diversity Role Models and Stonewall. Visit The L-Project on Facebook  for more information.

You can also follow the L Project on twitter at @thelproject11

I thought people might get a chuckle out of the video below.

I actually met my partner in a bar.  It was in San Juan, Puerto Rico of all places, thirty one years ago.  It was a dark and seedy place, with a go-go dancer on a raised stage with red velvet curtains, and a dark backroom off in one corner. I felt totally at home there.

Which is probably why I was quite comfortable when my future partner left the friends he was with to chat up little ole me, standing by myself, probably doing a lot of the things shown in this  video.

By the way, we show a lot of stuff here that’s gay, reflecting that at least in our local market, most people living with HIV are  - well, you know.  But we are not a gay site.  PositiveLite.Com welcomes writers of all persuasions.  If you feel you are under-represented here and would like to change that, drop me a line at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Bob : Hi Lisa. Thanks for agreeing to talk to PositiveLite.com.  I want to talk to you about the work of A Loving Spoonful because it sounds quite amazing. But before that  I want to tell you that  I’m loving that flash mob video of yours.  (We’re also posting it below). Do you want to tell me about it?   Is a flash mob a hard thing to pull off?

Lisa: It was our first ever flash mob and we were so excited, to be honest it was hard to keep that one a secret! A tremendous amount of work went into the flash mob and we really couldn't have done it without choreographer extraordinaire Tyrell Witherspoon and of course all the kids from Strathcona Elementary who practiced their little hearts out since November. Some of the kids told us it was the best day of their lives and we were so touched.  Having it in the middle of Pacific Centre Food Court during lunch hour was also part of our plan, and the look on people's faces was absolutely priceless. It was also really neat to see everyone holding their iphones and filming the flash mob. What will we do next? Can't tell you....it's a secret!

Bob:  OK.  Some of us are gay here. Who’s the cute guy in the middle – and is he single?

Lisa: Everyone is asking me about the cutie in the video! It is none other than Tyrell Witherspoon who choreographed the video....and yes he also dances....and yes he also sings. Next I'll be auctioning him off to raise more funds!! For those of you who want to know more or stalk him you can find him at www.tyrellwitherspoon.com.

Bob: And of course it’s in aid of CandyGram.  Now that’s a concept new to me.  You’ll have to explain how it works

Lisa: The CandyGram Campaign is a concept I came up with about a year ago to help support our programs. I was hearing people say that there were so many events to attend and it was simply one gala or another . I thought maybe there is a creative and fun way to engage people effectively using of course our favourite social media tools, Facebook and Twitter; and from there the idea of CandyGrams was born. The first step is to go to candygram.ca to order. There people will find 150 messages to choose from in the categories of Like, Love or Lust. Senders can select a friendly, flirty or frisky message and they can include their name, or send it as an anonymous secret admirer.  They can be sent to anyone:  friends, partners, husbands, wives, colleagues, and children.  The possibilities are endless and the best part is we do all the assembly and mail in for you anywhere in Canada.  For just $10 they include:  A special edition card, your unique message,  two delicious Purdy's chocolates, a Yelpstick lip balm and Shamin Jewellers 'Perfect Kiss' mints and $15 in store or online gift card. The value is over $25 thanks to the generosity of our sponsors.

Bob: We’ll provide links to the CandyGram website at the end of this interview too.  Now I want to talk about your work.  I see from the A Loving Spoonful website that you deliver 100,000 frozen meals a year to people living with HIV in need.  That’s quite staggering.  I’m curious about the logistics of that. First tell me about the food.  Where does it come from, who prepares it, etc?

Lisa: Our food comes from a company named Apetito. They provide all of our frozen meals which are delivered straight to our warehouse. The meal selection is actually very good. We have over 40 delicious meals to choose from and everything is free of charge to our clients.

Bob: Lisa, tell me about some of your programs.

Lisa: We have several different programs here at A Loving Spoonful. In addition to delivering frozen meals to our clients we also have a new Youth Program called Hot Meals for Homeless Youth. We deliver hot, ready to eat meals to a partner agency where youth can eat in a congregate meal setting and access their other services. We also have a Prenatal Program  where high risk HIV positive women can receive extra nutritional counselling along with an extended service period. As their needs change throughout their pregnancy we work with them to ensure their nutritional needs and preferences are being met. For instance frozen meals might be more appropriate around the time of birth while groceries might be more suitable during the months leading up to child birth. Typically 3 months after child birth the mother is able to transition onto the Family Pantry Program. Another wonderful program of ours is the Emergency Service Program where our Dietician or Director of Client Services receive a referral for a patient in a hospital that is soon to be released. Our staff will go to the hospital and meet with the individual to assess their needs. Once they are discharged from the hospital food will be delivered to their home on that very same day. We provide full nutritional support for up to 6 weeks and provide peace of mind so they don't have to worry about where their next meal is coming from.  Named after our founder Easter Armas, we have a program called Easter Sundays. Once per month at a partner agency we serve a gourmet Sunday dinner for 50 HIV positive downtown eastside residents.  Professional chefs volunteer their time to create a wonderful meal in a heart warming and inclusive environment.

Bob: And you must have a pretty sophisticated delivery system to get those meals to those who need them.  How does that work?

Lisa: A Loving Spoonful has been around for over 21 years and we've almost got it down pat.  Each week a dedicated group of volunteers come to A Loving Spoonful to pack and then distribute our meals and snack packs.  Volunteer drivers generously use their own cars, gas and time to lend a hand to those in need.  Our staff each week balance our volunteer resources to the particular needs of our clients to ensure everyone gets fed.

Bob:  I’m curious.  We in Ontario hear a lot about the homeless in Vancouver.  Are you able to reach them too?  I mean, they don’t have microwaves, right?

Lisa: We partner with ASO's who specialize in homeless and marginalized HIV positive clientele so that we are reaching as many people as possible. For example through the MAT Program (Maximally Assisted Therapy) run by the Pender Clinic  in Vancouver's Downtown Eastside we deliver dozens of frozen meals each week that they in turn heat and distribute on an as needed basis. Our meals act as incentive to encourage their clients to come in and access their medications and other services.

It's great you asked about microwaves because we often find ourselves looking for some to redistribute to our clients on service.  Just last month we used Twitter and Facebook to find several  microwaves a new home.

Bob:  What about nutrition, Lisa.  That’s clearly important for people living with HIV and yet the meals have to be prepared on a budget. Tell me how you balance all that.

Lisa: Nutrition and nutrition counselling  are such an important part of our service. We have a registered Dietician on staff who works very closely with our clients. Someone with HIV has a decreased immune system and requires much more nutrition than a healthy individual. People that are coming to us sometimes are facing serious food security issues, or require very specialized meal service. Our supplier Apetito does a great job in providing affordable, high quality and nutritious meals.

Bob:  So a typical meal might be what?

Lisa: There is everything from  Omelettes to Asian Glazed  Salmon and Spaghetti and Meatballs.  Also, we have a variety of meals to accommodate special dietary needs such as gluten free, low potassium and low sodium. We also have meals that are easy chew, minced or pureed.  Our Dietician and Client Service Director work closely with our clients to develop a suitable meal plan. Inside our snack packs you will find: milk, chocolate milk, fruits, bread, yogurt and other nutritious items.

Bob: What kinds of feedback do you get on the services you provide? I’m thinking of whether clients like the meals but more broadly too, are you able to learn how you are making a difference to individual lives.

Lisa: We continually receive feed back and do ongoing assessments of our services. Our clients absolutely love the meals and can't say enough about the large selection and variety. We know that for many, A Loving Spoonful has changed their lives. Because our food is delivered by the same volunteers each and every week a relationship forms and can break the cycle of isolation. We know that  our clients are gaining weight, improving their health and will on occasion offer to stop service because they no longer need it.

Bob: I’m not sure if this is on your agenda or not, but do you encourage self sufficiency in any way, so that your clients can – say  - learn to cook for themselves, if they have the resources, or perhaps learn  nutrition?

Lisa: We encourage self sufficiency for all of our clients and provide many resources while they are on service and once they have completed service. Most recently we launched our first ever nutritional newsletter. For our Family Pantry Program we provide a food hamper with pantry basics as well as fruits and vegetables. Our Dietician will feature one item in the newsletter and provide recipes and information in a fun and educational way that coincides with the food hamper that week.

Bob: It looks like you work closely with local ASOs. I’m assuming they are the ones that provide the bulk of your referrals, right?

Lisa: We work very closely with other local ASO's. Our referrals come from not only HIV doctors but street nurses, dieticians and social workers in the community. There is also an opportunity for self referral where individuals can simply call our office to gather more information.

Bob: You rely principally on donations for funding rather than government support.  That’s great that the private sector is so generous but don’t you think you deserve more from the government?  I’m thinking for instance that ASOs receive much more government support, no?

Lisa: We do receive some government funding but realize that we need to also get out there and fundraise to support our various programs. We have a tremendous amount of community support and encouragement, just take a look at our Facebook page! Even though we serve about 100,000 meals a year we are still a grass roots charity at heart. We receive funding from Foundations such as the MAC AIDS Fund as well as the Shooting Stars Foundation and Fillmore Family Foundation. Much of our funds are raised through our signature events and new initiatives such as CandyGrams. We strive to be a self sustaining organization.

Bob: Tell me about yourself.  What’s your background?

Lisa: I have been involved in the non profit sector for over 18 years. I really had to think about that one, it's been a long time. Prior to A Loving Spoonful I was the Associate Director of the Greater Vancouver Food Bank Society where I learned a lot about food security, community kitchens and saw first hand how many people and families in various parts of Metro Vancouver needed help. I came to A Loving Spoonful in 2008 and could not wait to be a part of this incredible and passionate organization. Hmmm...what else? I have two rescued cats named Shadow and Tango and a husband named Paul. They are all quite adorable!

Bob: The work must be incredibly rewarding.  Do you get to meet many of your clients yourself?  Would you like to do more of that?

Lisa: This work is incredibly rewarding and there is always so much more to be done. We aim for excellence and really do provide that on a daily basis. One of the things I am most proud of is the client care we provide. When a client comes into our office on occasion for a review or meeting, everyone makes a point to say "hello" and make the person feel welcomed. They are not just a client, they are "Steve" or "Mike" or "Nancy". I of course get to meet many of our clients and I am always so happy that they are so comfortable trusting us with their stories and feelings. It helps us better understand their situation and what they might be going through. I'll never forget one of our past clients David who told me about how A Loving Spoonful saved his life. He had nowhere to turn and no family or friends that could help him out. He also ended up suffering from a stroke which brought his spirits down even more. He told me about how he looked forward to seeing the volunteer every week who was delivering his food. He knew that he was not alone. He also reminded me about how delicious the meals were. David still keeps in touch and stops by once in a while. I know he feels lucky to have received our service but I am the lucky one to have learned from him.

Bob: Anything on the horizon for A Loving Spoonful?

Lisa: In the next year or so we have to find a new home.  It would be amazing if we can have a kitchen facility and offer a community kitchen program or simply be able to make some of our own meals like soups or chillies.

Bob: Tell me -  if you could wave a magic wand what would you want for A Loving Spoonful?

Lisa: This is an easy one...I wish there was a cure for HIV/AIDS and then there would be no A Loving Spoonful.

Bob: Thanks Lisa.  That’s a good note to end on. You do amazing work here  and we are so happy that we are able to talk about it with you.  And good luck with CandyGrams!

Lisa: Thank you so much.

A Loving Spoonful website: http://www.alovingspoonful.org/

Candygram website http://www.alovingspoonful.org/candygram/

A Loving Spoonful

100 - 1300 Richards Street, Vancouver BC V6B 3G6

604 682 6325 (phone) 604 682 6327 (fax)

I love that I am involved and connected into a radical group of people who believe in spiritual pursuits through physical movement and interconnection for greater peace, love, joy and freedom to all people – even our enemies.

Having said all that, I would also like to say we’re like a bag full of organic granola – filled with fruits, flakes and nuts!

Here is a copy of my top three current favourite yoga YouTube videos that I hope go viral cause they show the ridiculousness of me and my peers completely.

Number Three – Yoga Police

This is a clip taken from the television show Gravity which is about a group of people who are all suicide survivors.  This is the main scene from the second episode.  Saying too much will give it away.  Enjoy!

Number Two - Yoga Girl (shown below)

It’s a hilarious music video about a straight guy trying to hit on a yogini.  I have to say after seeing this and showing a good friend of mine, I told him never act like him.  For the record, I have seen men like this in class.  Too funny.

Number One - Shit Yogis Say (also shown below)

It’s another remake of that very popular title that is going around right now.  I have to admit that I have said several of these things, and not just once.  It’s a part of my daily life language.  Just the other day I was telling a friend and fellow teacher I was going to me late for lunch because the moon day caught me up and made me late.  I have a thirst for coconut water and my hips ARE so open right now.  But the most important line from all of this is:  You WANT to see where I can put my leg.