US travel ban to be lifted - ••ut not yet '2 <: 2 ;j :) ~ ...J L1 < :a

> no.158 August - September 2008

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2 Editorial 3 US ban to be lifted 4 Happy Birthday HIV 6 When less is more 7 Too far gone? 8 Behind the land of smiles: Thailand 12 A warm welcome: Kate from Poz Het 14 Prevention beyond condoms: Cover Artwork: Microbicides James Gilmour www.jamespgilmour.com

16 Coming from the space of true love Contributors: James Gilmour, Lance Feeney, Neal Drinnan, 18 Need to talk to someone? Greg Page, Rob Sutherland, Kate Reakes, Kathy Triffit, Kerry Saloner, Trevor Morris, Garry Wotherspoon, Leslie, Kane Matthews, Counselling at ACON John Douglas, Ingrid Cullen, Tim Alderman 20 Dry mouth and HIV 22 It's all in the mind? Mental health 24 Olga's Personals 26 Keeping on being positive: friendships through 729 27 Fear is high, trust is low: Positive sex workers 28 Buenos Aires 30 Working out at home: Health and fitness 32 Comfort food: So can you cook?

Talkabout 1 PositiveL t .. NSW the voiceof people with HIV since 1 ~ In this issue

CURRENT BOARD

President Jason Appleby

Vice President Richard Kennedy

Treasurer Bernard Kealey

Secretary Russell Westacott

Directors Rob Lake, Malcolm Leech, Scott Berry, David Riddell, Alan Creighton

Staff Representative Hedimo Santana Our cover highlights the welcome news Changes to the time out room Chief Executive Officer (Ex Officio) about changes in the US government's Positive Life NSW has been running the Rob take attitude to HIV positive visitors. We're not CURRENT STAFF time out room at the Mardi Gras (and quite there yet but, as the article on page Chief Executive Officer Rob take usually the Sleaze) Parties for about a three shows, the US is getting closer to a Manager Organisation and Team decade and a half now. In earlier times, the Development Harry Richardson non-discriminatory policy. In addition this Time Out Room was so popular it could be Health Promotion - Social Marketing issue covers a wide range of other topics: difficult to get into it. Use of the space has and Education Kathy Triffitt mental health, bingeing, microbicides, Health Promotion - Publications & changed over the years, and its use ebbed Peer Education Glenn Flanagan relationships, counselling, dental health, and flowed, particularly as any health need Systemic Advocacy Lance Feeney the UN, developments at Positive lessened considerably for the vast majority Health Promotion - Peer Support Heterosexuals and a beautiful photo essay Hedimo Santana on Argentina from John Douglas. of party-goers with HIV. In recent years, the Website Phillip McGrath We're also very pleased to welcome Lance numbers attending have been particularly TALKABOUT Feeney to the team as a Senior Project Officer low. For some too, the "HIV Chill out" Editor Glenn Flanagan in Systemic Advocacy. On page 18 Lance label has been a barrier. It's always been a Design Slade Smith outlines the major advocacy work coming up dilemma; how discreet should the space be CONTACTS at Positive Life. And finally from the issue: if as opposed to how well sign posted? In the Office Suite 5, Level 1, 94 Oxford Street, Darlinghurst you're interested in any aspect of HIV and light of the changes in need and numbers

PO Box 831, Darlinghurst 1300 employment consider coming along to our of people now accessing the space, Positive forum Making It Work on September 10th. Phone (02) 9361 6011 Life is reconsidering the need for a separate Fax (02) 9360 3504 More details about this are on page nine. Freecall 1800 245 677 Time Out space for people with HIV. We [email protected] www .positivelife.org.au Thank you Scott and welcome to will not be operating the space at Sleaze TALKABOUT Jason Ball this year, and have been talking with is published by Positive Life NSW. All views We would like to thank Scott Berry for ACON and Mardi Gras about the need for, expressed are the opinions of the authors and not necessarily those of Positive Life his leadership as President of Positive Life and potential users of, a more general Time NSW, its management or members. Copyright for all material in Ta/kabout resides with the NSW since 2006. During Scott's tenure Out or Chill Out space. We would like to contributor. Talkabout is made possible by subscriptions, advertising revenue, donations we prepared and launched our second hear your views on this. and a grant under the State/Commonwealth strategic plan and changed the name of AIDS Program. Talkabout thanks the many We think there are also separate issues volunteers without whom its publication would the organisation to reflect changes in the not be possible. about the affordability of tickets, which epidemic. With Scott stepping back, the Printed by Crackerjack Communications includes the concession rate for Mardi on 50% recycled paper Board has elected Jason Appleby as our Gras tickets. Of course, we will continue to ISSN 1034 0866 new President. Jason currently works as work with ACON, BGF and The Luncheon DISCLAIMER a Policy Analyst for AFAO (Australian Club to ensure the Mardi Gras ticket ballot Images of people included in Talkabout do not Federation of AIDS Organisations) and indicate hiv status either positive or negative. has had several years' experience both as is maintained, and to promote volunteering If a person discloses their hiv status in Talkabout, opportunities with ACON, MCC and either in a submitted article or in an interview a Positive Speaker as well as on our Board. for publication, that personal information is in Mardi Gras to help people on low incomes the public arena on publication. Future use of We also welcome Richard Kennedy as he information about such a person's status by steps into the Vice President's role. Richard to get tickets and attend. Please write to readers of Talkabout cannot be controlled by Positive Life NSW. has worked for several years at the Bobby Talkabout so we can air your views. Goldsmith Foundation. Glenn Flanagan

2 August - September 2008 US ban on HIV positive travellers to be lifted - but not yet! • Lance Feeney

On Wednesday July 30, US It is currently unclear whether Health President George Bush signed and Human Services will address the ban For more information on HIV into law a multibillion dollar AIDS in the near future. Reversing the federal and travel: relief bill that also ends the twenty Department of Health and Human year ban on entry of foreign Services (HHS) regulation, experts warn, The EuropeanAIDS treatment Group visitors and immigrants with HIV. may take months and may not happen website includes details of HIV The $48 billion AIDS relief bill, also before the new President and the next specific residency and immigration known as the President's Emergency administration is in the White House. rules around the world: Plan for AIDS Relief (PEPFAR), was US advocacy groups are pressing the www.eatg.org/hivtravel passed by a vote of 303 to 115 in the US current administration to immediately AIDSMap website from the UK House of Representatives on July 24th. start the process to lift the travel ban also provides basic detail on entry It includes an amendment inserted by on people with HIV. After the HHS restrictions around the world: the US Senate on July 16th to remove regulation has been lifted, people with www.aidsmap.com a statutory ban on the entry of foreign HIV visiting the US will no longer visitors and immigrants with HIV. be required to make false statements The website of the Australian The US is one of only 12 other about their HIV status on entry Government's travel advisory countries including: Saudi Arabia, documentation, adopt complicated and consular assistance contains Libya, Armenia, Sudan, Russia, Brunei, concealment measures to hide their information on living and working Columbia, Fiji, Iraq, Moldavia, South anti-HIV medications from customs overseas: Korea and China (not including Hong and immigration officials, and suffer www.smartraveller.gov.au/tips/ Kong and Macao) that ban travel and associated anxiety caused by potential working immigration to people with HIV. detection, subsequent deportation and a Up, Up and Away China recently announced that it plans life-time ban from reentry. booklet, produced in to repeal its ban on people with HIV Currently an HIV waiver (Waiver 2007, includes further next year. 1-601) can sometimes be obtained for detail about travelling The HIV travel ban was adopted by the travel to the US for business, conference, with HIV medications US in 1993 during a time of widespread family reunion, or pre-approved and other useful fear and ignorance about HIV. Activists medical grounds. You need to show that information for the from around the globe have advocated you don't have HIV symptoms, don't traveller with HIV. for the ban to be lifted. A repeal of the pose a threat to public health and can For a copy phone 9361 6011. ban does not yet clear the way for travel pay for medical care, if necessary. The At Home - Away, the pocket sized to the US by people with HIV. application process is bureaucratic and resource produced in 2004, covers The Department of Health and time consuming and can be declined by a wide range of travel tips from Human Services placed HIV on its list of immigration. Your HIV status will also meeting men, finding romance and diseases in 1987 including leprosy and be recorded on the US immigration negotiating sex, through travelling tuberculosis, barring entry to the US. database, the HIV waiver will appear in with medications. www.afao.org.au That prohibition is separate from the your passport (unless you ask for it to be travel ban imposed by the US Congress stamped on a detachable piece of paper) that has just been lifted. This means that and a new waiver will then be required Sources: Poz.com; Houston Chronicle; federal health officials are no longer for each subsequent visit. Few people Associated Press; CBS News, Los Angles bound by law to keep HIV on the list. with HIV have applied for waivers. Times.

Talkabout 3 HAPPY BIRTHDAY HIV

Neal Drinnan

TWO YEARS: second shock was how ill I became and the first place, but in my case I would how long the illness lasted. I became sick refute that. I'd had plenty of unprotected LAUGHTER & exactly two weeks after 'conception' and sex with positive people long before my TEARS took over three months to get better. depression came into the equation. No, Even then I was functioning at about depression is an hereditary trait that Don't they grow up so fast! My HIV is 60% of the health I had been used to runs through families like a genetic two years old and I think I've got the little previously. By the time it got to June strand bypassing some and manifesting bugger toilet trained, under control and 2007 my doctor who is a veteran of this in others. It has by far proven the most undetectable. Not seen and not heard? epidemic and to whom I had been going formidable adversary in my life and . . . Someone said that homosexuality, for twelve years said I really should give makes HIV feel like a treat! 'the love that dare not speak its name medication a go. I had been holding out, has become the love that just won't hoping for a five or ten year honeymoon shut up!' It seems now (in this neck period like so many others I knew of the woods at least) that its bastard seemed to have had ... For me it seemed a child HIV gives me ever more cause for case of the later you convert, the harder Within three speculative chatter. These days I'm more you fell. days I felt like a concerned about early onset dementia Interestingly the initial illnesses which from depression than I am about late included pneumonia, shingles and new person (or onset HIV, but let me tell you a thing or prolonged fevers had less impact on the old person I two I've found out about both. me than a condition I'd already been When I sero-converted two years ago I battling with for ten years: depression. used to be) was shaken twice. Once by the fact that The depression I felt was in no way I had finally contracted it at 42 after linked to the HIV and didn't seem to having completely convinced myself worsen because of it. I had been on and that I could not, and would not, contract off antidepressants for years. There are, After biting the bullet and starting on it. In hindsight this idea was clearly a of course, those experts who would say Kivexa and Efavirenz in June last year, I delusion on my part and trust me, the depression and its symptomatic lack of was blown away. Within three days I felt reason I hadn't contracted it was more self esteem contributed to the situation like a new person (or the old person I good luck than good management. The that allowed me to contract the HIV in used to be). The first night I was tripping

4 August - September 2008 off my tits and should not have driven a unpleasant or impossible but they do after twelve months, I am a convert. Just car the next day! The second night, the tend to affect erectile function a little recently I ran out for nearly two weeks most extraordinary thing happened ... and blur sensations to some extent. It's and the effect was tangible within days. In my dream (and let me tell you the druggie sex but it doesn't follow the I think about HIV and being on dreams that come with Efavirenz are recreational model some of us have medication for the rest of my life (if both compelling and enlightening) I was grown to favour. that is indeed going to be the case) then treated to what I could only describe as Secondly I find I can't drink as much remember all sorts of people are on 'a nocturnal product initiation promo' alcohol as I used to (I think the drugs all sorts of medication at my age. My in which I found myself wandering into might be trying to tell me something). father was on 15-20 tablets a day since a vast tunnel constructed entirely out of I get drunk faster and often experience he was 25 and died at 46 (not from HIV Kivexa boxes and blister packs. If you heart palpitations throughout the as far as I know). I think about all the can imagine Alice in Wonderland being night and the following morning. This healthy food I buy and cook, the vitamin led down the rabbit hole combined concerned me enough at one point that supplements I've found, the availability with the Monty Python scene from The I was given an ECG and fitted with a ofexercise and the access I have in Sydney Meaning of Life where the characters all heart monitor for an entire twenty four to services and health professionals and die at a dinner party from eating salmon hours. There was nothing wrong with then I remember people talking ten years mousse, then drive their Volvos to my heart. ago about how in fifteen years treating Heaven (which turns out to be a Holiday Thirdly, I do get more tired. I walk two HIV will be no more of an ordeal than Inn with topless waitresses ... ) then kilometres each way to and from work Diabetes. Well I think I'll take my HIV you can appreciate this dream. I awoke and spend ten hours, four days a week, at over a number of chronic conditions quite convinced that GlaxoSmithKline, my office with an hour at the gym in the thanks. With depression I'm learning the manufacturers of Kivexa® had middle. This often leaves me very wilted that life is far too important to be taken integrated this orientation program into and falling asleep at any movie or theatre seriously, and whatever happens, I their pretty orange pills ...And who is show that isn't utterly enthralling. already look set to outlive my father. For to say they haven't? In truth Efavirenz In thirteen months I have missed me HIV is now, as it was two years ago ... is the real dreamweaver and through it three doses of my medication and on the very least of my worries. I had entered The Matrix. Keanu had one occasion (I blame dementia for this) nothing on me. I accidentally double-dosed. I woke up Neal Drinnan has worked in publishing feeling so sick and so much pain around and journalism and is the author of my middle I thought I would die. I four novels - Glove Puppet, Pussy's seriously don't recommend doing this! Bow, Quill and Izzy and Eve, as well as And it is hard when something becomes The Rough Guide to Gay and Lesbian Efavirenz is the so habitual as these pills do, to remember Australia and numerous short stories. realdreamweaver if you've medicated or not. I suppose more organised people than myself use and through it I those pill boxes? had entered the But getting back to the dementia­ After Hours Matrix depression thing .. .I made a discovery through all of this that has been really snax chat chill positive, via a friend who suffered terrible depression last year. I have never been happy (ha ha) on SSRls for Together these two medications took depression. They help at first, but for my 'unprecedentedly high' viral load to me they send waves of nauseousness undetectable and increased my TCells through me from time to time, they from 250 to 800 in six months. My fears make me sweat like crazy which makes of side-effects were unfounded it turns them almost unbearable in Sydney's out and apart from feeling a little woozy summer, they steal all my empathy and if I get up in the middle of the night, I they affect sexual function in a number can't complain. of negative ways. When I discovered a What I have learned with the Efavirenz US vitamin company called TrueHope which I take between 9.30 and 10.30 at who specialize in a vitamin supplement night is that sex is better before they that effectively suppresses the extremes kick in too much. This usually means of depression, I was really stoked. They 1 1 1 having sex before taking the drugs or are expensive and my doctor pooh poohs 1!lii!lii~A~1• •••E shortly afterwards. They don't make sex them as being overpriced placebos but

Talkabout 5

Too far gone?

Greg Page examines a culture of bingeing and what it means if you're HIV+

Rosalind: Why then, can one desire too much of a good thing? From Shakespeare's "As You Like It", 1600

We all know excess can sometimes Australia had officially won itself the or even goes over the borderline of do you harm, although no less dubious honour of becoming "fattest becoming a habit. a mere mortal than Liberace did nation in the world". Four million So when is too much a bad thing? When once exclaim "too much of a good Australians - 26% of the adult does it become a problem? When do you thing is wonderful". OTT entertainer population - are now obese, compared realise that you've gone too far and need Libbers, who died of AIDS in 1987, to an estimated 25% of Americans, to pull yourself back from the brink? was someone who truly knew what with a further five million Australians Of course there are all kinds of value he was talking about, what with considered overweight. The report judgements involved here. What one his lavish lifestyle, extravagant from Melbourne's Baker IDI Heart and person considers appropriate, another diamond-encrusted costumes and Diabetes Institute was given the rather person may think is too much, or fascination with shiny baubles (one unattractive title of Australia's Future conversely too little. It's a bit like the old of his many nicknames was "The Fat Bomb. adage of whether you see the glass as Glitter Man"). How many other The report states this seemingly out­ half-full or half-empty- it's all down to people opened their own museum, of-control "fat bomb" is likely to cause your own perception. let alone one in Las Vegas? 123,000 premature deaths over the next Ultimately though when it comes to But hedonism, high-living, or self­ two decades. Now that's real food for overindulging, only you yourself can say indulgence can also have a less, pardon thought! Most at risk are middle-aged when enough is enough. That point may the pun, positive side - namely bingeing, men, which also just happens to be the come where what started off as a fun greed, or what once was better known as highest affected group of HIV+ people. pastime turns into a time-consuming the vice of gluttony. The question here So think first before you scoff. .. and passion, or perhaps most grimly, where really is - when is too much more than scoff. .. and scoff! your life appears to be spiraling out enough? It's something that should give However bingeing is by no means of control on its own and it's time to everyone, especially positive people who limited to simply stuffing too many Kit reassess and pull back. like to push the envelope in certain areas, Kats into your face. It's a condition that A good rule of thumb at this time is to cause to pause and reflect. can also be different things to different consider these four basic questions: Often today when we think of bingeing people, but where matters are simply Do I really need this in my life (or we think merely of overeating. Comfort taken too far. It could be shopping for stomach, as the case may be)? food has become something of a kind the sake of it (the sinisterly-named Is this good for my general health and term for how we often use food, and not "retail therapy"), collecting to the point well-being? good food at that, as a reward, a way to of obsession, going out for a big night Am I hurting anyone else, including prop ourselves up, or as a crutch to get many nights in a row, gym "junkies" myself, through my actions? through some of life's hardships. Little compulsively addicted to working out, Is the likely outcome of what I am wonder we've become a nation of fatties. drowning yourself in drink and/or a about to do going to be harmful? In June of this year it was reported wallet-draining amount of drugs, as Asking yourself these four simple Opposite page: When less is more. well as perhaps most pertinent of all to questions may make you re-examine www.jamespgilmour.com many HIVers, a sex fixation that borders, your motives and make you see things

Talkabout 7 more clearly. Do you really need to have a second cream bun or donut, for example? Or why are you constantly going to sex venues on weekends for drug-fuelled anonymous sex "benders" Behind the when you know it will take you the whole week to recover afterwards (and land of smiles possibly longer if you unlikely contract something along the way)? Consider the basic question - why am I bingeing at all? Shouldn't the old saying that "less is more" be of consolation here? Some steps to combat bingeing are channelling that energy, or bad behaviour, into something that will do you, or others, good. If you want to treat yourself, then Rob Sutherland on HIV and men who have do so, but keep a limit on things. Know sex with men (MSM) in Thailand and progress when you've had too much, or when at the United Nations you've gone too far. Keep a track of your actions by writing down what you have overindulged in over a period of time. It I'm not quite sure what it is, centering around the importance of may horrify you when you stare down at but something keeps drawing family and social structure. Both coexist a piece (or pieces) of paper to see where me back to Thailand. This is my in an unusual dichotomy, complicated and how far your actions have led you fourth visit in as many years, and now by a more liberal and western over a period of time. the most substantial consisting of approach to sex which is being fostered Everyone needs to let off a little steam 12 months of living and working in by a younger generation of Thais every so often. That's a given. But when Bangkok. I shouldn't be surprised growing up in a society now heavily you get to the point where your binge however, why I keep finding influenced by western-style media and behaviour is impinging and impacting myself here. It is a colourful and advertising, and often flaunting the on your ability to function in a day to day vibrant city, full of history, rich in ideals of aesthetic beauty, status and culture and with food that is so situation, or appears to the only way you consumerism as Thailand transitions to good that it is sure to add a few can escape from your reality, clearly there a middle income country. kilos to even the most avid gym is a need to change things in your life. goer. It is also home to a beautiful Find yourself a group of people who and welcoming people that are understand what you are going through resilient in the face of significant and what you are experiencing. ACON challenges, maintain a very Thai society offers excellent counselling services, as refreshing sense of perspective well as various support groups, that may and humour (essential in a city lacks much help bring some life-affirming clarity. such as Bangkok) and with a of the overt Being HIV+ you owe it to yourself to smile that is never far away. be kind to yourself. You can't change In fact, many call it the land of homophobia your diagnosis, but you can live with it, smiles, and whilst some Bangkok that often flares and can live well with it. Don't let it be taxi drivers may at times test the something that weighs you down and validity of that statement, for the up in Australian takes you down a path you'll never be people generally it holds true. society able to recover from. It is also a country of many Focus on the good things in your life contradictions and extremes. Bangkok - your accomplishments, family and particularly is a city renowned for its friends, the things that give you joy and sex trade, its go-go bars, its ping pong My work here in Bangkok is on a pleasure and - good karma alert! - in shows and its 'anything goes' nightlife. placement through AusAID's Australian doing good for others. You'll find you'll It is also paradoxically a place of quiet Youth Ambassadors for Development get it back twofold. conservatism when it comes to sex, (AYAD) Program. As a staff member As Liberace also once said, quite influenced by a strong and devout of the AIDS Council of NSW (ACON), rightly, "nobody will believe in you Buddhist population and what are and with their ongoing support, I am unless you believe in yourself". often coined as 'traditional Thai values' working with the United Nations Joint

8 August - September 2008 Programme on HIV/AIDS (UNAIDS), in All of this is not to say that MSM don't and provide access to specific information the Regional Support Team for Asia and the face many significant challenges. In fact, and where there is a clearly defined gay Pacific. Australia generally, and particularly when one digs beneath the surface, they community with a number of events and community organisations like ACON, have become glaringly obvious. Much of this venues where its members can socialize and a key role in showing leadership regionally acceptance is restricted to the larger cities come together. in this area and sharing the lessons we of Thailand, with less tolerant attitudes Of course there are many issues of have learnt. My placement is very much a often leading gay men to migrate to larger ongoing concern, such as violence and reflection of this and of ACON's expanding urban centers. HIV rates among MSM are homophobia, the diffusion ( or not) of the international work in the Asia Pacific region. also alarmingly high, according to a study GLBT community, HIV rates and same sex The focus of my assignment is on HIV by the Thai Ministry of Public Health relationship recognition to name a few, but relating to men who have sex with men around 30.7% in Bangkok with high rates in it is clear that the GLBT community in NSW (MSM). Wh en it comes to MSM, whether Thailand's second largest city, Chiang Mai has come a long way. These are sophisticated gay, bisexual, transgender or straight men, ( 16.9%) and the popular tourist destination considerations, compared to many of our Thai society is in many ways relatively Phuket (20%). Coupled with this is a high regional neighbours - a region where male more liberal than Australia. Generally prevalence among young MSM, where in to male sex is still illegal in 12 countries, society is quite accepting, at the least Bangkok 22% of under 22 year olds are HIV where gay men and people living with tolerant, and in any case lacking much of positive. Male sex workers and transgender HIV have a weaker voice, where prejudice the overt homophobia that often flares up also often experience higher rates of HIV on the basis of HIV is still widespread in Australian society. as they report more sexual coercion and and where access to treatment and health There are many examples of this, one receptive anal sex. There is also generally services is lacking. And while significant being the very fact that gay men appear to a relatively low level of condom use, poor inroads are being made on most of these more openly express affection without a rates of HIV testing and access to services. fronts, progress is often frustratingly slow. fear of violence or harassment, a situation International organizations estimate that It is estimated that by 2020, 50% of all new that is not replicated even in most parts of there are 10 million MSM in Asia and less infections in the Asia and Pacific region will Sydney, arguably Australia's most liberal than 8% have access to any HIV prevention be in men who have sex with men (Report city. It is a common sight to see same sex services and interventions. on the Commission on AIDS in Asia). partners holding hands or embracing in The contrast to the situation in Sydney Recently in June I was fortunate to the streets. A high school in northeastern and NSW more generally is quite stark. be invited to be part of the Australian Thailand even recently introduced toilets Wh ere condom use, HIV and STI testing and delegation to the High Level Meeting specifically for transgender and transvestite sexual health awareness is high among gay on HIV at the United Nations General students after a survey found that many men and HIV treatment almost universally Assembly in New York. This invite as students didn't feel comfortable with the accessible and heavily subsidised, where Australia's youth representative was choice between male or female toilets. strong community based organizations extended by the Australian Government In fact the rights of sexual minorities are such as ACON, Positive Life, BGF and largely because of my work with ACON and even protected in Thailand's constitution many others exist, where a gay press can my AYAD placement with UNAIDS. The adopted last year. effectively highlight issues of importance meeting was to review the global progress

Talkabout 9 on HIV since 2001 when the Declaration of can reach an alarming 50%, exacting a However even Australia has improvements Commitment was made to reach 'Universal devastating impact on these communities. to be made in its domestic response and Access' by 2010. This involved a target of The epidemic is outpacing the response this is particularly clear at this time of access to treatment and prevention services and this was widely acknowledged. increasing rates of HIV nationally. for all. At the meeting all 147 member states In many aspects, Australia is regarded reported on their progress in achieving as a world leader when it comes to its HIV these goals. response. It has established harm reduction Unfortunately despite clear progress in measures such as needle exchange programs some areas such as 3 million people being and has legalised brothel based sex work. on antiretroviral treatment since 2001, the Largely due to progressive policies, HIV The Asian and world is falling far short of its commitment. infection among both people who inject Pacific epidemic Even for this apparent step forward, we drugs and sex workers has remained were reminded that for every 1 person extremely low. It has been estimated that is largely who begins treatment, 2.5 become newly providing people who inject drugs with concentrated infected with HIV. In 2008 HIV must still be clean needles and injecting equipment in considered a crisis, with 6000 deaths due to Australia has averted tens of thousands of among specific AIDS everyday and the vast majority of the HIV infections. populations 30million people living with HIV without This was the focus of Australia's position access to antiretroviral treatment. As has at the meeting. We met with Australia's been the case for many years, the bulk of Ambassador Robert Hill and hosted HIV infections occur in Sub-Saharan Africa a session on injecting drug use at the with HIV playing out significantly, but Australian mission which was well attended. It is clear that a lack of political will is one slightly differently in our region. Wh ereas An additional focus was to urgentlyresource of the key barriers to improved progress in the African epidemic is a generalised one, the scale up of interventions aimed at men the fight against HIV, and there was much having spread across the general population, who have sex with men, sex workers and discussion on this issue at the meeting. the Asian and Pacific epidemic is largely other at risk populations, which are based Even in places where we do have clear data concentrated among specific populations. on evidence rather than ideology. The fact on the need to act and which populations Essentially these groups are sex workers that Australia's delegation had half of its to target, many governments and policy and their clients, men who have sex with members from community organisations makers fail to act adequately. Even when men (MSM) and people who inject drugs. shows a commitment in itself and many resources are made available they are not Within these populations, HIV prevalence other country delegations applauded this. always used most effectively by targeting the most at risk populations with best practice interventions. Meanwhile, 6000 people die from AIDS every single day. We were told by leading researchers that 'the quest for a vaccine is proving more difficult than we could ever have imagined' and a cure is rarely even mentioned. For the foreseeable future prevention is the best vaccine available to us and so we are left to promote and advocate for better resourced and scaled up prevention based interventions for all people as a basic human right. In the meantime back in Thailand, demonstrating their inspiring perspective on life, the Thais continue to smile. Rob Sutherland is an ACON staff member currently on placement in Bangkok with the United Nations Joint Programme on HIV (UNAIDS), Regional Support Team for Asia and the Pacific. This is with support from ACON and AusAID's Australian Youth Ambassadors The Australian delegation to the High Level Meeting on HIV at the United Nations: Rob, John Rule Deputy Director of NAPWA (National Association of People for Development (AYAD) Program. living with HIV/AIDS, Annie Madden Executive Officer of AIVL (Australian Injecting and Illicit Drug Users' League), Kay Hull Federal National Party MP for Rwerina, and Sofia Mackay from AusAID (Health and HIV/AIDS Thematic Group). [email protected]

10 August - September 2008 Making it work: Emplovment and HIV

HIV positive and working Making it work: Employment and HIV (full or part time} Wednesday 10 September 6pm to 8.30pm at the Y Hotel or returning to work 5-11 Wentworth Avenue Sydney • want to know your rights at work Speakers and a chance to ask questions • work and finances • making changes to your career or To RSVP phone Harry on (02) 9361 6011 working hours? or email [email protected]

POS itiVe ... f c-' N 5W Supported by a grant from South Eastern Sydney and lllawarra Area Health Service the voice of people with HIV since 1988

Positive Life NSW is looking for a range of articulate people with HIV to share their personal experience of HIV with interested media (radio, print, TV}, during World AIDS Day and other events.

If you are interested in being trained and Positive NSW supported for this new, ongoing, and the voice of people with HIV si nee 1988 rewarding role, call Lance (02) 93616011 or Supported by a grant from the NSW STI Programs Unit email: [email protected]

Talkabout 11 A warm welcome

Talkabout spoke to Kate Reakes, the new coordinator for Paz Het (Positive Heterosexuals), about support for people livinq heterosexually with HIV.

What brought you to Poz Het? face. One of the topics for the Annual Our workforce development is about I'd been living in Northern Ireland for Workshop is feedback from the second helping educate services around issues eighteen months and the bad weather phase of the Straight Poz study. Soon facing heterosexual HIV positive people and the lack of summer was starting we'll be getting involved in the next and appropriate ways to engage with to get to me. I was looking at the web (third) phase of the study. We also cater heterosexual people. to see what was happening back home, for our Western Sydney clients, with Shed What words of encouragement found this position and here I am. My events, The Shed is on every couple of would you have for a heterosexual background was in mental health and months, with a topical guest speaker. We person who has been diagnosed drug and alcohol, and I've always had a try to keep the number of HIV workers and doesn't know what to do next? keen interest in HIV and sexual health. that come along to a minimum so that People might feel nervous the first the event is truly a space for our clients. How have you found it so far? time they come to an event, but that's People can access our freecall normal. There's only one way to find - Really busy! There are lots of things telephone support from 9am to 5pm out if it's helpful or not. Give us a call or going on. Everyone; the clients, the Monday to Friday (if we are ever away come along. We're from all walks of life services, have been really welcoming. from the phone there is an answering and we're all friendly. We're building on some inspiring past machine, and we do get back to people). work, and looking towards the future The number is 1800 812 404. This is How can you reassure people who might be worried about their and launching our new strategic plan. completely confidential, and we can give confidentiality? What does Poz Het offer? people practical information about HIV, We're a small team. All our services are We have a very comprehensive peer refer to helpful services, and offer them confidential. Our open house nights are support program, including a monthly support and a listening ear. usually at the Tree ofHope and that's a very Open House meeting at the Tree of Hope We produce booklets specifically for discreet community centre. It doesn't look in Surry Hills. On Friday September 12 heterosexual people with HIV/AIDS, like an HIV or health related building. All from 7pm to 9pm we'll be talking about Sex Matters A-Z (sexual health for the other clients at Poz Het also understand disclosure. Then on Friday October 10 heterosexual couples living with HIV/ how important confidentiality is, so what (also from 7pm to 9pm at the Tree of AIDS) and Changing Lives (a resource is said in the group stays in the group. Hope) we'll be discussing relationships for heterosexual people living with Our groups have got a casual and relaxed and the issues facing sero-discordant HIV/AIDS). These are available on our atmosphere, and you can just come along, couples (including fertility). website (www.pozhet.org.au) or give us but ifyou give us a call first it helps us with We have an annual retreat at the end of a call for a hardcopy. planning the catering. August, when we go to the Hawkesbury Ourwebsitewillbe relaunchedinAugust, River. Another great chance to get and we hope it will be another forum to What are the significant issues for together is our Annual Workshop, and connect with others, and there'll be links heterosexual people with HIV? this will be on Saturday November to other information and services. Social isolation is a big issue. Not 15. People can meet others in similar We also provide advocacy, ensuring knowing other people, whether that means situations and have a significant time heterosexual issues are on the agenda for other positive people, or knowing partners talk to about some of the issues they other services and in policy. and family members of people with HIV.

12 August - September 2008 A lot of stigma is attached to being Poz het has just moved, same phone HIV positive in the straight community. line though? People don't often have the chance to We still have the same freecall number talk about what HIV means for day (1800 812 404), but we have moved. to day living. If people don't know Just across the road from our previous whether they can approach services, it address. Our new location is 155 Pitt has implications for their health. Then Street Redfern and we've got a postal there's the issue of finding ways to address (PO Box 3159 Redfern 2016). disclose, or talk about it, with partners If anyone would like to pop in and say and children. Other important issues hello they'd be very welcome. may include having children, and fertility and conception issues. Poz Het has a particular philosophy Coming up on Poz Het's about including the partners of calendar: www. people with HIV... ~ Retreat weekend 29th - 31st August We recognize that it's not just the (Hawksbury) person who's been diagnosed who's ~~et. affected by HIV. Partners have questions, Disclosure discourse Friday Sept as do families, children, parents and 12th 7pm - 9pm (Tree of Hope) org.a,u carers. All those people are welcome to PozNeg couples (and fertility) our activities. No one is excluded. Within Friday 10th October 7pm - 9pm activities we might offer something (Tree of Hope) specific, just for partners or just for the positive person. I've had a lot of contact Annual workshop Saturday November 15th 9.30am - 4.30pm from the partners of positive people, (Tree of Hope) who are looking for info or for support for themselves or their loved one.

HIV Health Promotion HIV Health Promotion HIV Men's Health Team Leader Officer Promotion Officer We need a new team leader to This position is all about creating This position is all about providing oversee the range of programs information resources for people peer support for people with HIV. we provide to inform, educate with HIV. This means developing and This means running educational and support people with HIV. producing awareness campaigns, 'f:t1._ese programs include targeted and support groups, providing one­ online content, pamphlets and on-one support, training volunteers campaigns and other resources brochures. Good writing skills are inclu'ding web content, educational and producing various workshops essential. It's a part-time job (28 hrs/ and p\er support groups, social and seminars for gay men with HIV. week) and it's based in Sydney. event~ and workshops. Excellent It's a part time job (21 hrs/week) writing skills are essential. It's a and it's based in Sydney. fulltim}! job and it's based in Sydney.

llApplications for all three jobs close on Friday 12 Sep 2008. For all the details, download ~a''job pack from the ACON website (www.acon.org.au/jobs) or contact our reception after I 11 am between Monday and Friday on (02) 9206 2000.

ACON is the leading health promotion agency for NSW's gay, lesbian, bisexual and transgender community. ACON also provides information, support and advocacy for people living with HIV or at risk of acquiring HIV, including sex workers and people who use drugs. ACON is an EEC employer and encourages people with HIV. in particular, to apply. www.acon.org.au BUILDING OUR COMMUNITY'S HEALTH & WELLBEING

Talkabout 13 Systemic Advocacy At Positive Life NSW

Lance Feeney: Senior Project Officer - Systemic Advocacy

Systemic Advocacy: and cooperatively progress access St.Vincent's Dental Department and objectives and strategies. relevant Area Health Services, to Ways we seek to influence the • Increase recognition and advocate for improved and speedier distribution of political, social understanding of the diverse needs of access to preventive and restorative and economic outcomes. people with HIV: remaining informed dental treatment for people with HIV in Representation of our interests about the current and emerging issues both metropolitan and regional NSW. affecting people with HIV across as citizens. metropolitan and regional NSW. HIV and the media Over a twenty year period, Positive Life • Contribute to measures to identify The availability of people with HIV has built powerful coalitions and effective and address the impact of stigma who are willing to provide a personal partnerships between community sector and discrimination on the quality perspective about living with HIV in agencies, government, researchers and of life and opportunities of people public forums and through mainstream clinicians. These partnerships collect with HIV byimplementing inclusive media is currently limited. We will and harness evidence. They also work to consultation strategies that seek input recruit, train and support people with create supportive environments, enabling from the full range of people living HIV to develop their media skills and people with HIV to enhance their own with HIV throughout NSW. to provide a diverse range of personal health and quality of life, and the quality • Establishing effective processes to perspectives about the issues that impact of life of their partners and communities. measure and communicate the impact on our health and wellbeing. The newly created Systemic Advocacy of our systemic advocacy work, to We will also resource the media with project plans to build on these peoplewithHIV,partners,stakeholders up to date information about HIV issues relationships with NSW Health, ACON, and relevant decision makers. in Australia, including: epidemiology, the Bobby Goldsmith Foundation, Area In the 2008-2009 financial years, we will the background to stigma, sensitivities Health Services, mainstream services, include the following priority issues in of disclosure, discrimination, emerging the clinical and research sector, NAPWA, our systemic advocacy work: issues in prevention, the impact of long AFAO and people with HIV - to term HIV treatments and the issues reinvigorate and enhance our advocacy Oral health and access to Dental facing people living long term with HIV. and achieve the following objectives: Services • Work with the HIV sector and Whether using publicly funded dental Insurance, discrimination and HIV relevant mainstream organisations clinics or private dentists, access to Access to insurance for people with HIV and people with HIV, to identify good and affordable dental care is vital varies. Attitudes to HIV as a pre-existing barriers and improve access to health to the health and wellbeing of people condition, and the long term prognosis and support services across NSW by with HIV. The EPC Medicare Dental impact on how insurance providers annually consulting with all relevant Scheme, introduced in November 2007, view the risk of insuring people with stakeholders to identify and act upon was a welcome treatment initiative and HIV. This impacts across the spectrum two priority areas/issues. provided improved access and treatment of insurance products including: travel, • Develop and implement joint options. TheFederalLabourGovernment health and life insurance in particular. approaches that improve and ensure has announced it will replace this scheme People with HIV - after less favourable ongoing access to services for people with a Commonwealth Dental Health treatment, or from fear ofless favourable with HIV by working with key HIV Program. We will be working with treatment - may decide not to take out and other stakeholders to identify NSW Health, Sydney Dental Hospital, insurance or not to disclose. This may

14 August - September 2008 affect their ability to plan for a secure Positive Life will now review the employer flexibility, time away from work financial future and contribute to evidence and make recommendations and in some cases, long travel times during financial hardship in their later life. about what measures could assist people work hours, to pick up medications. We will collect and publish information with HIV experiencing facial Lipo in the Positive Life will work with hospital on available insurance cover in Australia medium to long term. and other pharmacy services and NSW and assist people with HIV to have a Access to Mainstream services Health to improve access for people better understanding of their rights and with HIV. obligations when applying for insurance. A key role for this project is to identify We will also work with the Australian and act on barriers to services for people The UN Convention on the Rights insurance industry to bring them up to with HIV. As HIV treatments and of Persons with Disabilities experience changes, and as people with date with the improving prognosis and Positive Life gave evidence to the Joint HIV age, we will need to engage more life expectancy for people with HIV. Standing Committee on Treaties in with mainstream health and community response to the proposed ratification Employment and HIV care and support services. In doing this, of the UN Convention on the Rights of Employment continues to present organisations like Positive Life need Persons with Disabilities. challenges for people with HIV. to be able to raise awareness about the Dealing with side effects, intermittent needs of people with HIV and be ready We support the Convention and the illness and time away from work for to provide training and awareness to ratification by Australia. We however doctor's appointments and pharmacy support services providers and ensure question the health requirement related visits, requires flexibility on the part access for people with HIV. We will to immigration and called for a more of employers. The management of continue to work with health services to balanced consideration of both the costs disclosure, the impact of breaches of ensure that wherever we need to access and benefits to Australia of immigrants privacy, and potential discrimination health services, the care is high quality, and their families with HIV. within the workplace, can make getting clinicians understand any specific HIV We highlighted the continuing and keeping a job more difficult. interactions and needs, and that privacy exemption given to insurance providers We will assist people with HIV to and disclosure (and their impacts) are in the Disability Discrimination Act and continue to develop skills around understood and respected. highlighted the lack of consideration returning to full-time or part-time given to people with HIV by the Relationship recognition and the work, study or volunteering. We will insurance industry and the need for also assist working people with HIV to impacts for people with HIV on a more constructive, inclusive and understand their employment rights and pensions. balanced approach. responsibilities, manage career change, The financial impacts of the proposed Finally, we supported an increased financial planning, disclosure and privacy federalrelationship recognitionlegislation, priority for accountability under the issues, and to advocate for the flexibility in particular, how a working partner's Disability Discrimination Act and called to maintain health and life balance while income will affect the income and health also working. We will also use this work concession eligibility of the partner on for independent public annual reporting to consider ways to work with employers an age or Disability Support Pension on outcomes as well as mechanisms and unions regarding these issues. will be important issues for many people to plan and improve access to human with HIV. We will advocate for ways services for people with disabilities Facial Lipoatrophy and access to which ensure that people affected by the including HIV. affordable treatment legislation are properly informed, able to For more information on the UN Facial Lipo can impact negatively on plan to ease the impact and that measures Convention on the Rights of Persons mental health, socialisation and quality to limit hardship are put in place. with Disabilities, read our submission: of life. A range of cosmetic procedures www.positivelife.org.au/ advocacy/ have been successfully used to rectify Improved access to dispensing submissions facial Lipo. These procedures however of HIV medication Positive Life NSW values your are expensive and some need to be Taking HIV treatment as directed is the feedback. If you require further regularly repeated. most important factor in the success information or would like to discuss our The recent NSW Sculptra Special of anti-HIV treatment. Easy access to Access Scheme, provided a course of free pharmacy dispensing services is crucial to systemic advocacy work, please contact: treatment for people on low incomes maintaining treatment success. At present, Lance Feeney with facial Lipo and was a highly HIV medications are only available in Senior Project Officer successful collaboration of Government, NSW through hospital pharmacies and Systemic Advocacy community based organisations and specific services like the Albion Street Positive Life NSW Aventis, makers of the Sculptra product. Centre Pharmacy. These services generally Phone: (02) 9361 6011 Participants overwhelmingly reported a operate Monday to Friday during business Email: [email protected] positive experience. hours and require prior planning, Website: www.positivelife.org.au

Talkabout 15 Coming from the space of true love

Sam describes how he dealt with HIV as a neqative man arid then as a positive man, arid the relationships he has had alonq the way.

I came from a strict Lebanese his doctor and both tested negative, it stopped steroids and drugs, because I knew Catholic background, and wasn't was like trusting somebody with your it affected him. Drugs weren't a big thing in familiar with the gay lifestyle or gay life. But once I did, it was fantastic and my life anyway, and I would just do them sex. When I did explore my sexuality liberating. We were monogamous and it twice a year at a major dance party. and went out to nightclubs, I met a worked well. After six or seven months of the man and fell in love at first sight. After we split up, I dated another man relationship, I just wanted to go out He told me he was HIV positive. I was and he told me he was positive. By then and have some fun, and not feel so naive and came from a very sheltered I felt more educated and said: "I've been suffocated. We went out to a leather world, but I realised if I protected myself in a relationship and there's no problem." party and I told him I was going to do with condoms I would be safe. This was And he was so, so overwhelmed with drugs. He eventually went home, and I still new and scary. It was 1999. my response because he'd had other stayed out the rest of the night with my He was my first boyfriend, my very first men who had rejected him. I just said friends. lover. I had no sexual partners before to him, "We'll just protect ourselves. It's The following morning he called and that, and I felt thrown into a relationship all good." asked me over to have sex. I went over to already shrouded in danger. It lasted two The whole time we were together we his place and we did, all protected, maybe years, and it turned out to be destructive had safe sex, and we started off on a three times. It was the most sex I'd ever in some ways, because he had a chip on great note, but after the third month, the had with him in one short period. I was his shoulder, feeling like the world had honeymoon was over and things went so happy because I was thinking: "Wow abandoned him. But I felt very loyal to sour. Although he was no longer in love this is great." I was on a high. him, and even when we broke up on a with me, his therapist said he needed to A few days later, I did a two hour few occasions, I wanted nothing more work at the relationship. photo-shoot on a really cold night in than to be with him. I was on steroids at the time. Sometimes the nude. I came back from the photo­ I got tested throughout that time. I couldn't sustain an erection, and shoot shivering so bad I thought I had And every time I did, I would cry putting on a condom aggravated the caught pneumonia. The whole night I myself to sleep thinking I definitely had problem. I had a lot of psychological just couldn't stop shaking, and a couple something. After a while, I grew in the distress trying to fulfil him and sustain of days later I got the flu in a bad way. knowledge that it was difficult to get a sexual relationship, along with the My life is always geared towards health, HIV if you practise safe sex. stress of HIV. I felt my masculinity was but I hadn't been so sick in my life. My My next partner was negative and he, questioned because I had to be dominant partner was worried because he knew I like my first partner, was ten years older and impress him. When I became more was never sick. I had a sore throat and than me. He had more sexual experience of a bottom, I could sense he wasn't thought I should get it checked, and also and I freaked when he suggested we have fulfilled, or he was reserving himself in had a blood test done. A few days later unprotected sex. I didn't know what it some ways. the doctor called and asked me to come was like. I'd only ever known condoms, He didn't do any drugs because he had in. I knew something was wrong because and it was a big thing to let go of that been addicted, and wouldn't do anything this particular doctor is well known as protection. Even though we went to that would cause him to relapse. I also an HIV specialist.

16 August - September 2008 The test came back positive for HIV. It back home that night and taking this losing weight, and was scared of things was the middle oflast year. We went and medication and feeling violently ill from like lipodystrophy. I was trying to keep got the results together, and he fell apart. it. And feeling even more down and the secret of HIV as well as hold my life I just didn't know what had happened. crying desperately about the state that I together, and my career. My counsellor I had protected myself completely with was in now. described it as "like trying to keep five him. Never did the condom break. Becoming positive put a huge strain basketballs afloat under water." Never did he even ejaculate with the on our relationship. The sex declined After six months, my doctor told me condom on, never. They put it down to and it just added another weight he I could stop medication. I've been off my having a strep infection around the couldn't bear, although I came to him them now for a month and my life has time of going to these parties, taking from the space of true love. He used gone back to normal. I don't feel the drugs, having sex, and that he wasn't on the excuse that, sexually, we weren't pressures of remembering I have HIV. medication and his viral load was high. compatible now, and it got to the point I met my current partner four months How could this be possible? What did I where communication just ended. ago. He told me early on he was positive, do to deserve this? I don't know anybody and I said: "Oh my God so am I." I felt personally who's had this experience. I so relieved. We have an amazing sexual know guys who practise unsafe sex, and experience together, uninhibited, and still haven't become positive. I felt like I monogamous. had the raw end of the stick. The doctor Being with him has been a real blessing, said he probably gets two cases a year of It was like because it's exactly what I want. I've people who don't know how they got it, trusting someone become more liberated with sex. I can and it's not common. take medication, talk to him freely, and I didn't cope with it at all. My doctor with your life be open about being sexual. Emotionally, sent me to a counsellor, who I still see to physically and psychologically, we're on this day. Had it not been for her support, the same plane. We're both the same age I wouldn't have got through this. It and we want the same things. Having him was like when I first came out, and the shame of being gay, and now there was I wondered who would take me and as a partner at the moment has helped another secret to hide. I felt like nobody who would have me. I didn't feel like I me with the stigma attached to HIV. It's knew about what had happened, and could share what had happened with not confronting me wherever I turn. wondered how I was going to approach other men. I did tell a few friends and The more educated I become, the the subject. they were very supportive. I would stronger I become. I realised I wasn't When I was diagnosed and the doctor never disclose with casual partners, and going to die from this, and if I looked spoke to me, I could hear him talk, but they would never disclose. I would just after myself, I was going to have a long I just didn't know what he was talking protect myself and protect them. But and healthy life. I also realised I can share about. Looking back, he was telling me eventually a few guys did tell me they that knowledge as well. I've since met a about my viral load, and my t cells and were positive, and I disclosed to them, lot of positive guys and there's comfort how I should go on medication straight and we had unprotected sex. I started and solace in knowing them. away. And I normally don't even take to think I should just look for positive medication for anything. I don't even men, because we're both on the same Sam was interviewed by Kathy take Panadol. plane, and there's more pleasure. Triffitt for the forthcoming Positive I just couldn't believe what was Through this time I just had to wear Life campaign on serodiscordant happening to me. I remember going the brunt of the storm because I was relationships Disco Nights

These beautiful photos of the Northern Rivers which appeared in the last issue of Talkabout were taken by Dorien Karam

Talkabout 17 Need to talk to someone?

What brought you to ACON? not be enough for some people to there's a short waiting time, from one to I was working in South Africa, and explore deeper issues. This operates three weeks. If people can't wait because developed a counselling program for four evenings a week (Monday to their situation is more urgent, we will health care workers and medical students. Thursday), and works on a donation refer them to partner organisations. The high number of people diagnosed basis. We ask people to contribute $10 Intake officers will follow up regularly with HIV meant workers needed basic for each $10,000 they earn annually, and with clients to see how they're progressing. counselling skills. There was a huge wave suggest $5 per session if people are on ofvolunteerism,which led to many people Centrelink benefits, but we won't refuse What kinds of issues do people see being trained up as lay counsellors, and a to see anyone. you about? Daytime counselling is by qualified very different energy about HIV in South People come to us with a broad range and experienced counselling staff. Africa from 1999 to 2005. of issues, including drugs and alcohol, Our evening counselling is a volunteer HIV and sexuality were two areas of housing, same sex domestic violence, and program, but there are stringent passionate interest to me. We didn't know relationships. The most common issue selection criteria for the evening where the epidemic was going to take us (42% of our clients) is mental health counsellors. They're either in their final in South Africa, and sexuality was also in and this includes anxiety, depression, year of study, or they're newly qualified some ways unresearched and unexplained. stress or a diagnosable mental health or substantially experienced. All of our I wanted to continue myworkinHIV,and condition. The second most common counsellors receive clinical supervision. so I came to ACON in 2005. issue is relationships, and third is HIV. Do people need a referral or just HIV may not always be the priority What kinds of counselling does turn up at reception and say they'd issue they're coming to us with, but ACON offer? like to see a counsellor? might come up later. For example, their Short term counselling (six to nine You don't need a referral to see one of our relationship could be the reason for sessions) takes place in the daytime, counsellors. In fact, if someone has come contact, but then that could be partly and focuses on current needs. This to ask for counselling themselves, it means because they might be in a serodiscordant program is well established and has been they have really decided they want to deal relationship. running for many years. This is a free with an issue. We have an intake officer So, we also do couple counselling. It can service and its priority has been people who does a comprehensive assessment to be important to open up communication living with HIV, and people from the look at what's the best way forward and in relationships. We encourage people to GLBT community who are financially the most suitable course of action for the have those conversations here, whether it's disadvantaged and cannot afford a person who's requesting help. about open or closed relationships, using private service. protection outside the relationship etc. We now also offer medium term Is there a waiting period? It takes courage to come to the point counselling (up to 26 sessions) in the If counsellors are available we'll allocate of saying I need counselling. All the evenings, because six sessions may them as soon as possible, but generally counsellors are client centred in their

18 August - September 2008 work, and come from the perspective that it's not up to us to tell the client what to do. We try our best to work unconditionally with clients. What about confidentiality? We're very aware of the need for Living with confidentiality. We work in an organisation with its roots in HIV and AIDS, a disease that can be extremely stigmatized. Our record HIV? keeping procedures and protocols for maintaining confidentiality are very strict. The counselling team is a small team and we always get consent from the client to talk to other team members about their issues on occasions where it might be necessary to do so. In some instances we have a professional responsibility to find out all options for the client. This information is not shared outside the counselling team or with the wider ACON staff. What else do you offer? Just over a year ago, we started up a New HIV Diagnosis Priority Service. If someone has recently been diagnosed (and what 'recent' means is up to the client), we will provide telephone or face-to-face counselling within one working day of them making contact with us. We also run four different therapeutic groups. They include: exploring the blues (for people living with depression Counselling and anxiety), exploring anger, and exploring intimacy (one for women and one for men). The groups are free flowing, and the discussions are guided raACON by experienced facilitators. What kind of feedback have you had? A service for the gay, lesbian, We're seeing more of a need for counselling. Evaluations of counselling bisexual and transgendered and groups have shown clients report an improved sense of emotional and social communities, and anyone affected well being, with 90% rating the service by an HIV diagnosis as "excellent". Anecdotally counsellors also report seeing real change. For some clients it's the first time they can talk freely about same-sex relationships, or living To make an appointment please phone: with HIV. A lot of people also come back, (02) 9206 2000 or 11100 063 060 and get a boost to keep them going. Kerry Saloner is the Manager of the Counselling and Enhanced Care Service at ACON

Talkabout 19 Dry mouth and HIV

Dentist Dr Trevor Morris talks with Lance Feeney about: Dry mouth and how to prevent it

Dr Trevor Morris has established in people's health. Oral conditions were report either dry or slimy feeling mouth. a reputation over a twenty four often the first sign that all was not well. We are now able to test saliva quality and year period for high quality dental Hairy Leukoplakia and painful red flow with simple test kits costing about treatment and care among people fungal infections were most common. $60. We can then be more scientific and with HIV. He practises from his In 2008 the situation is quite different. work out whether we need to introduce Holdsworth House Dental Practice If you have a CD4 T-cell count of 300, it mouth-washes or other aids to improve in Oxford Street Darlinghurst. is likely you won't be experiencing any of the performance of saliva. Recently we discussed the these symptoms. Management of HIV is If someone is having trouble eating improvements in peoples' oral health much more sophisticated and while some because their mouth is very dry, then after the introduction of combination of the numbers may be low, immune the simple solution is to drink while therapy. The bad old days of KS lesions, function is generally better protected they are eating to wet the mouth and fungal infections and hairy Leucoplakia and consequently more effective. help digestion. There are also saliva - to name just a few - have thankfully During the early 1990s big parties were replacement products. These tend to be receded into history, but are there new in their hey-day and many party goers quickly swallowed and are very helpful environmental factors influencing our would go for days with little rest. In the when saliva levels are very low and they oral health in the time of effective anti­ weeks that followed it was not uncommon help soothe the skin lining in the mouth. viral treatments and HIV? to see quite an increase in severe mouth People however, need to be strongly infections - once again fungal and Before and after combination motivated, because you have to keep also ulcerative gingivitis. Unprotected using them throughout the day. anti-viral therapy and vulnerable immune systems were Combination therapy produced Many people are unaware ofdry mouth overwhelmed by exhaustion. It can still - presumably because they are too busy, significant improvement in health for happen but we seemed to have learned or not so body conscious. Where saliva people with HIV. Opportunistic oral few lessons along the way. conditions abated as viral replication levels are diminished we commonly see was controlled and immune function Saliva: the lubricant of raised decay rates involving unusual returned. Serious conditions such as the mouth tooth surfaces. The cost of repair soon Kaposi 's sarcoma resolved spontaneously Our mouths are probably the part of adds up and our ability to maintain and fungal infections occurred less our body that encounters the greatest teeth once they are repaired is also frequently, and with less severity. Between attack to our immune systems and the diminished if the problem of dry mouth 1996 and 2000, many of the symptoms important protection in the mouth is not resolved. and signs associated with poor immune comes from saliva. Generally, the more You can also help control the negative function began to disappear as the saliva one has the better. Saliva quality effects of dry mouth by reducing your uptake of anti-HIV treatment increased. is also important. If it is particularly intake of sugar. Sugar is one of the From around 2000 to 2005, people with thick and slimy, then it doesn't wet the principal contributing factors of decay HIV were presenting at dental surgeries surfaces of the mouth as well and acids especially where its consumption in much the same way as those who were as well as organisms are left undiluted. is frequent. Making changes here is HIV negative. HIV-positive people with lower T-cells - dependent on the individuals' motivation. Before antiviral therapy as CD4 T especially not taking anti-viral treatment It is not easy for some to change their diet cells crept below about 300, there was a - will often report some alteration to but where sugar levels are reduced the predictable and increasing deterioration their saliva. They become more likely to results are always worthwhile.

20 August - September 2008 The causes of dry mouth problem. Surface enamel is softened by plaque and thus controlling decay and Dry mouth can be caused by a range of the acid and then quickly worn away gum disease. If you brush your teeth factors; however there are some general from clenching and grinding; another twice a day, the incidence of decay is trends that are worth noting. side effect of the drugs. Teeth age more demonstrably further reduced. So we It could be argued that we are living in quickly than ever. Now and then we see 20 can say that brushing twice a day is a a faster more stressful world with more year olds with teeth that look twice their way of saving quite a lot of decay and constant pressures. Stress hormones tend age. Another scenario involves the older expensive treatment. We have no doubt to dry our mouths. Most of us are familiar person who has gum recession leading to that if people are able to, flossing will with a dry mouth at times when we are exposed soft root surfaces. Decay on root further reduce disease in the mouth. nervous. That's why a glass of water is surfaces is harder to treat and more often Drinking adequate water throughout always provided for public speakers. We leads to the loss of teeth. the day and avoiding excessive use of all get stressed at times, but for some of Alcohol if drink frequently also dries high acid, high sugar drinks and foods us being stressed has become the norm. our mouth. If it is mixed with sugar the can also tip the scales in your own favor Then when we are busy we often forget effect is once again compounded. There are also products on the market to drink enough water. 'You might begin Cigarette smoking also dries the - like mouthwashes, and mineralizing the day well hydrated but with business mouth with similar possible effects. crernes which can help. You need and distraction, forget to keep drinking More noteworthy smoking has a strong dialogue with a dental professional. We water as the day progresses. Well hydrated association with gum disease. A general can work out what products are best for in the morning dry in the afternoon! guideline is that if you smoke more than you in terms of cost and effectiveness. Saliva flow rates fall and ones breath may ten cigarettes per day, and if you have Each mouth is just a little different. Early also deteriorate as bacteria proliferate. any tendency to gum disease, it is likely intervention is far better than allowing We are also increasingly accessing to be accelerated many times. Nicotine problems to develop. We like to think prescription medications for a range of reduces blood flow to our gums and that our professional experience can health conditions both HIV related and thus the interface between our gums and assist in this way. non-HIV related. A very large number of the plaque that resides on our teeth is Some of us are just lucky and some drugs list dry mouth as a potential side­ altered, making it harder to control the have to work harder to keep things under effect. This can vary from person to person bacteria that make up plaque. Our body control. Feedback from a professional and it may or may not be significant. begins to lose the battle as the bone and about what is happening and what you Certainly some anti-viral medications fall gums that support our teeth breakdown may need to do is invaluable. It is not into this category. It is not a reason to stop leading to loose teeth. Three cigarettes a uncommon to tell people that they don't taking them, but we do need to modify day should not cause any problem. Once need some of the products they are using. our oral health care to compensate. If you you reach ten a day we begin to see rapid are unsure ask your dentist. progression of untreated gum disease. You won't know if you don't ask. Each year new products enter There is a clear relationship between If you have HIV in 2008, the news is the market. Lifestyle drinks; new oral health and self-esteem. People, who better than ten years ago. It's not so concoctions to help us through exercise have problems with their teeth, lose much a battle with HIV as keeping or hopefully to energize us through a social confidence. When people have yourself in a better state of health. There hard day or maybe during a long night. poor self-esteem they are less likely to are two principal factors challenging What we don't know is that they often care about themselves. They tend to give your oral health. Here we have focused contain mild stimulants that dry our up. They tend to neglect themselves. on dry mouth and how it has a strong mouths, and to make matters worse, still These factors then snowball, and make association with lifestyle, medications; are frequently both sweet and acidic. If the situation worse. prescnption and non-prescription you wanted to make the perfect food to Individuals may not be able to change drugs. The other factor is gum disease breakdown teeth you couldn't do much all or some of the above circumstances, and that, for the majority of people, can better. Moderation is one thing but however it is no reason to take a head be quite well managed with the help of some people report using these drinks in the sand approach. The cost is too a good dental team. Early intervention is everyday. great. Instead, cooperation with an best. It's cheaper easier and the outcomes Street drugs are also used in some parts understanding dentist can make a world of are better. of the gay community. Amphetamines difference. We are not there to judge you, Lance Feeney is the Senior Project are more popular than ever. Academically but to help you experience better health Officer - Systemic Advocacy - Positive they are linked to the syndrome of"Meth for longer, whatever that may require. Life NSW. For more information you Mouth". Essentially they help us to push can contact Lance: our bodies beyond normal limits. They Preventing dry mouth Phone: (02) 9361 6011 cause dry mouth directly and many We know that brushing your teeth every Fax: (02) 9360 3504 who use them are drawn to sugary or day with fluoride toothpaste makes a Email: [email protected] acidic drinks which exacerbate the saliva significant difference in controlling Website: www.positivelife.org.au

Talkabout 21 It's all in the mind?

Garry Wotherspoon on some possible impacts of HIV on mental health

Mental health has had a bad press people are likely to experience depression people? But if we are 'careful' not to tell - images of lunatic asylums like or anxiety in their lifetime. People who people, how do we get support? Bedlam or Callan Park, and movies are depressed may feel symptoms like Fighting prejudice was a key theme about 'crazies' with knives and oppressive sadness, fatigue and guilt. at the recent 17th International AIDS hatchets, have, for so long, been They may report feeling lonely, isolated, Conference in Mexico City. The 20,000 fed to the public. helpless, worthless and lost. And many delegates heard stories that indicated In recent years, increasing numbers people with HIV experience not only that there is still widespread concern of public figures have raised the issue unhappiness or sadness, but also about the stigma attached to HIV. of mental health. Former Premier of depression. Stigma, or the fear of stigma, might Victoria Jeff Kennett has championed be especially fraught for people mental health issues, and the current from different language or cultural NSW Treasurer Michael Costa has backgrounds. This can be because of 'come out' and talked about his own their communities' different beliefs mental health concerns. And two recent about health, illness and medicines. And Australian movies - Ten Empty and The Fear of the since Australia has cultural communities Black Balloon - have treated mental health impact of HIV can from all corners of the globe, these issues factually and sympathetically. fears might be an 'iceberg' - we only So stigma is lessening and attitudes are be a source of see the tip of it, with a massive burden gradually changing anxiety hidden below the surface. Similarly, The World Health Organisation some positive Asian gay men may be (WHO) has projected that depression particularly hesitant to disclose their will only increase as a global issue. status, given that their communities The WHO reports that it is currently can be quite interconnected. It happens. the highest medical cause of disability For most of us with HIV, there are a Someone you meet knows someone you worldwide, and predicts it will be range of circumstances which might know, and talks about someone they the second highest medical cause of cause a shock to our usual mental state. know. Other cultural groups often have death and disability worldwide by The moment when our doctor tells us similar experiences. 2020. According to the Mental Health that we are HIV+ is often stressful, and But some causes of metal health stress Association of NSW, depression is a for some, it can generate anything from are common. Many of us may worry common mental health problem here. It anxiety to acute depression, depending about the impact of HIV, whether is a long-lasting, often recurring illness, on the situation. Then, when we have actual or feared, on our health. While as real and debilitating as heart disease. come to terms with diagnosis, the next this can be a source of anxiety, there About 800,000 Australians experience hurdle might well be disclosure - who are strategies for looking after our depression each year, and one in five should we tell? Or can we avoid telling physical health: eating well, getting

22 August - September 2008 enough exercise, compliance if you are of dealing with worries in isolation. ourselves kindly (taking some time out on medications, cutting down on those Here, groups like Genesis or After Hours if needed), and here, the benefits flow pleasures that might have a negative (for newly diagnosed gay men), and 729 to both our mental health and our HIV impact - too many big nights out, too (for men living longer with HIV), are situation. Some people have called it 'the much pill popping, etc. I don't have invaluable. Organisations like ACON power of positive thinking'! to spell them all out, you know what I provide one-to-one counselling (see the mean. But there is one strategy to take interview on page 20). And there is also particular note of - cut out smoking - it beyondblue, an organisation that has Services mentioned in this helps in all health issues. been recently established in Australia, article: to provide support for people with depression. ACON Counselling (02) 9206 2000 If one still feels that one's world has or Freecall: 1800 063 060 www.acon. collapsed, then we may need a different org.au approach. The first step might be Strategies can Multicultural HIV/AIDS and Hep to acknowledge we are not coping, C Service (bilingual/ bicultural include treatment and look for other strategies. These co-workers provide emotional and prevention could be anything from treatment support, advocacy and information to 'preventation'. There are many to people with HIV from diverse treatments, but most of them fall cultural backgrounds) www. into two main groups: antidepressant m ul ticul tur alhi v hepc. net. au medications or psychological treatments. Freecall: 1800 108 098 There are a range of anti-depressants on beyondblue (an organisation We might also worry about the impact the market, but you should take your established to create a community HIV might have on our lives in general. doctor's advice when considering if you response to depression) www. Will we be able to do the things we'd need these. And a range of 'preventative beyondblue.org.au planned or hoped to do in the future? strategies' can also help people manage What impact will it have on our sex lives? their condition: everything from getting Peer support: For information Will it affect our relationships? And if enough rest to gentle exercise or using about Genesis phone Positive we're not in a relationship, will forming relaxation techniques, to moderate use Living Centre on 9699 8756. For a relationship be more difficult? of alcohol or recreational drugs, to trying information about After Hours, 729 Talking to someone can be a strategy to maintain supportive friendships. or other peer support groups phone for dealing with the impact on mental Every little thing helps. 9361 6011. www.positivelife.org.au/ health. A friend, counsellor, or peer And finally, we should accept the fact peersupport support group could diminish that sense that we can go easy on ourselves, treat

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Talkabout 23 r-4 ~~ Olga's personals

Men Seeking Men with view to LTR. ALA with recent times. WLTM guy with 'it' factor affectionate with magic hands and Attractive and Affectionate GAM. photo. Reply: 300707 & chemistry attractiveness. ALA lips, healthy HIV+, 5ft 8, medium 421173cm/63kg. Healthy, Athletic, Mid North Coast 33 yo dude in promise. Reply 111007 build, versatile, DTE, GSOH. Likes Toned andVersatile. Non Scene, Non boardies. Recently HIV+ & seeking Hung young looking 40 HIV+ laughable lifestyle, looking for Smoking. Looking for a soul mate to mates, partner, picket fence even. I'm I'm single, discreet, live alone, friendship/LTR, age open. ALA enjoy life with. Athletic Masc GWM nvs (not very serious). But am very healthy beach side lifestyle in Noosa. Reply 220408 most welcome. Reply: 100108 fclg (funny, cute, loyal, genuine) Fit Smooth, defined, blond brown Nice guy 43 HIV+ eastern Sydney City. Fit caring HIV+ guy, 'n healthy, non judgmental country hair and eyes. Small athletic build European bottom like to meet nice good looking 47 yrs 6ft 72 kg into lad that cooks, cleans and has power type bloke. Adventurous versatile guy with good shape for LTR for gym, yoga, outdoors WLTM DTE tools. Reply011007 top seeking passive versatile HIV+ good times, quiet nights and to be guy for friendship, relationship, Attractive 51 yo + Euro guy. bottom boy to butt worship, love happy together Reply 090508 prefer NS fit guy with positive SW Sydney, 185 cm, 92 kg blonde/ and adore. No drama, gossip or Locked up and lonely! 31 yr old outlook on life. Photo appreciated. brown hair, hazel eyes, smooth body, blame games, 4 a day, a lifetime, or HIV+ guy in jail, looking for mates Reply: 130607 professional working guy. GSOH longer. Reply: 171207 and more. 6ft 3, brown hair and eyes, Lilyfield, 46 HIV Poz guy, 74 kg DTE versatile tactile. Enjoys dinners Sydney Ryde Area. Male 42 ok looking. I'm DTE with GSOH. Not bad looking, mo, goatee, hairy & quiet times etc. WLTM toned HIV pos since May 2007. 70 kg, 5 Into music, movies. Open minded 5ft 9, WLTM Poz guy to 50 for LTR smooth bodied 40 - 50 yo versatile ft 9 Passive submissive seeking a and fun to be with. Want a pen pal for good times, quiet nights, occ GWM. A professional working dominant top guy in 30s or 40s. I and whatever else happens. Reply: rage. ALA No time wasters please. guy, who has a similar outlook and like straight acting guys with good 150508 Reply 140607 lifestyle, for a monogamous LTR. builds and cut. - Have a foot fetish Greek 31 years, very fit, attractive Seeking friend / partner, 53 years Reply 031007 and I like light bondage. Reply: HIV + male, accounting finance old, slim, good looking and positive Looking for a cuddle buddy. 070108 student (Parramatta area) ISO four years and well, GSOH and Hi guys I am 38 years old working Country guy, 43, poz, 183 cm, 73 specifically to make friends and have DTE. Looking for friendship / LTR, guy living in the Inner west. ISO a kg, slim build, hairy chest, non scene LTR with other Greek guys. Must be inner west area, genuine and loving normal guy to share a bit ofaffection and working. Interests are country very honest, healthy and hygenic. and versatile. Reply: 260707 with. Prefer a guy who is working life, animals, gardening and markets I am very straight acting and DTE Newcastle/ Central Coast/ and has a stable life. Love kissing to name a few. Seeking someone Reply: 160608 Sydney. Pos 42, 183 cm, athletic and cuddling. Looking to meet a guy special and LTR. Might be sincere, 46, HIV pos guy SW Sydney 84kg DTE GSOH versatile work to the age of 45. I am an Aussie guy, passive, no time wasters. Prefer would like to meet pos guys to 55 fulltime, not into scene, straight hairy with a stocky build. Needing someone over 30 and NS. You never for fun times and with a view to a acting, enjoy eating in/out, movies, the touch of a man. Reply 081007 know until you have a go. Reply relationship. Reply: 100708 DVDs, like to keep fit and well. ISO City located. Crossdresser. 190408 31 yo Kiwi guyliving in RootyHill, similar versatile top 30 to 45 y/o V pretty, good cook, loves fun Mid North Coast 50 yrs young, NSW. I'm affectionate, passionate,

1 ~~~~~ ~,1~ mi Advances in HIV combination therapy have resulted in people living longer and with improvements in their quality of life. It's worth taking the time to discuss your future treatment options and health with your doctor. Find out whether advances in HIV combination therapy can help you Thrive instead of just survive. Visit www.youcanlhrive.com.au

24 August - September 2008 good looks. HIV+ 5 years. Looking for Women seeking men a guy(s) to share good times with and ALA All Letters Answered other person for transport. HIV+ female. Wanting to meet LTR Long Term Relationship life. Into honesty, easy going, sensual Let someone know who you someone in the NSWNIC Border GSOH Good Sense of and sexually uninhibited people. Age, are meeting and where. You can area. I have been positive for nearly Humour nationality and beliefs no barrier. I'm NS Non Smoker leave a note, keep a diary, email a six years. Fit and healthy and not on very open, strong and happy. ALA ISO Looking For friend, or ask someone to phone Reply: 150708 meds. I am 5ft 4 brown eyes, blonde/ DTE Down To Earth you on your mobile to make sure brown shoulder length hair of solid WLTM Would Like To Meet GAM Gay Asian Male you are alright. Men Seeking Women build. Looking for someone genuine, GWM Gay White Male Apply commonsense and the Seeking free spirited, loving soul for friendship and hopefully long TLC Tender Loving Care basic rules of personal safety. mate. I am a youthful male in his 40s, term relationship. I love animals, quiet Maintain a healthy degree of from Melbourne, who would like to When placing and nights at home and the country life. suspicion: if anything seems odd, spend some quality time with a lade answering personals Reply: 120307 be careful. who accepts my HIV positive status. I Be clear about who you are and Seeking African man for marriage. travel interstate occasionally. I do not what you are looking for. Too How to respond to a much detail can be boring, and consider that I am compromised by Must be Christian, non-smoker, fully personal too little may be too vague. Be this status. Reply: 190808 employed and resident. Me: white, honest to avoid disappointment Write your response letter and seal 47yo +ve male, Sydney (European), attractive, sensual, quiet, family for you and your correspondent. it in an envelope with a 50c stamp gentle, sincere, hard working, oriented, very good cook, caring and Do not give out your work or on it - Write the reply number in intelligent, healthy, affectionate with affectionate, understanding. I have two home address, telephone number pencil on the outside - Place this two wonderful children, seeks kind children. Serious men only. No time or email address until you think envelope in a separate envelope hearted lady to share family life (single wasters please. Reply: 150307 you can trust the person. Use a and send it to Olga's Personals, mums welcome). Migrated last year, Hotmail or Yahoo address. PO Box 831, Darlinghurst 1300. love Australia. WLT correspond and For Friendship Like you, other people may meet with possible view to LTR Reply: be anonymous. You can't always Easy going man in late 40s, How to place a personal 010607 believe everything you are told. Write an ad of up to 40 words - Mid North Coast NSW. Straight looks and feels like I am in my 30s. When meeting someone: Claims that you are hiv negative young 46yo guy non user. HIV+ Unaffected by my HIV+ status, looking Have reasonable expectations. or claims about blood test results unstoppable in life. GSOH. Definitely for male and female friendships. I am Don't let your fantasies run away cannot be made. However, claims individual but like us all has moments. good company, have lots of interests with you - how somebody seems that you are hiv positive are Genuine, sincere, wants children, and can communicate and talk about might not be who they are face­ welcome and encouraged - Any seeking lady wanting the same. Kids to-face. almost any subject. Nothing to tie me personal that refers to illegal OK. Discretion given and expected in Meet for the first time in a down (kids are now adults). Looking activity or is racist or sexist will not return. Reply: 060208 busy public place, like a bar or for down to earth people for friend/ be published - Send the personal HIV+ undetectable and well, young club, or with friends. You can go looking, 48 looking for a woman under relationship. Solid build/average looks, to a private place after you have to Olga, including your name 40, healthy like me, non-smoker, non­ experience and intelligence. Live in met the person and think you and address for replies. Personal drinker, for company and sharing Sydney. Will reply to all mail including can trust them. Don't rely on the details strictly confidential. experiences. Sydney. Reply 210808 people from interstate. Reply 021107

Talkabout 25 Keeping on being Positive

Crickey, I had a similar feeling, starting Meeting new people,we all had different Newtown or the Aibion Street Centre in to write this article, to attending the first expectations, fears, questions. Some of Surry Hills. (Venues and dates for 729 729 group meeting. 729 meets the last us brought past baggage. Thankfully the can be found at www.positivelife.org.au/ Thursday of every month and provides group, though reluctant to hear the same peersupport/seventonine) support for long-term survivors of HIV. old records, was gracious and patient. As the year has ticked by, conversations "HIV does not discriminate", thank God. That patience has paid off, and we hope and friendships extended beyond It was very important and definitely to celebrate the anniversary with aplomb these meetings and flowed into homes, positive for me not to be discriminated and flair. The group has maintained its cinemas, restaurants, social gatherings, against by this group, because I would kind and considerate attitude to one BBQs, theatre, movies, walks etc. A recent not have qualified as a long term another (other than the occasional gathering said farewell to one of our survivor from the last century. I was sarcasm and queen bitch). This positive dear group members, moving to greener only diagnosed this millennium. outlook, along with everyone's effort pastures in Melbourne. The times, they Before I continue- "long term survivor"? (yes, effort, for nothing good happens are a-changing. We who used to be quiet Somehow that name does not ring well. I without effort) to be friendly and have come out of our tortoise shells and feel inclined to use the term "the fun of accommodating, has made this one are displaying the hare within. living life as a positive gay man". of few GLBT groups that has not been We are free in our conversations and August 28th 2008 will mark the group's clicky and drab. share, and shed, our past more easily. first anniversary since it was launched Members of this group are free to And so - where to from here? at the Sanctuary in Newtown. That attend or not, without any pressure. The On approximately 28.8. 2009 I will let meeting had a mighty healthy turnout I only pressure was knowing whether the you know. must add. meetings would be at the Sanctuary in Leslie

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26 August - September 2008 Fear is high, trust is low

What are the experiences and needs of HIV positive sex workers? Scarlet Alliance has been finding out.

For the last twelve months, Kane to be accessible, but not in a way which enforcement role, and are quick to report Matthews has been interviewing identifies them. behaviour they personally don't like. A HIV positive sex workers about number of participants, however, did their needs. Scarlet Alliance, the An inclusive environment from report being confident with their GP, and Australian Sex Workers Association, peer organisations having an open and honest relationship commissioned the National Needs All the participants felt apprehensive where full disclosure was possible. Assessment of sex workers living in disclosing their dual status to peer with HIV, the first since 1992, and organisations, whether HIV or sex worker Campaigns for shared thirteen sex workers, twelve of organisations. Being both HIV positive responsibility and the reduction whom were men, were interviewed and a sex worker can mean an individual of stigma for the project. experiences being treated as an "outsider': All participants felt the weight of stigma. At the launch of the final report, Kane "You tell them you're positive, you live The report recommends that HIV and remarked that "Fear is high, and trust with your partner, you have been positive sex worker organisations need to increase is low", and an important part of the for so many years... but sex work is a dark education campaigns to promote self care process has been taking the time to build side andyou don't tell manypeople because in casual and commercial sex, and that trust and relationships. Many sex workers you getjudged pretty quickly." strategies to reduce stigma are continued with HIV are understandably reluctant to and are inclusive of sex workers with HIV. Legal information disclose their status or their occupation The full report is available on the Scarlet Misinformation about laws relating to because of stigma (and this includes the Alliance website (www.scarletalliance. sex work, and widely varying state laws, dual stigma of sex work and HIV). Scarlet org.au) have meant that many sex workers with Alliance believes it to be an important HIV assume laws relevant to commercial principle that sex work is work, which sex and HIV are the same for non­ In summary sex workers with means that sex work is a valid form of commercial sex. The report recommends HIV need: work for people to choose. decriminalising commercial sex for • legalinformation,healthinformation Information and peer support people with HIV in ACT, Victoria, and peer support Because trust is difficult for HIV positive Western Australia and Queensland. It • accessible and risk free information sex workers, they are forced to rely on also recommends developing nationally • an inclusive environment from peer close friends and peers rather than consistent state-based legislation for HIV organisations (both HIV and sex professional organisations, even those positive sex workers, and the laws around worker organisations) organisations who claim to be supportive. sex work for people with HIV should • trustworthy and confidential Information for positive sex workers reflect the laws relating to private sex. services should be provided by supportive people "IfIgo to Melbournefor a dance party and • decriminalised sex industry laws and organisations, in consultation with I want to do some work while I'm there to pay • protection from adverse reactions HIV positive sex workers as peers. for my holiday, how am I supposed to know? based on stigma These sorts ofthings should be advertised and • reliable and accessible free condoms Accessible and risk free easily accessiblefor everyone to know." and lubricant information • support when dealing with Health departments, HIV and sex worker Trustworthy and confidential Government agencies organisations need to provide accurate health services • Campaigns for shared responsibility and easy to understand legal and health There was a trend for positive sex workers and to reduce stigma information for sex workers with HIV. not to trust health services with a fear • Recognition of the value of sex work Information targeting this group needs that these services take on more of a law

Talkabout 27 Beauty and passion: Buenos Aires

John Douglas shares his photos from his recent trip to Arqentina (arid the Antarctic peninsula)

There's increasing acknowledgement that HIV in Latin American countries demands more attention than received so far. When Mexico hosts the XVII International AIDS Conference 3rd - 8th August, it was the first Latin American country to do so. The highest levels of HIV infection are found amongst men who have sex with men . The volunteer I talked with in the Plaza de Mayo was happy to discuss information and resources, but would only consent to having the information booklet in the photograph.

A medical clinic offering HIV testing and counselling. It's estimated An anti-homophobia poster. The speech bubble says "My dad has a boyfriend". Buenos Aires that of the approximately 42 000 HIV Positive people in Argentina, has large and developed gay community and laws allowing civil unions between same-sex 79% access antiretroviral therapy. couples. Gays and lesbians in Argentina enjoy the same legal and social rights as heterosexuals

Old world charm, beautiful It wont be easy, you'll think it strange...The Casa Rosada. The arched balcony is where Eva Peron gave sculptures and architecture. speeches to her masses, and where Madonna unsuccessfully begged off-key for an Oscar nomination.

28 August - September 2008 Recoleta cemetery, where many of Buenos Aires' illustrious are entombed. Feeling a bit cross? Tierra Santa, Christian theme-park has to be one of the tackiest places Eva Peron caused controversy even in death when she was interred in the in the world. A gaudy animatronic Last Supper; a 13 metre high Jesus that rises up out the family crypt. Many disapproved of allowing a "whore" amongst the rich and ground and rolls his eyes and waves his arms; life-sized plastic figures from many bible well-connected dead. Eva's crypt is the most visited in the cemetery, crowded stories. If you go on Good Friday as I did, you can even help the actor portraying Jesus carry by tourists and those wishing to pay respects. Rest in peace? Not yet. the cross on his way to crucifixion. Heaven!

Floris Generica sculpture. Designed and funded entirely by architect Eduardo Catalano. Pharmacy. My kind of place The aluminium and steel petals are 20 metres high and close from dusk to dawn. for picking up prescriptions.

Buenos Aires is a good departure place for those wanting to experience Antarctica and the peri-Antarctic islands. The Antarctic peninsula has 90% of all the wildlife living on Antarctica within I0% of the continent's area.

King penguins. Port Circumcision. A Christian reference, apparently. The red building Sleepy seal, South Georgia Island. www.JohnDouglasArt.com in the background is a refuge hut, not a storage shed for foreskins.

Talkabout 29 Ask Ingrid Health and Fitness

Ingrid Cullen is a gym instructor with many years' experience working with HIV positive people.

Working out at home and making the most of expensive gym visits ·-· ·- ' Can you tell me three basic exercises I could do at home? To get you started, I will go one better and give you four exercises ~ . II you can do at home, with photos. You will then be able to add other I ,, 1•,. , j exercises from Talkabout or other sources. '\,... ' \ .1 The first exercise is for the lower body and works the bum, quads, \ ! .4' I hamstrings and calves. Step-ups ••• Start by setting up a step that is at least five centimetres, and I up to sixty centimetres, high. The stronger you feel, and the better .:.,. _,,- > -~, your knees work, the higher you can make the step. Increase the ..q,I I height of the step gradually as you build up strength and fitness. You can also wear a back pack with something in it to make you Step ups: for lower body heavier as you get stronger. Now that you have set up the step, stand in front of it. Step up onto the step with your left foot, bring your right foot up onto the step so you are standing on the step, then step down with your left foot then bring your right foot down onto the floor beside your left foot. You have now completed one step-up. Start your workout by doing one minute of these, leading with your left foot then swap to your right foot for another minute. Let's move on to the second exercise which works your chest, shoulders and triceps. Side push-ups As you get stronger, increase the depth of the push-up by lowering your body closer to the floor and putting more of your weight on the back arm. Start this one sitting on the floor, lean to the left and place your left hand slightly back and about thirty centimetres from your left shoulder. Now put your right hand in front of you, about thirty centimetres in front of your chest. Bend and straighten your left arm. You have now completed one push-up. Complete six to ten push-ups with your left arm, then swap to the other Side push ups: for chest, shoulders and triceps side and repeat.

30 August - September 2008 The third exercise works the back and biceps: One arm rows As you get stronger increase the weight by placing heavier items in your green shopping bag. Start with something like a two kilo bag of flour or sugar. Start this one by leaning on a table or back of the lounge with your right forearm. Lean forward with a flat back and grab the bag with your left hand. Raise and lower the bag by pulling your elbow back past your back. You have now completed one row. Bend and straighten your left arm six to ten times then swap to the other side and repeat. And now on to the fourth exercise which works the core stability muscles, the abdominals and lower back. One arm rows: for back and biceps Dead bugs As you get stronger, lower your legs down closer to the floor to make the exercise harder. Start this one by lying on your back on the floor. Place your hands under your lower back, palms down on the floor, lift your legs in the air and push your legs back and forward like a dead fly. Bend and straighten each leg. This counts as one dead bug. As you do this movement use your deeper stomach muscles to keep your lower back pushed firmly against your hands. Finish off your workout by doing one to two minutes of this exercise. The second question is: I find it hard to afford to go to gym. What would you advise I do? Workout at home with exercises from previous Talkabout issues, as well as this one, and add some aerobic exercise that you like, such as going for a cycle, swim, run or walk. Then buy a ten-visit gym pass for around $140 that you could use once a week for ten weeks, or for an intensive change of pace two hard gym sessions each week for five weeks. You could join in with a few friends, and hire a personal trainer to come to your home to set up a home circuit that you could do together. Then get them back every month or so to check on progress and change things around. Each person could bring a new piece of exercise gear to the session each month. These could be things like an exercise ball, dumbbells, kick board for the pool, water bottles that can be used as dumbbells, short handled green shopping bags that work like weights or a Dead bugs: for abs and lower back new walk or fitness trail that you can try. Another cheaper option is if you have a friend who lives in an apartment complex with a gym, hire a trainer to come there and show you what to do and then get them back every now and then to check you are doing things correctly and give you new ideas.

Do you have any fitness questions for Ingrid? www.positivelife.org.au/ Email them to: talkabout [email protected]

Talkabout 31 So Can You Cook? No 31

"Food, like a loving touch or a glimpse them probablymoreoften thanmymother you are health conscious or a nutritionist of divine power, has that ability to was willing to grate all the potatoes. She don't read on. It will only lead you to comfort." was ahead of her time after all. I can still despair. For all my other readers, get out Norman Kolpas bring to mind images of them during your doona, turn up your heater and winter, almost setting ourselves on fire in prepare to snuggle up in front of the tele with a steamy plate of memories. So what is comfort food? Basically, front of our open fire in the lounge room they are foods that invoke memories toasting slices of bread held on a carving of purer and simpler times, are fork in front of the flames. I don't know LAMB SHANKS evocative of childhood and all things why, but the toast done in front of the fire with PARSNIP 'home made'. They are also foods always tasted better than that made in the that bring you comfort seasonally toaster. Modern additions to my comfort LEMON & HERBS food catalogue would be salt and pepper (images of winter in front of a roaring 4 red onions, quartered prawns, Caesar salads, risotto, and just fire in your old 'Onkaparinga' dressing 6 garlic cloves, thinly sliced gown - with one tassle missing from about anything with cheese. 4 sprigs thyme the cord - with a bowl of steaming In a world where I often hear sports­ 4 lamb shanks (about 1.2 kgs) soup and a plate of hot buttery toast minded (read boof-headed) people l large parsnip, peeled to dunk in it, a hot chocolate to come, declare that food is only fuel and they 8 sage leaves thick and foamy with a marshmallow don't care what they eat as long as it is 250ml veal stock (use beef or vegetable melting on top of it); or bring you healthy and uncomplicated; and having if veal not available) comfort through difficult times either lived in a HIV world of nutritionists GREMOLATA at work, socially or in your family life who basically declare the same thing, 1 tablespoon small capers, rinsed and as when someone dies or gets ill. decrying the enjoyment and celebration drained Comfort foods willvaryfrom one person of food, it is good to see that people are 1 garlic clove, crushed to another, and can tend to change as we still doing food for enjoyment, to bring 1 lemon, zested get older. To me, comfort foods consist them comfort and to celebrate the sheer 3 handfuls flat-leaf (Italian) parsley of soups, roasts, casseroles and stews, exuburance of friendship and love. We leaves toasted sandwiches, macaroni cheese, could spend all day debating the healthy/ Preheat the oven to 200°C. Make a bed rissoles, spag bol, pan-fried sandwiches unhealthy aspects of comfort foods, of the red onions, garlic and thyme in a and schnitzels. Anything with chocolate, but it doesn't alter the fact that a good deep casserole dish. Put the shanks on rhubarb, hot steaming puddings, self­ number of us baby-boomers were raised top, then arrange the parsnip and sage saucing puds, mousses, pies and tarts sum on these diets, and there weren't the leaves over them and season well. Pour up the sweet side of things. childhood obesity problems and allergy over the veal stock, and cover with a lid or My mother used to make this Sunday proliferation that seems to be around foil. Bake for one hour, then uncover and night dish she called Mock Fish. How these days, especially since the advent of bake for a further 30 minutes, oruntil the it got its name I have no idea (though fast-food in its many guises. The last time meat is pulling away from the bones. strangely it did taste slightly of fish), as it I had KFC- and it was a hell of a long To make the gremolata, put the capers, was basically just grated potato, squeezed, time ago, I can tell you - it not only came garlic, lemon zest and parsley leaves bound with an egg, then flat cakes were out of a bain-marie but was dripping so on a chopping board and chop them fried to a golden crispness. Today it is much oil that I threw it out, and vowed together finely with a sharp knife. Serve called a rosti and is served even in high 'never again!' sprinkledover the lambshanks. class eateries. I loved them, and requested So it is time to celebrate comfort food. If Serves 4

32 August - September 2008 BARBEQUE PEPPERY COOKING TIPS GLAZED PROSCIUTTO & When using beans and vegetables MEATLOAF MOZZARELLA (eg cannellini, borlotti beans, capers, peppercorns, potatoes etc) from a tin, 1 small red capsicum FRENCH TOAST always rinse thoroughly under water 400g beef mince 2 brioche rolls, halved (or other soft before using. This removes the taste of 150g sausage mince rolls) the brine, and stops beans being 'farty'. 1 medium brown onion, chopped finely 2 tablespoons store-bought caramelised Keep unused grated mozzarella cheese 2 cloves garlic, crushed onion or chutney n a plastic bag in the freezer. Comes in ¼ cup packaged breadcrumbs 4 slices prosciutto handy for pizzas. 1 egg, beaten lightly 60g mozzarella cheese, sliced Keep cut cheese blocks wrapped in foil ½ cup coarsely chopped seeded green 2 eggs in the fridge. This stops the cheese drying olives ¼ cup milk ¼ cup coarsely chopped fresh basil out and going mouldy. The same applies Cracked black pepper 1 tablespoon coarsely chopped fresh to cold meats, though for no longer then 20g butter oregano 5 days. Spread the bases of the rolls with 8 bacon rashers, rind removed, sliced Keep bottles of lemon and lime juice in the caramelised onion, top with the lengthways the fridge. It is always a shame to waste a prosciutto and mozzarella and sandwich 200g green beans, trimmed lemon by only using a teaspoon of juice. with the tops. BARBEQUE GLAZE Keep unused cut avocado from going Whisk together the eggs, milk and pepper ¼ cup water in a bowl. Heat the butter in a large non­ brown by replacing the stone in the fruit 1 tablespoon tomato paste stick frying pan over medium heat. Dip and wrapping tightly in glad-wrap. To 1 tablespoon red wine vinegar the rolls in the egg mixture, drain briefly, stop going brown when cooking, rub 2 tablespoons brown sugar and cook for 2-3 minutes on each side or with lemon juice. Quarter capsicum; remove and discard until golden and the cheese is melted. seeds and membrane. Roast under grill Serves 2 or in very hot oven until skin blisters and blackens. Cover in plastic or paper for 5 minutes. Peel skin away; cut capsicum SELF-SAUCING into thin strips. CHOCOLATE Preheat oven to 180°C. Line a 8cm x 25cm bar tin with plastic wrap. Oil a PUDDINGS ALDERMAN provrdore 25cm x 30cm swiss roll pan. ½ cup plain flour Combine mince, onions, garlic, 1 ½ tablespoons hazelnut meal breadcrumbs, egg, olives, basil and ¼ cup brown sugar oregano in a large bowl. Press half 1 ½ teaspoons baking powder Quality Australian gourmet food the meat mixture into the bar tin. Lay 3½ tablespoons cocoa, sifted products sourced from the best capsicum strips over the top, leaving a ½cup milk of our boutique companies. 1cm border; press remaining meatloaf 35g butter, melted mixture over capsicums. 1 egg, lightly beaten Turn bar tin onto prepared swiss 1 teaspoon vanilla extract Alderman Providore run product roll tray; remove plastic wrap from ½ cup brown sugar, extra sampling parties for our stocked meatloaf. Cover top and sides of meatloaf 1 cup boiling water lines. If you are interested in with bacon, overlapping bacon. Bake, Preheat oven to 180°C. Sift the flour, hosting a party please contact uncovered, in moderate oven 15 minutes. hazelnut meal, sugar, baking powder and us on 02 9569 6537 I 0421 415 Meanwhile, make barbeque glaze; 2 tablespoons cocoa into a bowl. Add 454 or email us at Combine ingredients in a small saucepan; the milk, butter egg and vanilla and mix [email protected] bring to the boil. Reduce heat; simmer, well to combine. Spoon into 4 x 1 cup uncovered, 5 minutes. ramekins and place on a baking tray. Place (Sydney metropolitan and Pour off any excess fat from meatloaf, the extra sugar and remaining cocoa in a brush with glaze; bake uncovered about small bowl and mix to combine. Sprinkle suburban only) 25 minutes or until meatloaf is cooked over the puddings and pour ¼ cup of Check out the website: through. Stand 10 minutes before slicing. water over each. Bake 12-15 minutes or www.aldermanprovidore.com .au Serve beans with meatloaf. until the tops are firm. Serves 4 Serves 4

Talkabout 33

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Quantity Item Ordering organisation's name Health Promotion Fact Sheets

Contact in organisation 1 Efavirenz Managing Side Effects

2 Boosting your energy Postal address 3 Getting Started on Combination Therapy

State 4 I want to return to work

Ph 5 Living with body shape change

6 Positive Pregnancy-Available on the website only Fax 7 Clinical Trials

Email 8 A Night with Tina (Methamphetamine and HIV) - Available on the website only Date ordered 9 HIV and your mouth (a pamphlet is also available)

Quantity Item 10 The Dynamics of Disclosure -Available on the website only Social Marketing Campaigns 11 What you need to know about syphilis 10 reasons to test for STls encourages regular testing for sexually active positive gay men. - Health Promotion 12 Changing Horizons - Living with HIV in Rural NSW Fact Sheet No 15, one double sided poster and three post cards 13 Surviving the Centrelink DSP Review Positive or Negative HIV is in Our lives looks at the 14 Growing Older- Lving Longer with HIV learning and practices gay men take on to manage risk, disclosure and the assumptions about sero-status. 15. 10 reasons to test for STls -Available on the website only - Fact Sheet 1 Living with Risk and Taking Control: Why do we take risks? How do I manage risk and take 16 Relationship Agreements Between Gay Men control? If I have had unsafe sex what can I do to take back control? How do I deal with a positive diagnosis? 17 Dealing with diarrhoea - Fact Sheet 2 Positive Sex and Risk: What does risk mean after a positive diagnosis? Do boundaries and 18 Disclosing to your child attitudes to sex change? How do we think or talk about risk? - 4 post cards with key campaign images Posters (double sided) Getting On With It Again Living longer with HIV 1 0 reasons to test for STls (booklet) is based on stories and interviews and shares some strategies for change and enhancing the quality of life Post Cards of people I iving longer with HIV. HIV doesn't discriminate people do (3 postcards) Get The Facts Syphilis (booklet) updates HIV positive gay men who practice adventurous sex on strategies to Workshop Resource maintain their health and the health of their partners. Key messages focus on transmission, the importance of testing for syphilis and strategies to prevent them from getting or Let's talk about it (me, you and sex): a facilitator's resource & passing it on to their partners. workshop guide on positive sexuality. (160 pages)

All resources listed are free of charge. Positive Life NSW Fax: 02 9360 3504 Ph: 02 9361 6011 For large orders we will invoice you for postage. PO Box 831 Email: [email protected] Mail, Fax or Email Order to: Darlinghurst NSW 1300 Website: www.positivelife.org.au A national community-based HIV treatme infoline f,or people living with H,IV FREE CALL MONDAY-FRIDAY 2-7PH EST All CALLS ARE STRICTLY CONFIDENTIAL FREE FRON AUSTRALIAN LANDLINES AND MOBILE PHONES. If you need an Interpreter, plrne call the Translating and lnterpre.tlng ,Service ms Natlonal) on l3t 450 and ask to speak Callers to treataware can talk to trained HIV information educators about HIV treatment and health issues including: • Information about HIV and taking HIV treatments • Steps to good health care planning • Services and programs to support health and wellbeing. treataware aims to help you make the best HIV-related health choices in partnership with your doctor. 9.I~-~~..~.~9.J.~~.I!..f~~~:.t~~~W.~-~ HIV CllNICAl TRIAIS WIBSIU iCHlCHUU GUID'I JO HIV TRIATMBtT an internet-based register of Au~tralian a guide for HIV+ peeple researching , t- HIV clinical trials treatments options with their doctor~ FOLLOW THE LINKS ON www.treataware.info

A PROJECT OF treataware www.treataware.info h • u rt a p r

• om OU AIDS n 2 2

The Royal Botanic Garden,s. and Domain will be a wonderful backdrop for a leisurely Sunday morning stroll during AIOS Awareness Week to

show your support for people llvlng with HIV/AIDS.

You can walk the. two kitometres at your own pace anyt101e between

11am and 2pm 011 Sunday 23rd November. Get a team together and walk with friends, family or workmates.

The registration fee Is ofl:ly $20 and sponsors can pledge donations

of support All monies raised will go towards the advocacy, care and

support: services of NSW's three peak HIV/AIDS charlllcs.

A short walk will, go a long way. r e 'al s I or re information II 1 1011

Proudly supported by: Botanic Positive 1:~NSW Gardens aeon ,.,...... - ..tt ~ ►ttv .i...... ,. Trust fi..D'.~GOOIIC:OV.',IUr~ ~~~ HtHHW j£,,Lffl& \".IELL.8Et~K, ----