I just spent three days in Toronto, my old stomping grounds,  at the Gay Mens Sexual Health Summit. It was a well attended affair, perhaps 150 or even more - I’m not good at numbers - of the brightest lights on the prevention scene in this province.  And me.

The HIVstigma.com team was front and centre for a large chunk of the program. James spoke, Steve spoke, Jason spoke and five of our eight bloggers - Gaston, Murray, myself, David and Nik - each gave short presentations on what messages we’ve taken away from the blogs. I mostly talked about the links I’d seen here between stigma and what guys have told us about how it impacts the kind of sex they have, who they have it with and how they discuss it.  Murray’s presentation was funny in parts - he read out some of the abuse his blogs received in the early days, which now seem to cause me much less offence than they did at the time.   We’ve all grown from this.  All in all, the gathered prevention types liked us, they really liked us, I’m convinced.

I also got a chance to chat with another presenter, Nico from Ottawa, who I’d never met but who has been good to us here in numerous ways, not least of which was linking us to his own blog http://ickaprick.blogspot.com/ . Nice guy he is, with lots of good ideas on blogging about HIV-related issues. It made me think lots about how we can best use the medium in future initiatives.

Also launched were two amazingly good guides for positive gay men, produced by - who else - GMSH. Both pocket-sized, one is a legal guide to help poz guys understand HIV and the laws on disclosure, etc. The second is a poz guide to sexual health. Want to know what significant risk means? How about viral load and how it impacts the risk of transmission?  How about re-infection? Are STI’s bad news for poz guys?   It’s all here, probably for the frist time in one place.  Count me impresssed.

One thing l like about these little guides, available from your local AIDS Service Organization any day now, is that they are VERY sex positive, perhaps in ways we haven’t seen before. I like the way they also contextualize risk. It’s always stuck me as ironic that we poz guys are portrayed as mountain climbers by big pharma, as if mountain climbing is the activity we should all aspire to.  But surely mountain climbing is a high risk activity if ever there was one.  It raises the question for me why are some high risk activities seen as good (mountain climbing) and others (anything associated with sex) usually seen as bad, and to be avoided?  Clearly it’s not about the consequences, but something else.

The answer I think would take more space than I have here to unpeel.  But think about it.  And have a cigarette while you’re doing that.  Maybe a donut even.  Or live a risk-free life.  Your choice.

Anyway, what does all this sex positive talk have to do with combating HIV stigma? I’d argue “quite a bit”. I’ve always thought our societal hang-ups towards sex have loaded the shame factor on to HIV, which in turn leads to the stigmatization of poz guys. So adopting an entirely sex-positive approach to prevention issues and by extension, to the lives of people living with the disease, can only help, I think.

To give you an idea of the realistic approach to sexual health you’ll find in these guides, here’s an excerpt from the training material that I really, really liked. The concept discussed isn’t new of course, but I can’t help feeling we’ve been reluctant to express it. Until now. Again, it’s about putting risk in perspective.

“Sexual health choices should be understood in the context of other risks we face in our lives. We negotiate risk in our lives every day and make decisions, both consciously and unconsciously, about the levels of risk we are willing to accept. Every time we ride a bicycle, walk on a city sidewalk, eat foods capable of harbouring bacteria, drive a car or take an air plane, we are taking a risk with our health. We hear a great deal about the health risks of smoking cigarettes, drinking alcohol and eating fast food - risks that may eventually shorten our lives. Yet a great many of us continue to smoke, drink and eat fast food*.

One more thing. I’ll likely be posting only one more entry after this. ***sigh*** But it’s almost time to go into evaluation mode. Feel free, though, to comment to the very end. Parting shots are welcome. Say what you think about this site - good and bad. Either way, we’d still love to hear from you.

*Source:poz prevention; knowledge and practice guidance for providing sexual health services to gay men living with HIV in Ontario c 2008 People with AIDS Foundation.

Here’s something for your amusement. It’s a British take on the coming-out process. There are five clips combined; the fourth one in particular is priceless.

http://www.youtube.com/watch?v=7fEdyBdx_Ls

I should own up to the fact that this video is here mostly for its entertainment value - it strikes me as very, very funny. It has only a rather remote connection to HIV stigma, although it’s there if you look for it. (It’s about turning homophobia upside-down - and homophobia is often a contributing factor to HIV stigma, right?) Anyway, what’s more to the point is that it’s an attention-grabber, something that in the world of blogging is deemed a very, very good thing. It lures people in, one of the challenges that HIV-related blogs invariably face. Which is why we’ve been discussing here  - see my last post - techniques that make blogs that address ***shudder*** HIV issues  more attractive to gay men in general and neg guys in particular.

Here’s one tried and true way to catch the eye of the average gay guy. Liberal use of pics like this . . .

Yet another way to attract readership is the judicious use of tags and keywords - we’re talking filthy, raunchy pig sex talk here. Just ask Nico.

Turning to more - ermmm - serious matters, and on the eve of the Gay Men’s Sexual Health Summit in Toronto, I wanted to say a few thank you’s. In particular, I want to acknowledge some of our fine allies who’ve included promoting this campaign in their outreach work. I hope to hell I’m not missing any, but here’s a list of those who I know have gone the extra mile.

AIDS Committee of Cambridge, Kitchener & Waterloo (ACCKWA)

Africans in Partnership Against AIDS

AIDS Committee of Durham

AIDS Committee of London

AIDS Committee of North Bay & Area

AIDS Committee of Ottawa

AIDS Committee of Simcoe County

AIDS Committee of Toronto (ACT)

AIDS Committee of York Region

AIDS Niagara

AIDS Thunder Bay

Access AIDS Network

Africans in Partnership Against AIDS

Asian Community AIDS Services

Black Coalition for AIDS Prevention

Centre Francophone de Toronto

HIV/AIDS Regional Services (Kingston)

Ottawa Public Health Department

Peel HIV/AIDS Network

Peterborough AIDS Resource Network (PARN)

Prisoners HIV/AIDS Support Action Network (PASAN)

Honestly, this has been a great group effort. Thanks guys and gals.

And for those attending the summit, I’ll be there on a panel talking about this very campaign. Say a polite hello - or talk filthy raunchy pig sex talk. Your choice.

Nicholas Little, an HIV prevention worker from Ottawa, has been a great supporter of this site. And today, not because I’m lazy, but because he says it so well, I’m going to quote, with his permission, a big chunk of a recent post on his own blog.

Nicholas says we need to do an about face; to turn our attention to those guys who assume they are negative but are in fact positive - and highly infectious at that - rather than continually focussing on poz guys as the problem, and by doing so, stigmatizing them.

Interesting.  Even our own community has being doing a lot of work focussing on poz guys lately. I don’t think his line of thought negates the poz prevention work that is being done in this province, and which I strongly believe in.  But it does suggest a new and highly productive avenue for poz prevention to explore further, by expanding its target audience perhaps. Anyway, here’s what Nicholas says . . .

A recent UK study shows that over 50% of recently HIV+ gay men leave UK sexual health clinics undiagnosed. FIFTY PERCENT. And of those men who also have another sexually transmitted infection (making them more infectious to others), 80% left the clinics without being tested for HIV. EIGHTY PERCENT.

This blows my mind. We waste outrageous amounts of energy pushing men who know they are HIV+ to the margins of society — straight into prison cells, in fact — while we ignore the real crisis right in front of us. Study after study confirms: too many gay men are not getting tested for HIV - especially those engaging in high risk sex who need to be tested most.

We know who our true target audience is: gay men under the false assumption that they are HIV-, who have recently sero-converted (making them more infectious because their viral load is higher) and who may also have another sexually transmitted infection (make them yet more infectious). This is who HIV prevention campaigns should be focusing on. This is who is most likely to pass on the virus.

Not men who know they are HIV+. Not HIV+ men who self-disclose about their status (the majority). Not HIV+ men who, with their partners, employ harm reduction measures to keep everyone safer (the majority). Not HIV+ men who maintain good general health (by eating well, building strong social support networks with friends, combating HIV stigma, nurturing self-esteem and getting regularly tested for other STIs, among other things).

The UK Study should be sounding alarm bells. The longer we play into the paranoia about people who know they are HIV+ wilfully infecting others, the longer this epidemic will go on. We are wilfully deceiving ourselves and paying a very high cost because of it.

Just this past weekend an Ottawa gay guy told me, I always take my own condom because I am afraid the positive guy might have poked holes in his condoms in advance. I asked him, Do you even know any positive guys? He shook his head no. You do actually. About 11% of your random hook ups are positive. About 11% of guys at the Ottawa gay bars are positive. And seriously, dude, do you honestly think these guys are sitting around in some kind of vengeful stitch n bitch poking holes in big batches of condoms? These guys have way better things to do with their time. Like grocery shopping. Like doing their laundry. Like laying on the couch missing the days when Bob Barker was the host of The Price Is Right. Because they’re fucking human beings, not vindictive aliens. They’re regular, boring, everyday gay guys like you and me. And for all you know, I AM one of those 11% of gay guys. So I’m going to put this condom on that I lovingly perforated for you at home and we’re going to fuck already.

He laughed. And we did.

You can read the full text of Nicholas’s blog post, including recommendations for the way to go forward. It’s good.  It’s here: 

 http://ickaprick.blogspot.com/2009/01/50-of-hiv-gay-men-leave-clinics.html#comments

 Thoughts, anybody?

Having dabbled with the condition myself, I was curious about the links between depression and stigma.  So I poked around on the net looking for research on it. There is in fact quite a bit there. But as someone who didn’t even know that the word “construct” was also a noun until my forays in to research, it’s hard going for this wannabe social scientist.  With apologies to the Barry Adams of this world, I’m not good at gobbledegook

Anyway, my brush with clinical depression a few years back is far from unique. Apparently 55% of us people living with HIV have had - or are having - depression. Reminds me of my first time in a psychiatrist’s waiting room. It’s a weird place to be for first-timers, not a bit like that one in the Bob Newhart show.  And so this newbie to the wonderful world of mental health issues had a bad case of not feeling like I belonged there. Frankly I thought everyone else in the waiting room was a nut job - except for me, the normal one, sent here by mistake by my regular doctor. Proving, of course, that the popular perception of people with mental health issues is not kind. They have their own brand of stigma to deal with, in fact.

As it happens I had a good psych doctor, and so a combination of pills and cognitive behavioural therapy set me as straight as this gay boy could ever be. Well, actually, I did have a relapse, but now I’m “clean”. I think.

Anyway, here’s what I think the research on all this says. People living with HIV who reported feeling highly stigmatized also experienced significantly more symptoms of depression.  One reports says that the debilitating impact of HIV-stigma needs to be more fully acknowledged. i.e. that it’s bad for your health. (Seems to me there may be a bit of cause vs. effect argument to be made here, though. In other words, is the depression the result of heightened stigma, or is the heightened stigma the result of the one-two punch of HIV AND mental illness?)

There is also some research out there on the impact of depression on risk taking. As a poz guy, though, my experience is that depression - and the pills that go with it - can have a disastrous effect on one’s libido, not to mention erections. So that disclosure and/or risk taking can be a complete non-issue when you’re battling the Big D. On the other hand, one hears that there are in fact some links between depression and risky behaviour. I don’t know.

As I’m sure you can tell, this isn’t really my area of expertise. (Exactly what is, I’m still trying to discover.) But I’m mighty interested in hearing from anyone who knows anything about this, or has had experience with depression, either poz or neg, and is perhaps even comfortable commenting on how it has impacted their sexual health.

Over on gay.com, there’s a nice little write-up about our campaign. That feature, though, has produced a storm of debate amongst gay.com readers; you can follow it here: http://lifestyle.gay.com/2008/12/world-aids-day.html   Be warned though, there is some real vitriol here, amongst the pleasantries and pats on the back.

One thing that the gay.com discussion reinforces is that while most guys seem to get the point of the HIVStigma.com campaign, our message is sometimes interpreted in unintended ways. One gay.com reader, for instance, says he’s looked at our web site and it’s “largely about HIV+ guys complaining that potential sex partners reject their sexual advances.” Another says “Yes, the campaign here in Toronto seems to focus on HIV+ men complaining that HIV- men won’t have sex with them”

Yikes! I hope not! There’s precious little evidence - not from the facilitators here or from those poz guys who’ve dropped by and left comments - that anybody is saying anything like this at all. Those so-called complaints just haven’t come up!  And if they’re talking about our slogan “If you were rejected every time you disclosed would you?” I’d strongly dispute that’s at all what it’s about.

There have been also a few suggestions that our slogan implies we’re condoning the practice of not disclosing, condoning unsafe sex. I suppose people read what they want to read.  And I suppose I should be ignoring these negative spins rather that commenting on them, but I am what I am.

I don’t want to ignore the fact that A LOT of the response to this campaign has been really, really good. That’s what I’m hearing. But the possibility sometimes crosses my mind that our campaign message is too obtuse for some, too subtle, too open to interpretation. So perhaps we need to restate from time to time that we’re talking about stigma here. It’s about stigma’s impact on HIV prevention, and it features and tries to engage both poz and neg guys in that discussion. It’s about the role that stigma has in transmitting the virus - including making it difficult for poz guys to disclose, including deterring others from getting tested, including preventing talking to each other about HIV.

The simpler version is that talking about stigma helps reduce it.

But going back to the gay.com discussion about our site, clearly that discussions highlights divisions within our community, which transcend poz/neg lines. It’s pretty clear from the gay.com discussion there is a fair bit of poz-phobia out there too, which also transcends poz/neg lines, And the disclosure issue in particular seems to be really, really divisive.  (Which suggests to me we should be talking about it more, not less.) But is this just activists arguing heatedly, as activist often do, and that banter isn’t really representative of how Joe the plumber gay guy feels about things? Joe the plumber gay guy may not care much about HIV at all, in fact. I don’t know.

Anyway, read the gay.com discussion and see what you think. And come back here and talk about it.

We’ve talked here a lot about the law lately, and how it sucks. So much so that I’m tired of talking about it - for now. So let’s talk about non-verbal communication instead.

Sounds like for everyone who’s fessing up with “yes, I’m poz“, or ” I’m really, really negative” (even though they don’t know that for sure) there’s a bunch of us who, because of stigma, drop hints about status instead. Certainly on the internet (”safe sex only“), but also in the real world.

All of which is not good news for me. I don’t get hints very well. Which is likely why I stay waaaay too long at parties. Or consistently don’t get my partner the christmas present that he really, really wanted.

Sounds like I’m not alone, though.  When it comes to sex, not all of us are getting the hints or interpreting them the same way. A new study out of the University of Windsor and ACT suggests codes are being used by guys who think others understand them, particularly in a barebacking context, but that those codes aren’t necessarily being understood by their partners. Crossed wires, in other words. You can read highlights of the study here: http://www.aidsmap.com/en/news/E07C1E22-00BA-40D9-99EE-64C6E46D7F5A.asp

Two quotes from that research relate to men who’ve  had non-verbal communication about unprotected sex:

“Several positive men described non-verbal interactions where a failure to introduce a condom or to halt a penetration is understood as informed consent. One said : “Well you start doing it, if they don’t stop, then you keep going“.”

And “discussing saunas, several HIV-positive respondents expressed the view that: “If they start to fuck you [without a condom], you probably figure, well, unless he’s an idiot, he’s probably positive himself.” However none of the HIV-negative interviewees mentioned this.”

Now these comments are from a barebacking subculture where researchers suggest “there is a worldview in which all present were adults who fully understood the risks they were taking“. That may not be the real world all of us operate in, where the concept of protecting each other is, if not universal, at least well established. But even in the real world, it strikes me that if condoms are on the table - or not - before the fucking starts, it sort of speaks volumes. What it says, though is less clear.

I’ll be the devil’s advocate here. Given that it’s sometimes difficult for poz guys to talk about their status and even some neg guys would rather have root canals than bring the topic up, is “hinting” about your status better than nothing at all? Or is it a complete waste of time? And are guys picking up clues on serostatus from things like location - bathhouses have “a reputation” for instance - or even from the way people look?

And what’s your experience of communicating in code, giving out or picking up signals, on the Internet or in the dark? And does it ever work?

So I’m off to Toronto this evening for the big public meeting about criminalization that Tim mentioned in his latest blog entry. I could instead have gone to Peterborough where, by chance, there is also a public meeting on criminalization today.  Criminalization is clearly a hot topic these days,

I don’t know why I’m kind of taking this personally. The law isn’t likely to affect me directly; I’ve said before I’ve been in the habit of disclosing, because it feels better than not disclosing. But I still see this as a personal attack. An attempt, and a successful one at that, to paint folks not really very different from me as criminals requiring punishment, public humiliation and imprisonment. And I hate that.

(For those new to this, the law is a bit complex, but the simplified version is that there is a duty for poz guys to disclose their status where there is a “significant risk” of transmitting HIV. Don’t do that and you risk prosecution. You only have to read the papers to know that’s not an idle threat.)

Now it’s being suggested that we not only need to disclose, but that we need to have some record of that conversation. In writing perhaps, or as observed by a friend. So if you thought verbal disclosure was hard enough, strikes me it just got one step harder.

Harder or not, that getting-things-in-writing thing may fit poz guys going in to a relationship, but it certainly doesn’t seem a good fit with how we relate to each other in baths, back rooms and other places where sex is a pretty anonymous affair.

So if that get-it-in-writing approach to disclosure doesn’t fit, because of the venue - you are in a room at the baths, for instance - all that’s really left is to practice safer sex. Always. No slip ups. Nothing wrong with that, I suppose; it strikes me as the right thing to do. Except I suspect prevention experts - and I’m not one - would tell you that didactic approach doesn’t work very well. We’ve always talked about choices. It’s why you don’t read “Use a Condom Every Time” ads much nowadays. It’s pragmatic rather than practical. and doesn’t recognize the complexities of human behaviour. Just like the law.

Wait. How about poz-on-poz sex? Surely that’s safe, legal-wise?  Well, not so much, say the legal experts. Because of the danger of re-infection or super-infection or whatever the hell it is, the notion of “significant risk” in unprotected sex between two poz guys remains, So there is a theoretical risk of prosecution without disclosure, even in those circumstances, we’re told.

So it seems to me that gay men - or some of us - are being painted in to a corner and running out of options. In short, I’m thinking more and more that criminalization, for any number of reasons, sucks big time.   Look how it even limits what we can say on this site!

Or did I miss something here?.

In my last post, I jokingly remarked that abstinence seemed attractive. This was in response to the notion that criminal law is leading us to a place where poz guys will have to have a signed pre-hookup contract. Because, we’re told, we’ll need it in writing that we’ve discussed our sero-status before doing the nookie thing, or risk getting prosecuted.   Jeez!

But a new study of poz guys out of BC tells us that abstinence isn’t such a good thing. Researchers measured how much those BC poz guys were getting their rocks off and correlated that data against their quality of life. Turns out that 70% were having sex (although not necessarily during the interview itself ***giggle***) while the remaining 30% were - errmmm - just resting. And didn’t you know it, the 70% scored way better on all the quality of life measurements.

In plain language, it seems sex is good for poz guys’ well-being. Which is hardly a surprise because isn’t sex good for anybody’s well-being? (Sometimes I think in looking at us like laboratory animals, studies stigmatize us in ways the researchers don’t even dream of.)

But anyway, the question arises, if the numbers are to be believed, why are 30% of poz guys choosing abstinence?  It seems a rather drastic prevention strategy, and one we’ve had fun knocking the Bush administration for years for promoting.

I do know when I was first diagnosed, I though that was the end of sex for me. Happiness too. Those thoughts didn’t last long though - I can’t remember how long, because it was a long time ago, and my brain cells are - errmmm - just resting.  But apparently choosing not to have sex is a natural reaction to diagnosis, if only for a little while. But that shouldn’t account for 30%.

I’m not sure there aren’t plenty of people out there who’d rather we didn’t have sex though.  Ever! Certainly it’s clear there are plenty of neg guys who don’t want to have sex with us at all, safe sex or not; its just too yucky.  And if they don’t want to have even SAFE sex with us, I think we need to know what’s going on here. Would negs be happier if we poz guys just had sex with each other, so that negs stay “clean”. Or would they prefer we not have sex at all. I need to know.

Any 30%ers want to step in and help us understand all this abstinence stuff?

70%ers can step in too. I think this site is sex positive, but just how are we doing as a community to promote a sex-positive environment for all of us in the age of HIV?

And why is it that straights don’t seem to have this problem, judging by this ad :  watch?v=ro-mXyA0MCI 

Is rejection really what makes it difficult to tell guys we are positive. The campaign slogan aimed at negative guys certainly suggests that: “If you were rejected every time you disclosed. would you?” it says.

But we’ve heard from guys here that there are plenty of other reasons why disclosure is a big hurdle, and from guys who question whether it’s even necessary.   Some guys may be comfortable enough with a sex partner knowing their status, but they don’t want THE WORLD to know. People gossip. And then there are others who prefer not to disclose because they are taking care of their partners’ safety, as well as their legal obligations, by reducing or eliminating risk.

Some guys have pointed out that, for them, rejection is no big deal anyway.   Is there anybody out there who isn’t rejected - regularly, they say?   For being too old, too young, too fat, too thin, not buff enough, too hairy, too smooth, too “ethnic” - the list is endless. So what’s the big deal about rejection?

I’m thinking though that rejection is a big issue for some - I believe research tells us that.  So I was interested in some pointers I came across recently discussing how to handle it. This is what I read in the draft of a handbook addressing poz guys’ sexual heath issues :

“Sometimes guys say “no” to us when they find out we have HIV That’s far from certain but it happens. So you may need to get some skills to handle the “no” while staying positive and proud. It may help you to think about these things:

• Your worth as a person didn’t change when you got HIV.
• It’s not really about you. His “no” is about him - what he thinks and feels about HIV
• You did what you felt you had to do. You told him you were HIV positive. It was probably not an easy thing to do. You respected yourself and you respected him. No one can take that away from you.

Helpful? I think so.

Anyway, I’d be interested in your thoughts on rejection. It is a big issue?. Does it bug you? How do you handle it?   Talk to me.