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What growing old looks like when you’re living with HIV

We need to be seen as ‘whole people,’ not just HIV patients, says survivor and advocate

Ron Rosenes has been living with HIV for close to four decades. (Devin Heroux/CBC)

 

Ron Rosenes has been living with HIV for nearly 40 years.

The long-time advocate, who turns 71 this summer, said he’s confronted health problems that come with age — perhaps even earlier — an increasingly common reality as more Canadians with the virus live longer.

“I seem to be living long enough to get the same crap as everybody else,” he told The Current’s Anna Maria Tremonti.

At the end of 2014, an estimated 65,040 people were living with HIV in Canada, according to the Public Health Agency of Canada (PHAC). While improved care and treatment might mean that population is living longer, diagnoses in older people have also increased. New diagnoses in those aged 50 years and older went up from 21.9 per cent in 2014 to 23.9 per cent in 2015, PHAC found.

With a growing cohort of Canadians living longer with HIV, survivors and the people who support them face new challenges in healthcare, financial support and combating new expressions of an old stigma.

We really, really need our medical and our healthcare professionals now to view us as whole people.– Ron Rosenes , HIV adv ocate  

Health problems show up sooner

Rosenes has had prostate cancer and open-heart surgery, but said it’s difficult to pinpoint that to his HIV status or genetics.

According to Dr. Julian Falutz, the director of the Comprehensive HIV Aging Initiative at McGill University Hospital Centre, age-related complications are occurring earlier in patients with HIV compared to those without.

“[HIV] can act as a stimulus for some of these conditions, such as lung cancer, heart disease, bone problems, osteoporosis, liver problems,” he said.

Lifestyle factors, like whether a patient smokes and when they started effective HIV treatment, need to be taken into account as well.

New diagnoses of HIV are on the rise in the 50+ age group. (Ron Boileau/CBC)

Rosenes said that healthcare professionals don’t expect these issues in a relatively younger patient.

“We really, really need our medical and our healthcare professionals now to view us as whole people,” he said. “They used to really view us specifically through the lens of our HIV.

“But now that we are growing older and having all these other problems, we need to head them off at the pass.”

Older adults, not just people with HIV, still have sex lives, Ron Rosenes tells Anna Maria Tremonti. 1:46

Falutz is in the early stages of researching HIV and frailty. He estimates that in five to eight years, one-third of Canadians with HIV will be over 60.

Stigma, isolation, money worries

In addition to health issues, people living with HIV experience a vast amount of stigma, said Kate Murzin, an HIV-and-aging specialist at Realize, which offers rehabilitation services to HIV patients.

That stigma can stop them from accessing support services because patients fear “discrimination either from the providers themselves, or even from … other adults who are accessing those programs.”

“That’s one of the things that I really try to stress first and foremost — there is no risk whatsoever in providing personal care and support to someone aging with HIV.”

Rosenes also noted the financial difficulties that survivors face.

Many people who were diagnosed with HIV had their work lives disrupted for decades, he said, missing out on the years when people gather assets for their retirement.

The Current
’60 is a hard age to consider going back and getting a job’

Tom McAulay is gearing up for a job search, 25 years after he was last in the workforce. 2:14

Now, as more effective treatments give HIV patients greater control over their lives, they find themselves trying to re-enter the workforce in their 50s and 60s. Falutz said this is a challenge in itself.

“They’re finding it very, very difficult for the usual reasons that older people have in finding jobs,” he told Tremonti.

“They have possibly the ongoing health issues, as well as the stigma, the social isolation and the financial constraints,” he added.

“I think what’s important to keep in mind [is] it’s not just how long you live, but how well you live.”

Source: http://www.cbc.ca/radio/thecurrent/the-current-for-may-17-2018-1.4666763/what-growing-old-looks-like-when-you-re-living-with-hiv-1.4666773

Access to hepatitis C treatment increasing among people living with HIV.

Increasing numbers of people co-infected with HIV and hepatitis C (HCV) are accessing treatment for HCV as antivirals become more effective – but challenges beyond increasing access, remain.

medicines on a shelf

A new study shows that despite new direct-acting antiviral (DAA) medication for hepatitis C (HCV) – which leads to high cure rates and increased linkages to care – HCV incidence remains stubbornly high. Results from a recent study in the Journal of the International AIDS Society (JIAS) reveal high rates of re-infection, thought to be driven by social and cultural factors, such as stigma and discrimination.

HCV treatment was transformed in 2011 with the introduction of direct-acting antiviral medication, which can cure HCV within two to three months in 90% of cases. The introduction of these new medicines was particularly good news for those living with HIV, as over two million are thought to also be co-infected with HCV. Furthermore, chronic viral hepatitis accounts for around 10% of deaths among people living with HIV.

But there’s a lack of data on the effectiveness of DAA treatment in eliminating HCV among people living with HIV in the real world.

To address this, the study assessed cascade of care data from seven HCV elimination initiatives and studies among people with HIV/HCV co-infection. These were carried out in Australia, Canada, France, Georgia, the Netherlands and Switzerland.

Of the seven studies, four focused on HCV elimination in gay and bisexual men living with HIV, while three included a combination of people who inject drugs, gay and bisexual men, and other people living with HIV.

The authors found encouraging evidence that DAAs led to better linkage to care, with around 50% of patients diagnosed with HIV/HCV being linked to treatment. They also found higher retention rates; some 96% of participants finished their DAA treatment, while 93% of people with co-infection being cured of HCV.

Treatment uptake varied substantially between studies, from 21% in some cases to 91% in others. Nevertheless, the results showed that the introduction of DAAs has led to a substantially higher treatment uptake overall. In the Swiss studies, for example, treatment uptake increased four-fold after the introduction of second-generation DAAs.

However, this wide variation in uptake indicates that barriers to care go beyond a simple question of availability, and may arise from a number of social and structural factors. These include HIV and HCV-related stigma; discrimination on the basis of sexual and gender identities or drug use; and the criminalisation of certain groups such as people who inject drugs. This is despite each of the countries having effective harm reduction programmes in place, as well as laws that prohibit discrimination on the basis of sexual orientation.

Although DAAs have led to an impressive increase in uptake over a relatively short time period, half of those living with HIV/HCV are still not accessing DAAs.

To change this, the researchers suggest training healthcare workers in the identification and treatment of re-infection cases. At the moment, high rates of re-infection mean that even very high treatment success rates will not result in reductions in HCV incidence. Behavioural interventions to reduce risk behaviours are needed to reduce the incidence of HCV.

The authors note that further research is needed to quantify the number of undiagnosed infections and to evaluate the effectiveness of elimination programmes in other countries, particularly those with more hostile environments towards people who inject drugs and people who are LGBT.

Source: https://www.avert.org/news/access-hepatitis-c-treatment-increasing-among-people-living-hiv

More representation from queer community needed in politics, says openly gay councillor

“Straight people just don’t think about our needs” says Coun. Stevenson during final speech at 2018 IDAHOT Breakfast

Celebrations started early for this year’s International Day Against Homophobia and Transphobia.

At the 14th annual IDAHOT Breakfast hosted by Qmunity, the provincial resource centre for queer, trans and two-spirited people, Vancouver city councillor Tim Stevenson wore a rainbow tie while making his last speech as a representative for the event. His tie matched the one his husband had bought for them for the special occasion.

Stevenson started by celebrating the opening of QMunity’s new location later this year.

“I’ve been dreaming about a centre of this kind for 38 years,” Stevenson, who was president of QMunity in the early ’70s, told the crowd over the clinking of silverware on plates. By 7:30a.m. the banquet hall was full of queer organizations and allies, all of whom looked as amazing as the $150 breakfast burritos being served.

The new building will host a resource centre on the main level while supplying permanent housing to people living with HIV and AIDS through McLaren Housing Society of British Columbia, as well as for refugees escaping queer-hating communities.

“It’s the first centre I know of that’s combining these three initiatives under one roof,” says Stevenson.

Earlier this week, Vancouver became the first city in Canada to designate a “Year of the Queer.” On May 23, pride, trans and two-spirited flags will be raised at City Hall when festivities will be held to jointly celebrate the anniversary of 15 queer organizations.

But Stevenson says he is still concerned about the future of the queer community.

“None of the achievements we’ve made are written in stone and very few individuals in the community are stepping into politics,” Stevenson said, urging the crowd to consider getting involved.

“Otherwise it’s just straight people speculating about queer issues. We need to be elected not just to bring matters to the table, but also to be seen so people think of us and look out for us.”

Stevenson served as Gay UBC’s president before gaining attention for a 12-year battle with the United Church of Canada, which in 1992 ended in him being the first openly gay person ordained in a Christian denomination. After the NDP asked him to run for MLA, he became the first openly gay person elected to provincial parliament in 1996, cabinet minister in 2000, and city council in 2002.

When asked if he’ll run for city council, QMunity’s new executive director Osmel Guerra Maynes laughed.

“I just came here. Let me breathe a bit!” he said. Of Latino and black background, Maynes arrived in Vancouver one week before starting his new role on April 16.

“My work is on the ground, grassroots, pounding the pavement and ensuring that diverse voices are heard.”

He wants to help Vancouver understand that the queer community needs more diverse spaces. “The queer community encompasses everyone. Bi-POC folks, black, Indigenous, women, lesbians, trans people — we’re all part of that community.”

Speakers who shared the podium with Stevenson and Maynes included emcee Charmaine De Silva, NEWS 1130 director; Anita Braha, the chair of Vancity’s board of directors; Morgan Camley, chair of QMunity’s board of directors; Lucia Misch, a spoken word artist from the Bay Area; and Dr. Mary Bryson, the researcher behind Cancer Margins, a nationally funded project examining how minority sexuality and/or gender shape cancer health experiences.

Author: Becca Clarkson

Source: http://www.vancourier.com/news/more-representation-from-queer-community-needed-in-politics-says-openly-gay-councillor-1.23306078

Want to figure out the rules of sexual consent? Ask sex workers.

The #MeToo movement has pushed issues of consent to the foreground of our cultural zeitgeist. Confoundingly, though, some of the movement’s most vocal champions seem to be the worst at respecting the very conventions they are espousing. Shortly after now-former New York attorney general Eric Schneiderman filed a lawsuit against Hollywood producer Harvey Weinstein, for example, Schneiderman resigned in the face of four sexual-abuse allegations. In a public statement, he claimed that he had simply been engaged in “role-playing and other consensual sexual activities.”

If Schneiderman really believes that to be true, his understanding of what consent actually involves seems to be fundamentally confused. Consent demands thoughtful communication, careful reflection and sometimes takes practice. Few know this better than people who deal with consent every day as part of their jobs: sex workers, for whom negotiating consent and setting boundaries is central to the work of sex work. It’s our ability to tackle these issues that makes us good at what we do. As the conversation around consent moves ahead, it’s time others start learning from our own hard-won experience.

If turning to sex workers for conceptual clarity and moral guidance rings odd to you, it may be because we sex workers have been systematically excluded from these discussions. Many refuse to acknowledge that sex workers are even capable of exercising consent. This is the rhetoric of what anthropologist Laura Agustín calls the “rescue industry”— a term used to describe people and institutions who conceptualize all sex workers as victims in need of saving. Catherine MacKinnon has argued, for example, that “in prostitution, women have sex with men they would never otherwise have sex with. The money thus acts as a form of force, not as a measure of consent. It acts like physical force does in rape.” More recently, Julie Bindel has proposed, “In almost every case it’s actually slavery. The women who work as prostitutes are in hock and in trouble. They’re in need of rescue just as much as any of the more fashionable victims of modern slavery.”

This thinking casts sex workers as victims, entirely without agency of our own, while ironically speaking authoritatively about us without asking for our input. It’s a stance that parallels the hypocrisy behind Schneiderman purporting to champion consent for women while allegedly ignoring it in practice.

This is a mistake. As Lola Davina, former sex worker and author of several books, including “Thriving in Sex Work: Heartfelt Advice for Staying Sane in the Sex Industry,” put it to me in an email, she views “sex workers as soldiers on the front lines of the consent wars.” That squares with my own experience, which suggests that the lessons we teach may be broadly applicable. In my own work as a phone-sex operator, which I also write and podcast about under the name Jessie Sage, I’ve had numerous clients who have called me to rehearse future conversations or negotiations with their wives or partners. And my experiences merely scratch the surface of what’s possible.

With this premise in mind, I recently reached out to community organizer and writer Chanelle Gallant to ask what she thinks sex workers can offer. “Something unique about sex work is that consent is seen as a collective responsibility,” she said. “Sex workers organize to build their power and the ability to prevent abuse.” In some cases, that might involve exchanging information about bad customers, workplaces or managers. In others, it might be about collaborating to improve workplace conditions.

This collective organizing also translates to the interactions of individual sex workers with their clients. Stripper and journalist Reese Piper told me that she has had to learn how to avoid situations with people who will violate her. “Sex workers know how to walk away from people or situations that are dangerous or not worth our time,” she said. “It’s part of our job to detect dangerous customers. And it’s also our job to invest in customers that will value our labor.”

Alex Bishop, a sex worker and activist, talks about gaining these insights and skills as a gift that sex work has given her. She told me, “Before I did sex work, I didn’t think as deeply about sexuality and consent. I was still young and naive and slept with men because they bought me dinner or were nice.” It was her job that helped her change her way of thinking, so much so that she suggested she would like to see everyone try out sex work “for a few weeks,” if only to help open their eyes. To her way of thinking, “sex work instills a lot of confidence in those that do the work. It becomes easy to say no because you find yourself saying it all day long to clients.”

Piper agrees, telling me, “Stripping taught me how to value my time, my emotional energy and my body. It taught me how to stand up for myself. I never used to tell men who accosted me on the street to go away. Now it’s easy. I don’t feel bad about valuing my space and soul.”

Mistress Eva, who specializes in domme work, describes her interactions with clients as safer and defined than those outside of sex work. At the airport on the way home from DomCon, she took a few minutes to write to me: “I never have to hesitate about entering an interaction as a sex worker, because our interaction is always preceded by negotiation and an understanding of our combined desires and limits.”

Circling back to Davina, I asked for specific examples of how sex work has taught her how to negotiate consent. She explains, “Here’s what sex work taught me: I can say ‘yes’ to a lap dance then say ‘no’ to kissing. I can say ‘yes’ to kissing, then say ‘no’ to a blowjob. I can say ‘yes’ to a blowjob, then say ‘no’ to intercourse. … Saying ‘yes’ to one sexual act is saying ‘yes’ to that particular sexual act, and nothing more. Sex workers navigate these waters all day, every day.”

Recognizing that they can add a lot to our conversations around consent, many sex workers have taken it upon themselves to teach consent in their sex work practices. Ginger Banks, who has been a sex worker for eight years, told me, “After learning more about consent [as a sex worker] I see so many different ways that we violate it, possibly [unintentionally]. I think it is important to discuss this topic of consent with our fan bases.” Reflecting on her experience as a porn performer, she explained, “This is why I try and integrate the consent into my films, compared to just having it done just off camera. This way I can teach people about consent while they watch my films.”

It should be clear, then, that despite what the rescues industry assumes, we sex workers spend a great deal of our time both exercising and practicing consent. Significantly, we do so in the context of our relationships with clients. These sort of low stakes transactional interactions are fertile ground for productive consent work. Sex workers can, and often do, walk away from interactions with clients who fail to value consent. Accordingly, clients must practice negotiating consent in order for a transaction to continue.  And, as my own experiences suggest, those are skills that they can transfer to their other relationships.

Given all of this, I’d argue that we need to empower sex workers to continue to do the sort of valuable, consent-focused work that we are already doing. In relationship to consent, we need to stop thinking about sex work as the problem, and start thinking about sex workers as part of the solution.

Source: https://www.washingtonpost.com/news/posteverything/wp/2018/05/21/want-to-figure-out-the-rules-of-sexual-consent-ask-sex-workers/?noredirect=on&utm_term=.e18f7d30f169

Vancouver rental units designated to LGBTQ refugees

Queer and trans refugees could soon find some relief from Vancouver’s housing crisis thanks to a new partnership between Rainbow Refugee, the City of Vancouver and a non-profit housing society.

Last week representatives from Rainbow Refugee met with staff from City Hall, and other LGBTQ support organizations, where the groups confirmed that Rainbow Refugee would be given a few units to house LGBTQ refugees in a new affordable housing complex that will be built at the corner of Burrard and Davie Street in Vancouver’s Gay Village.

Sharalyn Jordan, board chair of Rainbow Refugee, said finding housing for LGBTQ refugees in Vancouver is the most difficult part of the group’s work.

“Finding housing, it’s our biggest headache, absolutely the hardest thing to organize,” she said.

Jordan, who is a professor at Simon Fraser University and involved with LGBTQ resettlement work across the country, said she believes this is the first time anyone in Canada has secured affordable rental units specifically reserved for privately-sponsored queer and trans refugees.

Source: https://www.sfu.ca/education/newsevents/foe-news/2018/may-2018/vancouver-rental-units-designated-to-lgbtq-refugees.html

Canada to test first needle exchange program in a North American prison

Program aims to stop the spread of infections such as HIV, Aids and hepatitis C among inmates who are drug users

The pilot project will be launched in a men’s facility in New Brunswick and a women’s prison in Ontario – both chosen for high rates of injection drug use.
 The pilot project will be launched in a men’s facility in New Brunswick and a women’s prison in Ontario – both chosen for high rates of injection drug use. Photograph: Rick Callahan/AP

Canada is set to test the first needle exchange program in a North American prison in a bid to stop the spread of infections such as HIV, Aids and hepatitis C among drug users behind bars.

The pilot project will be launched in June, in a men’s facility in New Brunswick and a women’s prison in Ontario – both chosen for high rates of injection drug use.

While diabetic inmates have had access to needles for years, this marks the first time drug users will be given similar resources.

Over the last decade, the percentage of HIV-positive Canadian inmates has fallen by nearly half, but rates of infection remain 200 times more common in the country’s prisons than among the general public. Hepatitis C is 260 times more common among prisoners than the general public, according to public health officials.

“We’re focused on ensuring that correctional institutions are secure environments conducive to inmate rehabilitation, staff safety and the protection of the public,” said public safety minister Ralph Goodale in a statement.

Advocacy groups applauded the move. “This is something we’ve been working toward for more than 20 years,” said Sandra Ka Hon Chu of the Canadian HIV & Aids Legal Network, who said that needles can sometimes be shared more than 50 times between inmates.

The union representing correctional officers said the scheme set “a very dangerous precedent”, arguing it puts their staff at greater risk.

“Correctional Service Canada has decided to close its eyes to drug trafficking in our institutions,” Jason Godin, the union’s president, said in a statement.

The program is partly a response to ongoing litigation against the government by legal advocacy groups and a former inmate, Steven Simons, who was infected with hepatitis C while incarcerated. The litigants argue the current “zero tolerance” policy on drugs and needles violates a constitutional right to life, liberty and security of the person.

While the program is the first of its kind in North America, a number of European countries have experimented with needle exchanges since 1994.

A World Health Organization survey of 55 European needle exchanges found no increase in drug use, nor did they find any instances of needles being used to threaten prison staff.

Author:

Source: https://www.theguardian.com/world/2018/may/15/canada-to-test-first-needle-exchange-program-in-a-north-american-prison

Expert says political courage needed to open safe injection sites in Manitoba

WINNIPEG — One of the country’s leading experts says Manitoba needs to find the political will to bring in safe injection sites. Dr. M.J.
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WINNIPEG — One of the country’s leading experts says Manitoba needs to find the political will to bring in safe injection sites.

 

Dr. M.J. Milloy says multiple studies have shown safe consumption sites prevent overdoses, stop the spread of HIV and hepatitis C, and increase public safety by reducing the number of needles on the street.

The epidemiologist with the B.C. Centre on Substance Use and a principal investigator into a five-year evaluation of Vancouver’s first safe injection site, said it’s no longer a scientific question whether sites should be established.

“The question in my mind is not whether Winnipeg needs this facility but whether or not there will be the political will or courage,” Milloy told The Canadian Press on Tuesday in an interview from Mexico City.

A copy of a report commissioned by the Manitoba government on addiction services and provided to the media Monday morning included a recommendation to open a safe injection site in Winnipeg. By the afternoon, the recommendation was deleted in a copy posted by the government online.

Dr. Brian Rush, who wrote the report, said the recommendation was removed in the final draft because he didn’t have enough evidence and data to back it up.

Health Minister Kelvin Goertzen has said the government didn’t interfere with the report. “There simply doesn’t exist the data and evidence in Manitoba” to back up the need for an injection site, he said Wednesday.

Premier Brian Pallister has also said he doesn’t support the idea. Pallister told the legislature last month Manitoba isn’t facing the same drug overdose situation as British Columbia and other jurisdictions.

“We have not had the incidences, not even remotely close, of tragedy, of tragic overdose, for example, in the streets or on the street corners of the city of Winnipeg,” he told the house in response to a question from Opposition NDP Leader Wab Kinew.

“In fact, fully 70 per cent plus of the incidents are happening in homes of users or of users’ friends.”

Pallister said at the time he was waiting for Rush’s report and would follow its recommendations.

Milloy said Pallister’s argument is a common one but “there are areas in Winnipeg which have the sorts of concentrations of urban poverty and drug use which … would be well-served by supervised injection facilities.”

“I don’t think the argument that we are not Vancouver, we don’t need this, is necessarily founded on good science,” he said.

Kinew said Wednesday experts agree safe consumption sites work and the government has taken it off the table “simply because of the premier’s own personal beliefs.”

Ontario, Quebec, British Columbia and Alberta have all opened multiple safe injection sites.

Winnipeg’s Main Street Project, which offers clean needles and harm reduction supplies, has seen demand for needles jump to 1.5 million from 500,000 in the last year.

The downtown shelter is applying for federal approval to open a safe consumption site, which involves reaching out to the province. Executive director Rick Lees said he knows “they have a different view.”

“These are people that are homeless in many cases or unable to find a safe place to use,” Lees said. “They are also burdening our health-care system … so it makes sense for this particular population to have a safe consumption site.”

Kelly Geraldine Malone, The Canadian Press

Note to readers: This is a corrected story. A previous version said Milloy is an infectious disease epidemiologist with the B.C. Centre for Excellence in HIV/AIDS

Source: https://www.baytoday.ca/national-news/expert-says-political-courage-needed-to-open-safe-injection-sites-in-manitoba-925397

How Colonialism Explains Female HIV Rates in Africa

Around the world the HIV rates for men and women are more or less equal — except, that is, in sub-saharan Africa. This is the only region in the world where the HIV rates for women are substantially higher than that of men. Scholars call this the “feminization” of HIV and AIDS in Africa and have devoted a great deal of effort into studying why.

Some 80% of all women who live with HIV live in sub-Saharan Africa. So getting to the bottom of this question is vitally important to combating HIV and AIDS globally.

Economist Siwan Anderson is the author of a fascinating new study that that offers an explanation for why HIV rates for women are high in some African countries. In a forthcoming paper in the academic journal The American Economic Review, she finds that the legacy of the legal system of the former colonial power contributes to very high female HIV rates in former British colonies compared to that of the former colonies of continental Europe that used the civil law tradition.

And this difference, as she explains, is in how common law and civil law countries approached property rights for married women.

She finds that female HIV rates for countries under common law — which is the legal tradition of former British colonies — are twice that as female HIV rates in civil law countries, which is the legal tradition of continental Europe.  The reason? Married women are more easily able to access property rights in civil law countries and therefore are more able to refuse sex.

This is a fascinating and revealing study that offers compelling evidence for one cause of the feminization of HIV/AIDS in Africa.

 

By: Mark Leon Goldberg

Source: https://www.undispatch.com/how-colonialism-explains-female-hiv-rates-in-africa/

Without Treatment, Neurological Effects of HIV Start Early

New research is underscoring the important role early treatment of HIV plays in preventing neurological effects associated with the disease.

Researchers from McGill University, Washington University in St. Louis, and Yale University, wanted to know more about the phenomenon of reduced volume and reduced cortical thickness in some regions of the brains of patients with HIV. Specifically, the team sought more information about when these neurological effect start, and what role (if any) combination antiretroviral therapy (cART) plays in combating these effects.

To study the question, the team looked at MRI scans from 65 newly infected HIV patients who sought treatment at the University of California, San Francisco. All of the newly infected patients had contracted HIV within the past year. Those data were compared against the scans of 19 HIV-negative patients and 16 HIV-infected patients who had contracted HIV 3 or more years ago.

Ryan Sanford, a PhD candidate at McGill’s Montreal Neurological Institute, told MD Magazine that the study data showed a clear progression of neurological impacts.

“Based on the data that we have reported on, it appears that the volume loss and cortical thinning is ongoing in those that do not receive treatment,” said Sanford, the article’s first author. “This conclusion is also supported by data from the pre-cART era that demonstrated ongoing brain atrophy in those that did not receive treatment and had advance disease.”

Moreover, the study indicated that once cART therapy begins, the volume loss stops and cortical thinning began to reverse in the frontal and temporal lobes.

“The current debate in the literature is whether these cognitive deficits are due to poor penetrance of cART into the central nervous system or legacy effects from early infection,” Sanford said. “Given the results of this study, and a study published earlier this year in JAMA Neurology, it appears that the cognitive deficits that we see today are most likely legacy effects from early infection.”

Sanford said he and colleagues wanted to give physicians and patients a better understanding, and thus better strategies, for combating the neurological effects.

“I think the message we wanted to portray in our conclusion was that treatment does work in the brain and they should be treated as soon as possible,” he said.

The long-term impacts of HIV-associated neurological deterioration are well documented and can include memory loss, dementia, and vision and balance problems.

Sanford noted that his study was focused on cross-sectional analysis, and did not include longitudinal data, so it’s difficult to know from this research exactly what the neurological impacts might look like in the long term.

“If we look at the absolute rate of brain atrophy and compare those changes with normal aging cohorts from previous work, we do see that the rate of brain atrophy in this HIV cohort is higher than that of normal aging,” he said. “However, future work is warranted to verify that statement.”

The study is titled, “Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary HIV Infection.” It was published last month in Clinical Infectious Diseases.

 Author: Jenna Payesko
Source: http://www.mdmag.com/medical-news/without-treatment-neurological-effects-of-hiv-start-early

Windsor, Ontario Police Service does not support supervised injection sites

Chief Al Frederick said his department has not done any research on the sites

This is where the proposed Overdose Prevention Site would go. (Chris Ensing/CBC)

 

Windsor’s police chief said the service does not support an application that could bring a provincially funded, temporary supervised injection site to the downtown core.

The application for an Overdose Prevention Site (OPS) was submitted by the Windsor Essex Community Health Centre and the AIDS Committee of Windsor on April 30.

Police Chief Al Frederick said the service was not consulted ahead of the application.

When asked if the Windsor Police Service supports the site, Frederick said “we do not.”

Worried about crime

The OPS would open at Unit 1 711 Pellisier Street in the city’s downtown core if the application is approved by the province.

Inside would be a place where users could inject drugs supervised by harm reduction workers with access to medical supplies to reverse potentially deadly overdoses.

Windsor police Chief Al Frederick says there needs to be more consultation with the community on all aspects of the site. (Dale Molnar/CBC)

Frederick said he had three major concerns:

  • A need for consultations
  • The site has not been approved
  • Spin-off offences

“We need to fully understand the spin off types of offences that may occur in communities where these facilities are located,” said Frederick.

Site welcomed

“There should be a safe place for people to use and then also have access to services while they’re using,” said Brandon Bolt, who grew up in Vancouver and now lives in downtown Windsor.

He was in high school in Vancouver when the Insite Supervised Injection Site was opened in the city.

Downtown Windsor resident Brandon Bolt approves of bringing a temporary supervised injection site to the city’s core. (Chris Ensing/CBC)

Bolt supports a similar, temporary site being setup a short walk from his home, citing cleaner materials that prevent infections, on-site harm reduction workers for medical help and access to addiction services for people on injecting.

He also believes it will cut down on a too familiar sight for people walking through the city’s core.

“The needles won’t be out and about in our neighbourhood either so it’s beneficial for the people using and it’s beneficial for the neighbourhood, too.”

Bolt said those who don’t support the site may not understand what it does.

 

Brandon Bolt said he supports a temporary supervised injection site opening up just a short walk from his family’s home.

“I think they should know the real numbers about this stuff,” he said.

“To me it seems like they’re speaking from a place maybe of ignorance or just of extreme bias rather than a place of weighing costs and benefits.”

The numbers from Insite

A number of studies have looked at the Insite supervised injection site model since it opened in 2003 and offered the following results, according to a paper by the Ontario HIV Treatment Network that collected the data.​

That paper said:

  • “One study found that 75 per cent of Insite clients reported a change in their injecting behaviours as a result of using their services.”
  • “Another study found that 23 per cent of respondents who had been Insite clients had stopped injecting by the end of the study period, and another 57 per cent had entered addiction treatment.”
  • “One year after Insite opened, 30 per cent of clients reported using detoxification services.”

Source: http://www.cbc.ca/news/canada/windsor/windsor-police-service-does-not-support-supervised-injection-sites-1.4660024