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Winter is not a surprise and neither is homelessness

Why is Toronto so tragically unprepared to take care of our homeless population when deathly cold weather arrives? Let’s prepare for next year today and do whatever it takes to help today’s homeless today.

A man sleep on a sidewalk near the intersection of Bay St. and Queen St. W. in downtown Toronto on Wednesday.
A man sleep on a sidewalk near the intersection of Bay St. and Queen St. W. in downtown Toronto on Wednesday.  (CARLOS OSORIO / TORONTO STAR) |ORDER THIS PHOTO  

It’s Canada. It’s winter. And unsurprisingly we find ourselves in a multi-day cold snap. For most of us it’s not that big a deal. Our outdoor New Year’s Eve celebrations get cancelled, we snuggle a little deeper into our sweaters and we turn up the thermostat. When we have to leave the house or work we bundle into warm jackets and minimize our time outside.

Unfortunately the homeless in our community do not have the same options. As a family doctor and an emergency department physician I know that for the homeless these bitterly cold conditions are not just an inconvenience but a potentially life threatening condition.

I remember ending the year 2013 standing near Yonge St. and College St. at the memorial for Richard Kenyon, who received care at my clinic. He froze to death over several hours outside of large grocery store.

Since then others in Toronto have died from the cold. I have a sense of dread as the temperature plummets that more of my patients and those of my colleagues who also work with the precariously sheltered will die of exposure on our streets. Safe, accessible, warm shelters are not the only answer but they are a critical part.

It is heart warming to read about citizens pitching in, however, this does not seem like an appropriate, systematic approach to an urgent health issue. The city has taken a number of steps to increase the capacity of our shelter system. Recognized experts, such as street nurse Cathy Crowe, have clearly said that the actions to date are insufficient. My patients and others have raised concerns over the total number of beds, their location and the overall conditions of the available warming shelters.

One of the frustrating elements for someone at the front lines of care is that it seems like we are in a chronically reactive mode. We seem surprised that we have dangerously cold weather that affects some of society’s most vulnerable people. We are left reading about last minute-openings of shelters, heated debate about the adequacy of responses. A war of words, petitions, articles and opposing interviews have broken out — particularly around an urgent call to open the armouries for additional shelter as has been done multiple times in the past and finally agreed to on Wednesday. I have not heard a compelling argument against this recommendation.

As a doctor I know that our health care system has incredible contingency plans and resources at the ready for events (fortunately) far less likely to occur than cold weather, including large chemical spills, huge fires, multi-trauma accidents and even nuclear events. I am proud of our system for being ready for these potential disasters. I am far less proud that we seem unready to provide appropriate resources for what is a commonplace health risk for the highly vulnerable.

Let’s consider three points:

First, let’s acknowledge now that next year winter is going to come again and almost certainly we will have some dangerously cold days. Let’s start planning for those days now and not rely on last-minute community campaigns to drive policy or the generosity of a few remarkable people who pay for hotels or open their homes.

Second, this urgent issue is a broader conversation in the city and nationally about how we care for the tens of thousands of homeless across the country. It is a complex problem without easy solutions … but solutions do exist and many recommendations from expert groups have been made. As winter turns to spring and this immediate urgent issue abates we need to make sure we do not lose sight of this broader problem.

Finally, today, lets do everything we can make sure we do not wake up tomorrow to a headline of another homeless person frozen to death on the streets of Toronto. If we need to improve the conditions of the current facilities let’s ensure that happens. If there are better options let’s act on them now. These are members of our community and they deserve to stay warm enough to live.



‘We dropped the ball’: Some Indigenous people had access to HIV drug for years without knowing

‘It shows gaps and fissures within our heath-care delivery system,’ activist says of Truvada coverage

Two-spirit activist Harlan Pruden says First Nations organizations failed Indigenous people by not disseminating enough information about a groundbreaking HIV/AIDS treatment.

Two-spirit activist Harlan Pruden says First Nations organizations failed Indigenous people by not disseminating enough information about a groundbreaking HIV/AIDS treatment.

When two-spirit organizer and HIV/AIDS activist Harlan Pruden heard the news that the preventative drug PrEP was now available cost-free in B.C. he was elated.

“It’s phenomenal news that B.C.’s community now has access to this evidence-based, effective HIV prevention intervention,” Pruden said.

But he said very few Indigenous people know that the brand name version of the drug, Truvada, has been free for First Nations people in the province for several years.

“What is astonishing about this is that First Nations and Inuit rarely have first access to anything, and where was the news story about this three years ago?” Pruden asked.

First Nations have had free access since 2013

The B.C. Centre for Excellence in HIV/AIDS recently procured an affordable generic brand of PrEP, also known as pre-exposure prophylaxis treatment, that enabled the province to provide it for free to those at a high risk of contracting the virus. It can reduce the risk of HIV infection by more than 90 per cent.

Meanwhile, the First Nations Health Authority confirmed that First Nations in this province have had free access to Truvada since the end of 2013. Over the last three years, only 23 people have made use of the free drug.

Pruden blames Indigenous organizations for not getting the word out.

“I think that we dropped the ball given that the community could have been accessing this intervention if they chose, but nobody knew about it,” Pruden said.

In its defence, the FNHA said decisions related to specific health treatment options occur between clients and care providers.

“We do encourage clients living with risk factors to talk with their health-care provider or doctor where treatments like PrEP and other options can be discussed,” a FNHA spokesperson said.


Starting on Jan. 1, the province of British Columbia began covering the costs of pre-exposure prophylaxis treatment (PrEP) for at-risk people. (CBC)

But Pruden argues there should have been promotional material displayed in communities or on social media, similar to how the recent news about universal access was disseminated.

“It shows the gaps and the fissures within our heath-care delivery system,” he said.

‘I feel it was a missed opportunity’

Indigenous people only represent five per cent of the total population in B.C., yet account for 15 to 17 per cent of new positive HIV tests each year, according to the Provincial Health Officer’s Annual Report.

PrEP user and Community-Based Research Centre director Jody Jollimore said he feels there was not enough awareness and education created in First Nations communities about PrEP being free to them.

“I feel it was a missed opportunity. There are a number of barriers, and as activists we left behind a population, and we are trying to rectify that,” he said.

Dr. Julio Montaner of the B.C. Centre for Excellence for HIV/AIDS blames the lag in communication on the nature of fragmented Indigenous communities.

“I think it would be fair to say that when you have programs that are available to a particular community and not the larger community, the knowledge translation that happens in the community is limited,” he said.

Harlan Pruden

Harlan Pruden was a Barack Obama appointee to the U.S.’s Presidential Advisory Council on HIV/AIDS from 2014 to 2017. (Harlan Pruden)

By Angela Sterritt


Diabetes in people with HIV over 50 overwhelmingly linked to old antiretrovirals, not age or body weight

People with HIV over the age of 50 are more likely to have developed type 2 diabetes if they started antiretroviral treatment before 1999 or had a longer exposure to older antiretroviral drugs such as stavudine (d4T) or first-generation protease inhibitors such as nelfinavir or indinavir, according to a study of people receiving HIV care in British Columbia, Canada.

The onset of diabetes was much less likely in people aged 50 and over who started treatment from 2010 onwards, or who started treatment at a higher CD4 cell count, according to study findings published in the journal BMJ Open Diabetes Research & Care.

The findings are likely to provide reassurance that modern HIV treatment carries little risk of promoting the development of diabetes in people with HIV.

Diabetes mellitus, or type 2 diabetes, develops as a consequence of failures in the body’s ability to handle glucose. Production of insulin, the hormone which regulates glucose levels, may decline or cells may stop responding to insulin. When this happens glucose stays in the blood and is not taken up by cells for use as fuel. Over time, a high level of glucose in the blood leads to damage to small blood vessels, causing kidney damage, cardiovascular disease, lower limb damage and loss of sight.

Type 2 diabetes is more common in people who are obese and becomes more common with age. People with HIV are more likely to be diagnosed with type 2 diabetes but it is unclear to what extent HIV-related factors lead to a higher incidence of diabetes in people with HIV.

To investigate this question researchers at the St Paul’s Hospital, Vancouver, the University of British Columbia and the British Columbia Centre for Excellence in HIV/AIDS analysed the incidence of type 2 diabetes in people living with HIV who started treatment at St Paul’s Hospital up until July 31 2015. The cohort was predominantly male (89%) and white (83%) with a high prevalence of hepatitis C co-infection (43%) and AIDS-defining illness during the follow-up period (31%).

Patients were classified as having developed type 2 diabetes if at any time they had a blood sugar measurement above 11.1 mmol/L, or HbA1C > 6.5%, or had been prescribed antidiabetic medication or been recorded as diagnosed with diabetes.

Out of 1065 people who were aged 50 or over in July 2015, 235 people developed diabetes during an average of 13 years of follow-up. This represents an incidence rate of 1.61 new cases per 100 person-years of follow-up, 39% higher than the observed rate in the Canadian general population.

The study found no significant difference in the risk of developing diabetes by age at HIV diagnosis or age at treatment initiation, nor was developing diabetes associated with having hepatitis C virus antibodies or with injecting drug use. Sex, weight, or latest body mass index were not associated with the risk of developing diabetes.

In a further analysis restricted to people who had pre-treatment viral load measurements available (N = 1065), the development of diabetes was associated with several HIV-related factors including lower CD4 cell nadir, lower CD4 cell count at antiretroviral therapy (ART) initiation and ART initiation in the period 1997-2004. People who started treatment with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen were less likely to develop diabetes (p = 0.003).

After controlling for other factors in a multivariable analysis, people who started treatment in the period 1997-2004 were almost 50 times more likely to develop diabetes compared to people who started treatment between 2005 and 2009 (adjusted odds ratio 48.9, 95% confidence interval 21.32-112.17).

In univariate analysis the duration of treatment with each of stavudine (d4T), zidovudine (AZT), lopinavir, indinavir and nelfinavir was associated with an increased risk of developing diabetes. In the case of stavudine, each 10% increase in time on the drug was associated with 39% increase in the risk of diabetes (OR 1.39, 1.27-1.53) while for nelfinavir, the risk increased by 63% for each 10% increase in time on the drug (OR 1.63, 1.19-2.24).

On average, people who developed diabetes spent 21% of their time on treatment taking a regimen that contained stavudine, whereas those who did not develop diabetes were exposed to the drug for 7% of the time they had taken antiretroviral treatment (p < 0.001). There were similarly pronounced differences in the duration of drug exposure between those who developed diabetes and those who did not develop diabetes for the nucleoside reverse transcriptase inhibitors (NRTIs) didanosine and zidovudine, and for the protease inhibitors indinavir, nelfinavir and lopinavir. People who developed diabetes had significantly less exposure to the newer antiretrovirals tenofovir, atazanavir and darunavir compared to those who did not, reinforcing the authors’ conclusion that diabetes in people with HIV is chiefly a consequence of first-generation antiretroviral treatment.

The effect of some protease inhibitors and NRTIs on the development of insulin resistance is well-established, say the authors, who report that the incidence of diabetes began to drop sharply after 2000, with only two diagnoses of diabetes in the entire clinic population between 2010 and 2015. This change coincides with the replacement of indinavir, nelfinavir and stavudine by NNRTIs and by the nucleotide analogue tenofovir in first-line antiretroviral treatment.

The authors say that it is important to monitor for type 2 diabetes in people with HIV, but stress that “the incidence of diabetes mellitus is likely to decline in PLWH [people living with HIV] who initiated ART more recently with the use of newer ART agents.”

Author: Keith Alcorn


B.C. to cover cost of abortion pill Mifegymiso

Starting Jan. 15, province to become the sixth in Canada to make the pill universally available at no cost

Starting Jan. 15, B.C. joins five other Canadian provinces in offering the pregnancy termination drug for free.

Starting Jan. 15, B.C. joins five other Canadian provinces in offering the pregnancy termination drug for free. (Submitted by Celopharma)

According to a B.C. health ministry press release, universal, no-cost coverage for the drug, which is also known as RU-486, will be available to patients with a valid prescription at pharmacies around the province.

Mifegymiso is an alternative to surgical abortion and can be used to terminate early-stage pregnancies of up to nine weeks.

“It’s the gold standard in terms of health care for women,” said Dawn Fowler, executive director of the Vancouver Island Women’s Clinic, which advocated for the change. “It significantly reduces barriers to access for women across the province.”

The cost of surgical abortions has been covered in B.C. for many years, but medication abortions for women without PharmaCare coverage can cost approximately $300.

‘It’s a game-changer’

Additionally, over 90 per cent of surgical abortions take place in high density centres like Vancouver and Victoria, according to Dr. Wendy Norman of the UBC Faculty of Medicine.

“It’s a game-changer, particularly in B.C. with our geography. Women from all over the province are sometimes travelling many hours to get to a community where they can have a surgical abortion,” said Norman.

“[Now] your abortion can be done by going to see your usual primary care physician or nurse practitioner in your own community. You don’t have to leave your family, your children, your job to travel to a big city to have an abortion anymore.”

Mifegymiso became available to the Canadian public in January 2017 and is already available free to women in Alberta, Ontario, Quebec, New Brunswick and Nova Scotia.

“This medicine has been available for nearly 30 years in more than 60 countries in the world, so we know that it is effective and safe,” said Norman.

Patients who are prescribed Mifegymiso must first undergo an ultrasound to confirm they do not have an ectopic pregnancy, which occurs outside of the uterus.

The medication consists of two different drugs — mifepristone and misoprostol — which are taken up to 48 hour apart.

“Shortly after, cramping and bleeding would happen that would be very similar to a miscarriage. Within a day or two that bleeding is usually complete,” said Norman.

According to the news release, all B.C. pharmacies will be able to order the drug as needed and stock will be available at rural and remote pharmacies, as well as those that have previously dispensed high volumes of the medication.

Provincial Health Minister Adrian Dix said increasing the availability of Mifegymiso was the right and prudent thing to do.

“This just ensures fairness of access to everyone, wherever they are in B.C.,” he said.

By Karin Larsen


Why Has Science Only Cured One Person of HIV?

Image: CDC

In 2007, a young American man living in Berlin became a marvel of modern medicine when, 12 years after he was diagnosed with HIV, the virus suddenly disappeared from his body. Timothy Ray Brown had been diagnosed with leukemia and received a stem cell transplant treat it. His stem cell donor, it turned out, had a rare genetic mutation known as CCR5-delta 32 that gave Brown resistance to HIV infection. Brown became known as “the Berlin patient.” Ten years later, he is still the only person to have ever been cured of HIV.

A new study published Thursday in PLOS Pathogens shows a new potential route to curing HIV—though it also highlights the extreme difficulties facing researchers.

“We’ve effectively only cured one patient,” Scott Kitchen, the lead author on the UCLA study, told Gizmodo. “But that provides a lot of hope.”

In the new study, researchers took a page from Brown’s treatment, hoping to stimulate the body’s immune system with engineered stem cells to fight off HIV. First, blood-forming stem cells were engineered to carry genes that transform the cells into targeted killers, capable of detecting and destroying HIV-infected cells when they show up in the body. The technique works by hijacking the same molecule, CD4, that allows HIV to bond to a cell’s surface, using the molecule as a signal to bind to HIV and kill it. Then those stem cells were put into the bodies of two primates via a bone marrow transplant. It’s a form of treatment known as CAR-T immunotherapy.

“HIV damages the cellular immune response—that’s what makes it so effective,” Kitchen said. “So in order to effectively clear it, we need an effective immune response. We’re providing that.”

CAR-T has shown promise in treating HIV before, but with this new approach, researchers found that the primate’s bodies kept producing the CAR-expressing cells for more than two years after the initial infusion without any adverse effects. This suggests the potential for a long-term solution that could reduce a person’s dependence on antiviral medications and potentially even completely eradicate HIV from the body, attacking even HIV lurking dormant in the body’s reservoirs whenever it comes roaring back to life.

“We believe it is a component to a cure, used in combination with something like antiretroviral therapy,” Kitchen said. “This shows a cure is effectively possible.”

Recently, there have been some other promising breakthroughs in eliminating HIV, but so far, researchers have mainly succeeded in curing HIV in mice. Earlier this year, scientists at Temple University used CRISPR to edit HIV DNA out of mice. A handful of clinical trials are under way attempting to cure humans with HIV through combinations of gene and stem cell therapies, but it’s unclear whether these will actually work long-term. (Earlier this year, a biohacker also injected himself with a DIY HIV cure, though it’s highly unlikely that his approach will work.)

Technologies like gene editing have made finding a cure for HIV seem possible, but there are still many technical hurdles in the way. A true cure may still be a long ways off.

The biggest hurdle in creating a cure is making something that lasts long enough to battle the persistent reservoirs of the virus in the body. This is the problem that the UCLA research was trying to solve. But to get there, scientists will have to improve the ability to edit cells within a patients body, rather than removing them, editing them in a lab, and then reinserting them back into the patient. There is also room for improvement in our ability to locate the genes that need to be manipulated, which are scattered throughout the body. And to further complicate things, because HIV is known to develop resistance to treatments—even CRISPRa combination of therapies will likely be more successful.

This year, the Foundation for AIDS research put out a request for proposals to address those hurdles.

“The availability of tools and targets suggests that designing a gene therapy intervention to cure HIV is arguably a question of technology rather than discovery,” Rowena Johnson, the foundation’s director of research, wrote in a paper at the time. “However, the feasibility of the approach is still a major hurdle. The timeline, cost, and complexity of testing gene therapy in the clinic are formidable.”

So far, there has been much more optimism in using gene therapy to make the body’s cells immune to HIV instead. In these approaches, the virus is prevented from entering a cell in the first place. It’s an easier task, because it doesn’t require dealing with the problem of a dormant virus that flares up over a long period of time. Several clinical trials for these kinds of therapies are also under way.

“Brown was just an extraordinary case,” Kitchen said. “He went through two bone marrow transplants. That would normally kill someone. And we still don’t know exactly how it worked.”

In the case of the new UCLA research, the biggest hurdle is figuring out the most effective way to transplant the smallest number of stem cells possible into the body of an infected patient. Ideally, he said, they would like to develop something like a vaccine that doesn’t require an invasive procedure like bone marrow transplant, but for now, that thought is mostly “science fiction.” Still, Kitchen said, clinical trials for their new approach are likely just two or three years away.

A cure might not be right around the corner. But for the first time, it’s starting to appear on the horizon.

Author: Kristen V. Brown


Province to fully fund HIV-prevention drug PrEP

In August 2016, the Common Drug Review recommended PrEP for coverage, contingent in part on a lower price for the drug Truvada being secured. (

B.C. government to fully fund pre-exposure prophylaxis following pressure from activitsts, doctor

A preventative medication to protect British Columbians who are at a high risk of HIV infection will soon be made free, following activists and doctors calling on the government to subsidize the drug.

Effective Jan. 1, pre-exposure prophylaxis – also known as PrEP – will be available at no cost through the BC Centre for Excellence’s HIV Drug Treatment program, which is funded by the Ministry of Health through the B.C. PharmaCare program.

Daily use of the oral antiretroviral medication is recommended by the World Health Organization and the BC Centre for Excellence in HIV/AIDS as an effective method to prevent HIV in people at risk of infection, the province said in a statement Thursday.

In an open letter to the province published in August, B.C. doctors and public health groups including AIDS Vancouver Island and Living Positive Resource Centre called on Premier John Horgan to begin funding the drug.

“As organizations that serve vulnerable populations, we know that PrEP works and that stigma around talking about sex, HIV, and being gay is a continued barrier to reducing HIV diagnoses. We know more than ever about how to treat this virus and how to prevent it,” the letter read.

In addition to funding PrEP, the province is also expanding the existing PEP program to include coverage for non-occupational exposure, so those who are exposed to HIV have immediate access in order to prevent a new infection.


Local, national alarm over CDC censorship 

Words matter.

That’s why so many people and organizations were alarmed by reports that the Trump administration told top Centers for Disease Control officials to avoid seven terms as they prepared budget documents: transgender, fetus, evidence-based, science-based, vulnerable, entitlement, and diversity. (The CDC’s head denies that the terms are banned and that any language suggestions were meant to help dodge criticism from Republican Congress members, but skepticism abounds.)

And that’s also why the Out Alliance – formerly the Gay Alliance of the Genesee Valley – organized a demonstration last Thursday protesting the directive. The organization’s leaders say the CDC’s whole purpose is to work on saving lives, and the administration’s reported actions remind them of a time when silence about a serious public health crisis cost many lives within the LGBT community.

“One of the last memorable times the CDC and other federal agencies have avoided certain language was really notably during the AIDS epidemic in the 80’s,” says Rowan Collins, communications manager for the Out Alliance. “People were dying every day from HIV- and AIDS-related illnesses because the federal government refused to say the words and refused to put money behind programming.”

The country didn’t make progress on the HIV/AIDS epidemic until the government and the public acknowledged the crisis and the fact that it was disproportionately affecting gay people, Out Alliance leaders said in a press release about its demonstration. Public health threats need to be described clearly in order to be addressed, or the consequences can be fatal, the release says.

But as the CDC has acknowledged LGBTQ people and their public health needs, it’s been able to do research that has, in turn, led to better policies and health outcomes for the population, Out Alliance leaders say.

Organizations across the country now fear that the CDC is about to take a big step backwards. If agency officials aren’t free to talk about vulnerable populations – whether they’ve been directly ordered to avoid the term or whether they feel pressure to avoid the topic – then the agency may not be able to adequately address the specific public health needs of rural populations, of people living in tribal areas, and of low-income people, Collins says.

The Out Alliance and other LGBTQ advocacy groups across the country are also worried about the inclusion of “transgender” on the list of banned words. They fear that the CDC may not look at “the transgender community and the specific health risks that exist within that population,” Collins says.

Michael Halpern, deputy director of the advocacy group Union of Concerned Scientists, lashed out at the directive as an extension of the Trump administration’s “assault on science.” He pointed to the Trump administration’s scrubbing of climate change references from federal websites as an example. And he referred to several other actions restricting public and media access to scientific data, killing studies on issues including teen pregnancy, and preventing staff from speaking on issues including climate change.

In one post, Halpern called on the CDC’s new director, Dr. Brenda Fitzgerald, to make it plain and clear that agency staff members aren’t restricted from using the so-called banned words and that they’re encouraged to make science the focus of their work. And he referenced that agency’s own scientific integrity policies – though they date to the end of the Obama administration – which emphasize research and results that drive decisions and aren’t influenced by policy or political issues.

“Actions that divert the agency from its grounding in science could compromise the progress they are making in tracking opioid overdoses, reducing teen pregnancy, protecting the elderly from the flu, and slowing HIV transmission among transgender Americans,” Halpern wrote in one of the posts.


Institute Of Human Virology Targets Schools For HIV/AIDS Campaign


The Institute of Human Virology, Nigeria has restated its resolve to shift the HIV/AIDS campaign to schools by working closely with the school authorities to achieve an HIV free country.

Dr Patrick Dakum, the Chief Executive Officer of the Institute stated this in Abuja as he listed the inauguration of its N2 billion seven-floor twin tower building and the shifting HIV/AIDS campaign to schools as priority of the institute.

According to him, the institute would strive hard to ensure that youths as the leaders of tomorrow lived an AIDS-free nation, saying that IHVN would be available to mentor students to achieve an HIV free country.

“Nigeria has made a tremendous effort in the fight against HIV. We were formally at 5.8 per cent but today it has reduced to 2.9 per cent, so we have achieved a great deal. We targeted the schools this year and we will work closely with the school authorities and the students,” he said.

Admitting that much still needed to be done to achieve resounding success in the fight against the HIV/AIDS scourge, Dakum it becomes imperative to target schools ‘because it is the youth that is becoming more infected, so we need strategies to help them stay negative and prevent themselves from becoming positive.’

Dakum, therefore, urged Nigerians to spread the message of HIV across their neighbourhood as every individual has a role to play in the fight against the spread and to stop stigmatisation.

He said the institute had been partnering effectively with the Federal Government in the treatment of HIV/AIDS and other opportunistic infections.

Dakum said the institute had been engaged in the treatment and management of HIV/AIDS patients and other related ailments in 35 states and FCT.

On the N2 billion seven-floor twin tower building on Airport Road, Abuja, he stated that the project now on the fourth floor would be inaugurated in the first quarter of 2019.

Looking Back on 2017 in HIV/AIDS, and What’s in Store for 2018

Looking Back on 2017 in HIV/AIDS, and What’s in Store for 2018

The Political Climate Challenges Our Ability to Keep Making Gains in Ending the Epidemic, Even as We’re Beginning to See Some New Possibilities for Success

Kenyon Farrow

Kenyon Farrow (Credit: Derrick Watkins, DW Photography)


I can safely say this was a year for the record books, and in some ways that we’d never expected. Given the Trump administration and the Paul Ryan (R-WI)/Mitch McConnell (R-KY)-led House and Senate efforts to repeal the Affordable Care Act, we were in danger of losing so much ground. The President’s budget called for major cuts in domestic and global HIV spending. Work to end mass imprisonment and the war on drugs was set back by the appointment of Jeff Sessions to the office of the attorney general, and his vow to ramp up the full prosecution of people under criminal drug laws, no matter how minor. The threats to immigrants in the U.S. have created an even more hostile environment, particularly for people of color, and the list can go on and on.

But the HIV community fought.

Not only did the community fight, but we won several key battles. HIV/AIDS organizers Jennifer Flynn, Jaron Benjamin and Paul Davis created a national, grassroots strategy of civil disobedience that mobilized thousands of people to demonstrate against the rollback of the ACA. And their strategy — which many believe was the deciding factor in pushing back round after round of terrible bills — helped do what many of us always say we want to do: move HIV out of its silo and connect it to larger movements for social justice. Positive Women’s Network, under the leadership of Naina Khanna, created toolkits and mobilized call-in days for people living with HIV around the country to become local leaders in the fight. In conjunction with the grassroots mobilizing, the Federal AIDS Policy Partnership worked tirelessly on Capitol Hill to advocate against the regressive bills that would have left millions without health coverage.

It’s no exaggeration to say that if it were not for the waves of civil disobedience from the HIV community, reproductive rights/justice, disability justice organizations, and the entire country could have lost all of the unnamed benefits and protections that the Affordable Care Act put in place.

Not Just Defense: Progress in the Pre-Trump HIV Agenda

Not all the work that happened was fighting against losses. Many people in the community continued to pursue the fights that were important before this administration and Congress took seat in office. Advocates in several states introduced legislation to end or severely reduce the use of HIV criminalization laws. We were most successful in California and Colorado, where we won clear victories. Advocates across the country continued to support Michael Johnson in Missouri; though he remains in prison, he did win an appeal that led to a reduced conviction of 10 years, and an admission by the prosecutor that the law (one of the most severe in the nation) should be repealed. Missouri advocates are currently working to build off of the momentum to develop a new bill to repeal this law.

Other activists continued to join the national movement to develop local, county and state “ending the epidemic” or “getting to zero” plans around the country. The ACT-NOW: FIGHT AIDS coalition led a fiery plenary session at this year’s United States Conference on AIDS, showing the collaborative leadership of activists, providers and health department leadership towards ending the epidemic in the U.S., city by city, state by state. Treatment Action Group and Southern AIDS Coalition partnered to support key jurisdictions in the South to develop End the Epidemic plans; Nashville, Alabama and Louisiana have held meetings to begin working on those in 2018. And in New York state, the first to launch a plan, there’s evidence that the strategy is working: The state recently reported drops in new HIV diagnoses — even among Black and Latino gay and bisexual men, among whom very few jurisdictions have seen any success. Unfortunately, overall rates of HIV remain extremely high among Black gay/bisexual men nationwide, and resources for transgender women and men remain low. Overall HIV rates for Latinx gay/bisexual men and transgender women continue to climb, for reasons we have yet to find.

One of the most significant game-changers happened this year when the Centers for Disease Control (CDC) announced it was adopting the science that shows people who are undetectable do not transmit HIV. This change happened not just because of the incontrovertible science. Prevention Access Campaign, which launched the U=U movement, organized for more organizations and health departments to sign on to this statement, and continued to advocate for CDC leadership to do the same.

Issues Brewing for 2018

While there were some major successes in the field over 2017, we still have some major issues developing in 2018 to which we will be paying close attention.

In addition to the outright attacks on the ACA, the tax reform bill passed at the end of 2017 threatens to upend the individual mandate upon which the ACA depends. This would mean that individuals could choose not to purchase insurance, removing the incentive for insurers to offer plans on the ACA marketplace to begin with. This would leave fewer options in plans for people living with HIV, and make the existing plans largely unaffordable. And people living with HIV in states that did not expand Medicaid have even fewer options for coverage. We will continue to cover how the health care landscape is creating challenges for access.

Other issues brewing for 2018 that are direct threats to existing HIV research, prevention and care abound. Recent news reports have suggested Congress is considering moving resources from the Ryan White HIV/AIDS Program into opioid addiction treatment and services. Evidence-based harm reductionmodels and drug treatment are critical to a comprehensive strategy to prevent HIV. But there are debates about whether the focus on creating more infrastructure on opioid use in rural and white America will come at the detriment of resources for urban and Black and Latinx communities.

While federal spending on research through the National Institutes of Health (NIH) is often touted as one of the few areas of bipartisan support in Congress, HIV research funding has specifically been questioned by some Republican members of Congress, and may not receive overall increases to the NIH budget that have been appropriated in recent years. And while AIDS research funding remains in question, the NIH has begun its process of restructuring and setting priorities for global AIDS research networks, which will affect the HIV research portfolio through 2027.

News and Facts Matter

We end the year with news that we may be going back to Bush-era style gag orders on CDC word usage. The Federal Communications Commission voted to end net neutrality, which means even public health news sources like could be blocked by internet providers because they don’t like the source of news and information about sexual health for people and communities living with HIV. We have a lot of things happening at once that may challenge our ability to keep making gains in ending the epidemic as we’re beginning to see some new possibilities for success.

But the reason I’ve remained in HIV so long is not just because I’m a Black gay man. It’s not just because, despite being HIV negative, it remains a primary issue that impacts me and my community. I have continued to do this work because I have found community in people who’ve proven to be the bravest, smartest, and most strategic I’ve ever known, despite being a group that’s among the most socially maligned. The HIV community knows how to show up, despite our many differences, when we need to save people’s lives. We remain committed to facts, to evidence, and to sharing information as resources to help people feel less alone, less afraid.

We will continue to provide the news, the analysis, and the opinions of the community. We don’t have a choice — lives are at stake now. But for us, they have been for a long time.

Kenyon Farrow is the senior editor of and

Follow Kenyon on Twitter: @kenyonfarrow.


‘Heart of Davie Village’ Unveiled in the West End

Since their first recorded history, ‘gay villages’ have played an important role in the increased visibility and acceptance of the LGBTQ2+ community.

Designed by local Westender, Jim Balakshin, the ‘Heart of Davie Village’ gateway sign will be a beacon for the community that will symbolize the reorganizing of heteronormative spaces into more welcoming and safe landscapes.

Read on as Jim explains the inspiration and process behind the Heart of Davie Village, the connection to the community, and how he hopes the piece will be interpreted:

What is the inspiration behind your installation, the ‘Heart of Davie Village?”

The development of the city of Vancouver is highly influenced by the arterial streets that cross the landscape. The identity of many neighbourhoods are defined by the urban villages that line these corridors and serve nearby residents. This installation aims to celebrate the diversity of the West End and vibrancy of the Davie Village.

Describe the installation

The Heart of Davie Village is a 1.25m x 1.25m (4 feet x 4 feet) heart-shaped neon sign. The piece is double-sided and mounted on a pole 3 metres (10 feet) in the air. The sign was constructed using traditional signage materials such as steel and glass tubes, and was completed by skilled craftspeople and artists who have decades of experience hand painting signs and bending neon tubing.


Why a neon sign?

There was a time in the 1950s when Vancouver had more than 19,000 neon signs —one for every 18 residents! The city was adorned with a dazzling array of animated neon tubes in a kaleidoscope of colours that symbolized cosmopolitan glamour and excitement. By the late 1960s however, opinions changed and anti-blight crusaders convinced City Hall that neon was a sleazy light source that overshadowed the city’s natural beauty. New laws were passed which prevented the fabrication of signs, and neon light slowly disappeared from city streets. Today only a few dozen great examples from that era remain. I chose to use neon because of its uncanny ability to appear timeless, neon can project memories and fantasies from an earlier era, yet still generate meaning and significance today. Even though neon signs are increasingly being replaced by light emitting diodes (LEDs) and digital displays, new electronic signs cannot replicate the artistry and soul of hand blown neon tubes nor the vitality neon adds to an urban environment. For that reason, many historic neon signs have become treasured landmarks in both time and space.

In what way(s) do you hope this piece will shine a light on the West End?

Since their first recorded history at the turn of the 20th century, ‘gay villages’ have played an important role in the increased visibility of the LGBTQ2+ community, and the overall acceptance of gender and sexual minorities.

Often located in highly-dense, inner city districts, ‘gay ghettos’ emerged as places of refuge for members of the queer community in an age when society made no effort to disguise rampant homophobia, transphobia, and discrimination. These villages embraced diversity and became landing pads for newcomers to cities.

At a time when homosexuality was illegal, very few establishments welcomed members of the LGBTQ2+ community.

These early gathering spaces appropriated spaces for safety and support, and fostered a shared sense of identity that celebrated sexuality rather than hiding it. LGBTQ2+ Establishments began congregating on Davie Street in the 1980s. This increased sense of belonging and community overflowed from the bars into the streets, and eventually spread throughout the entire neighbourhood.

The ‘Heart of Davie Village’ is a recognition of the historical geography of the Davie Village and the contributions of the community towards the political advancements of LGBTQ2+ rights across Canada.

“Like lighthouses, visible at great distances, they draw travellers through the darkness down highways and city avenues, promising that under the neon glimmer is a sanctuary.” – Chris Ross

How do you hope the public will interpret this piece?

The design of this project was highly influenced by the historic vernacular of roadside signage and advertising imagery. The size, materials, symbols, colours, and typography are simple typologies and are open to interpretation. I hope everyone can find meaning in it, and feel a sense of place and belonging. My wish is that this piece will symbolize the collective spirit and diversity of this great community, and the vibrancy of the Davie Village.

Follow Jim on Instagram: @jimbalakshin  #heartofdavievillage #lumiereyvr