20 May 2019
I have to say that I am very excited to see Alexandria Ocasio-Cortez (AOC) take notice, and better yet take action, on the issues of HIV, prevention and drug pricing in the US. I have a lot of respect for her fearlessness, her tenacity, and most of all her ability and willingness to speak truth to power and privilege. What a great addition to the US political scene.
I love that she really went after the CEO of Gilead Sciences about the price of their product Truvada, used in HIV treatment, but also in HIV prevention as pre-exposure prophylaxis, or PrEP. Apparently, Truvada, at least as PrEP, is subject to some patents owned by the Centers for Disease Control, which is declining to enforce them or to collect royalties on them. Gilead disagrees with the validity of those patents. I’ll leave that one to the intellectual property lawyers and to the politicians who ought to be demanding answers about the abandonment of public investment to private profits, as AOC and some of her colleagues are doing.
When I see a screaming headline that “People are dying for no reason” because of the price of Truvada as PrEP, I have to take a step back to reconsider what all of that means to me, a gay man living with HIV and diagnosed late (advanced HIV infection) in 1997-1998 (I was fortunate enough to cover the end of year holiday period with my little drama). Here I am in the 22nd year after my diagnosis, very much alive. I know that journalists, and least of all headline writers, can misconstrue and oversimplify, but careful messages get understood.
The PrEP Story
It took a long time to prove and with a few controversial trials, but the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) has proven itself to be an effective tool to prevent HIV infection for people exposed to risk. All people, not just gay men, with some caveats for the length of time it takes one of those molecules to reach protective levels in vaginal tissues…but it does get there. It’s interesting to call it by its scientific generic name because in much of the world generic versions that cost a lot less than the name-brand. In the few hold-outs, including the US, the name brand is still covered by patents that prevent generic competition, keeping the price up.
In Québec, where I live, the nature of the distribution of prescription medications has meant that people have not been paying the full sticker price for the name brand product for quite some time, and now there are no fewer than three generic substitutes that have satisfied our regulatory tests of equivalence. No special payment program, and because the name brand was already in use for HIV treatment (in combination with other drugs), it was available for PrEP even before we had guidelines for doctors to follow.
The Patent Game
The same company has a new version of this drug combination that it is testing and applying to have approved for use as PrEP (and which is already approved for use in HIV treatment, so there we go again). The big claim for the new version is that it minimizes the side effects of the original, which could cause problems with kidney function and bone density for a certain number of those taking it. Notably, a number of studies have shown that those problems correct themselves over time after the person stops taking it, but the person also loses the protection from HIV. So, good for them for continuing to research and finding a version with fewer side effects.
Does everyone need the new version? No, just the people with the side effect problems. Does the company want you to think almost everyone has those side effect problems? Looks like it from their marketing efforts, but not so much if someone sues them over the side effects of the original. And just to underline a coincidence without wishing to allege any wrongdoing, the company is bringing out this new improved version just as their patents on the old one are expiring all over the place. Just sayin’.
HIV and Death
Here’s where I have a problem with what the Representative from New York has to say about the issue. She seems to be suggesting that not being able to access PrEP is a death sentence. What does that mean for people living with HIV?
After the introduction of protease inhibitors as part of effective treatment combinations in the mid-1990s — 1996 in Canada, just in time for me, I might note — the rates of mortality in rich countries with access to the treatments plummeted. The graph, picked form the internet, shows it pretty clearly. We die less than we used to, with our treatment supply uninterrupted, at least.
These days, in our wealthy countries, we speak of HIV as a manageable chronic illness, and focus on problems related to aging with HIV — that problem we couldn’t have conceived of in the 1980s when everyone around us was dying. We are more likely these days to die of classic things like heart disease, liver disease, various cancers, the complications of diabetes, things that may be aggravated by HIV or by the treatments we have taken to control it. We die less of the classic complications that would define AIDS in someone infected with HIV.
It’s true that in the US that access to treatment is often through special programs whose funding has to be fought for on a recurring basis, because the lack of comprehensive health care for the population (like in every other wealthy country) is too radical an idea to be adopted. The current administration’s cuts also threaten the global response, as PEPFAR and the Global Fund have helped make that radical graph curve above a reality for a number of other countries. Apparently generosity and compassion are in short supply these days.
Stigma and the Death Message
One of the biggest problems we have always had working to end HIV is the stigma that is attached to it. Whether it is because of the ways in which HIV is classically transmitted (sex, drug use) or the often irrational fear of “catching it”, stigma puts the brakes to a lot of efforts to encourage people to get tested, to sensitize the general population about HIV, to be as adherent to medication as we need to be to stay undetectable, to be able to take our place in society and enjoy all the same rights and, yes, obligations as everyone else.
It’s been a tightrope act to navigate between messages that encourage people to stay negative and messages seeking to reduce the fear of people living with HIV, and we haven’t always done it well. I’m not sure we’re really doing it as well as we ought to today. We know that fear doesn’t last as a motivation, and we know that instilling fear of HIV infection to encourage prevention efforts actually contributes more to fear of people living with HIV. Not helpful.
What we really need to do is communicate a more pertinent and accurate portrait of what it means to live with HIV today, in all of our very different circumstances, to reduce fear and increase empathy. There are plenty of good reasons not to want to get HIV that don’t involve making people afraid of us. We might be living longer, but we have challenges that I wouldn’t wish on anyone. As I often said after my diagnosis, I really never intended to become this high maintenance in my life. Well, here I am, and I’m apparently doing an okay job of it.
So getting back to our allies, please take the time to understand the whole context. Don’t stigmatize the million-plus people living with HIV in the US by waving around a death message in defense of access to PrEP. Do you know that PrEP is not even recommended if your HIV-positive partner is on effective treatment and undetectable (actually, under 200 copies/ml)? Talk to the AIDS organizations in your state, in your city. Talk to the passionate activists — including plenty of HIV-positive folks — who are your allies on a whole host of other issues, too.
Just know what you’re talking about and think about the consequences of how you say it.
05 May 2019
What a lovely note on which to end the 2018-2019 season of the Opéra de Montréal.
The usual disclaimer applies as always — not an expert, just have my own observations, sometimes comment out of left field…
Right from the beginning I knew I was going to like this production of Carmen. The overture so familiar that I was almost convinced that Bugs Bunny had done three operas, and not the two I can remember more clearly. Bizet, who died without knowing what a hit this work would become, is to be revered for a lively start, but the credit for the scene that greets our eye as the curtain goes up goes entirely to the Opéra de Montréal.
Carmen walking in silently, pulling and constrained by an enormous train of red fabric from which she eventually breaks free (but will see again). It doesn’t take long for the stage to become populated by a huge crowd, there almost all the time, which is lovely for its wealth of costumes, but even more so for the many chorus singing roles. Love that!
Carmen might be the headliner, but let’s take a moment to talk about Micaëla, who enters searching for Don José to deliver a letter from his mother, but also to show her love for him, and his mother’s wish that he marry the messenger! France Bellemare has a really strong and beautiful voice. If she had more parts to sing, she would surely have stolen the show. Just lovely.
Seductress Carmen, arrested for her part in a fight in the factory, uses her wiles to persuade Don José to let her escape. He suffers the consequences, but seeks her out after his release from prison and she persuades him then to commit a further transgression by deserting to join the gang of smugglers.
Act 3 opens with a lovely visual effect, a series of lanterns working their way onto the stage behind the scree. There were images on the scree (projections?), but the way I saw it, it seemed like some of those lanterns were coming through it into the foreground. I think I was fooled by the visual effects! In any case, we ended up in the smugglers’ camp, and two of the Gypsy women (yes, I know, Roma women, but Bizet lived in another time!) were reading their own cards, with ever more fanciful and profitable fortunes, right up to the death of a wealthy husband, leaving the card reader a wealthy widow (she seemed delighted by that). Count on Carmen to cast a pall over that party, with a self-reading of doom and gloom and death! No wonder her relationships don’t last long!
Fabulous toreador Escamillo makes a play for Carmen, but all he succeeds in doing is provoking Don José into a fight. Carmen has to intervene to break it up. Micaëla announces Don José’s mother’s severe illness and imminent death, he leaves with her, and that is too much for Carmen. End of that relationship…where is that toreador?
There’s a lovely crowd scene celebrating the arrival of the various teams of bullfighters, each with a role so specific that I was confronted by my ignorance of bullfighting and what everyone’s role might be. Escamillo is, of course, of the highest rank and the most lauded. Also the most adored by Carmen, apparently, who has moved on rather nicely from her last failed relationship.
If only Don José had moved on, too, we might have a happier ending. Instead, we get the spectre of controlling intimate relationship violence, as he tries to prevent Carmen from returning to the bullring and eventually stabs her. Cue the return of the red cloth, this time a giant banner hanging from above, attached to Carmen in her death like a river of blood and completing the metaphor. Don José proclaims his guilt and invites arrest. The curtain falls before we get to that.
So now that I have mistold the story (that you find elsewhere with greater clarity, I’m sure), let me share my uninformed opinions about the singing, the costumes and the sets!
This is really what I look for in an opera: catchy tunes, beautifully sung, opulent costumes (and SO MANY of them, what with the crowd on the stage!). I love that there are many duets and many songs for the chorus, as they sounded fabulous. The children (there were many of them, too) were excellent in their roles and excellent singers as well. I couldn’t see in the program who they might have been, but we suspected a school somewhere in Montreal.
Oh, and let me appreciate the nods to flamenco. The rhythms are not in Bizet’s work, but we do get a couple of guitars on stage, the sound of castanets from the orchestra, and some distinctly flamenco moves. I love flamenco and associate it with the Carmen story (though as an aside, I also associate with this lovely video of a protest in a Spanish bank — how more delightful can you get than deploying this powerful culture-specific art form to protest the ravages of modern finance?!)
The set was spare, the outdoor square doubling as an indoor space by the addition of furniture, some other elements descending from above to suggest a more industrial area (smuggling space). The multimedia aspect was a little light in this one, with a short thunderstorm and the projections and other use of light that I have already noted.
We left very satisfied, though, and would highly recommend seeing this on one of its upcoming dates (7. 9, 11 and 13 May 2019). Tickets here if there are any left!
31 March 2019
This gathering is now. I sent this message to be read by my younger sister on my behalf:
When I think of John, all of those things that you have heard so far — and will no doubt hear more of — come to mind. He was always someone who didn’t do things halfway and seemed to be able to teach himself how to do new things — and do them well — all the time.
What I will remember the most, though, is that other thing he did well: loving his family. You could see that in the way he played tirelessly with his grandchildren, down on the floor with the young ones, challenging the older ones to excel as he always did at sports almost too numerous to mention.
You could see it in the way he and Terry raised their own children, helping them when they needed it, encouraging them to be their best at whatever they wanted to do. How many trips for various sporting events? How many practices, how many family ski outings and curling bonspiels? They were endless and neither Terry nor John would have had it any other way.
You could see it in his interactions with all of us in-laws: brothers and sisters, son and daughter. He could always find common points of interest, he could tease, and he could compete, and always with a level of calm and thoughtfulness that made us all feel welcome, feel at home.
And the most important thing for me to see was John loving my sister Terry. They were together 47 years and built a life of love and stability for their family — for all of their family — that none of us will ever forget.
Thank you John.
The family's obituary for John can be read here.
22 December 2018
That time of year again, already.
On this date 21 years ago, I was gasping for every breath, and my doctor sent me up the hill to the emergency room of the Montréal General Hospital with a note to tell them (and me, of course on the way) that he suspected that I had pneumonia, and a pneumonia that was an AIDS-defining illness.
I couldn’t have expected then, despite all of what my doctors (yes, they multiplied) told me in the months that followed, that I would still be here talking about this 21 years later. At the time, depleted of oxygen and having passed out at least twice on the weekend preceding the doctor visit, I really didn’t think I had the strength to fight anything.
When I tell my story these days, I always make a point of recognizing that I have lived my experience of HIV/AIDS with all of the privileges that one could hope to have. I’m an educated, middle-class white man in a developed country with ready access to healthcare and medication, and — probably most importantly of all — I have a solid support network of family and friends I did not hesitate to reach out to, and by which I have never been disappointed.
Far from taking my life away (that first gut reaction can be brutal, even in the face of all of the information and advice coming from the medical professionals), this path I am on has given me purpose, focused more than it ever might have been if I, and many, many of my friends, were not on this path.
I also have something else to celebrate at this point in the history of the epidemic. The knowledge, and probably more importantly the official acknowledgement, that a person with HIV treated successfully cannot transmit the virus sexually is a game-changer in how I and so many others feel about ourselves as “carriers” of a disease that still strikes fear into the hearts of those who have very little experience with it. I know that the fear of transmission is misplaced, and has been scientifically proven to be misplaced, and that is a big relief for me and many others. It is also a great incentive to carry on with treatments that are first and most importantly giving me relatively good health, but are also ensuring that I can’t transmit HIV.
But lest we think that it’s all over now, let’s just remember that it isn’t. I might have the additional advantage of being employed in an organization that wouldn’t fire me for being HIV positive, but I can’t say that my status wouldn’t be a barrier to seeking other employment elsewhere, as it is for many. The solidity of my support networks mean that I don’t have to worry about being very open about my status, because the people who really matter in my life know and accept me. I also have enough knowledge, confidence and resources to be able to insist on receiving the treatment that keeps me alive and healthy.
I’m not so much on the sex and relationship market these days, so I don’t have to face that kind of rejection or discrimination. Actually, when you don’t feel you need something, it is surprising how much power and confidence you can have in managing situations that might arise. I do have several of those meeting applications on my phone, but it seems that I mostly use them for window-shopping and then occasionally to give information about HIV to people who might have questions, or to those I need to remind of my status that is clearly included in my profile.
There are many more battles to fight. Too many people lack access to treatment and to prevention tools, not only around the world, but here, too. And way too many people lack the kinds of support networks that I could take for granted until I needed them and received confirmation of their excellent state. Yes, many battles, and I am glad to be able to say with confidence that I will be around a bit longer to help fight them.
Cheers, 21st anniversary!
23 October 2018
Melvin Edward Monteith died on 23 October 2018 after a long illness. He was predeceased by his wife of 56 years, Enid Norah (Lucas) Monteith.
He is survived by his sister Doreen (Roy Baillargeon) of Kamloops, his children Mike (Linda), Brandy (Brenton Wilkie), Terry (John Pisarczyk), Ken, Syd (Tracy Baird), 8 grandchildren and 12 great-grandchildren.
Mel grew up in Kamloops, graduating from the Senior Matriculation programme at Kamloops Senior Secondary School in 1952. In his final school years, he worked summers for the BC Forest Service and landed his first full-time position in Wells Grey Park in 1952. Before his retirement in 1994 he had attained the positions of Ranger and District Manager, and was well-liked by those he worked with, especially those who worked for him. His own superiors may have been less impressed by the application of his motto: it is better to beg forgiveness than to ask permission.
Mel was a devoted husband and father. From his proposal to Enid at the time of his first post in Wells Grey Park to their marriage in 1953, through many job postings around the interior of BC, to his loving attention as Enid’s health declined after their retirement and he became her primary caregiver, theirs was a story of devotion and attention.
His children all remember the countless ways he showed his love of the family — the summer camping trips, the winter skating rinks, tobogganing, skiing, a swing and a climbing rope at every home they lived in, the attendance at countless sporting events and much, much more. Mel and Enid built and maintained a family that sticks together, despite geographical distance and differences of opinion. A loving home and support for the hopes and dreams of all are the legacy Mel and Enid leave behind as parents, grandparents and great-grandparents.
Mel was hard-working, intelligent, practical and caring. He was fair and open-minded, a ravenous reader of science-fiction and overall a very likeable man, right to the end. His children were endlessly amazed by his capacity to complete complex mathematical calculations in his head faster than they could do the same with their calculators.
One of Mel’s great accomplishments was the building of the family’s log home. He worked hard on weekends and holidays to accomplish this work, largely by hand, from felling the trees, to peeling the logs and winching them atop the structure to carrying rocks and mortar up ladders to build an immense central fireplace. The result was a beautiful home fitting for the loving family he had created.
Mel will be remembered in a private family gathering. There will be no service by request.
In lieu of flowers, please send donations to the Kamloops Hospice Association, Marjorie Willoughby Snowden Hospice Home, 72 Whiteshield Crescent South, Kamloops, BC V2E 2S9. Their web site here.
You have all our love and appreciation for being the best father a family could have, Dad. We miss you terribly.
16 September 2018
Okay, we’ll just start with the usual warning — that I am no musical or operatic expert — and add another about the time and place and the horrible place of women at the time of the penning of the opera, the time it was set and…well…even today. Yes, #GildaToo.
All of that said, the Opéra de Montréal’s production of Rigoletto was a delight and an excellent way to start off the new season. I have a personal penchant for bouncy Italian music, soaring duets and solos, and even for a good rollicking chorus, and I got them all. Those and the bonus of soprano Myriam Leblanc treating us to some exceptionally beautiful high notes and bass baritone Vartan Gabrielian setting my little gay heart aflutter with some lovely low notes. And I believe those two are both locals, or at least Canadians! Lovely!
The story is, of course, completely awful. The lascivious Duke has his way with any woman he wants and tends to punish the men who dare to stand up to him about that. Very little opportunity to hear what the women involved might want, of course. A carelessly broad curse tossed out by Monterone following the “seduction” of his daughter, the Countess Ceprano, seems to have stricken Rigoletto, the court jester, even more than the Duke who did the “seducing”. (Yes, those quotation marks are an expression of doubt around the issue of consent.) Rigoletto, for all his mocking of the male “victims” of the Duke’s philandering with “their” women, wants very much to protect his daughter from his employer.
The crowd will have none of that, thinking that Gilda is Rigoletto’s mistress, not his daughter, and they set out to kidnap her, involving a strangely unsuspecting Rigoletto in the plot, blindfolded of course. Gilda is delivered to the Duke, who she already knows as “a poor student” who spied her in church and has professed his love to her. The crowd’s recounting of the kidnapping of Gilda to the Duke is one of the delightful musical moments (crowd edition) of the production for me.
Rigoletto gets Gilda back and arranges for her to escape to Verona disguised as a man while he takes advantage of an offer from the assassin/innkeeper Sparafucile (Gabrielian — swoon — beautiful voice AND dangerous!) to be done with the Duke forever. Rigoletto pays half up front after he and the yet-undisguised Gilda overhear the Duke’s overtures to Sparafucile’s sister Maddalena (and he sings that women are fickle!), to return with the second installment when the deed is done. He insists on being the one who will throw the body into the river.
Maddalena develops a soft spot for the Duke and proposes that her brother instead kill Rigoletto when he returns, thereby getting the whole sum anyway, but Sparfucile has scruples and will not betray his client. Not until version two of the ruse presents itself in the form of a beggar who knocks at the door. Killing the beggar instead of the Duke to fool Rigoletto is just fine, apparently. Alas, the beggar is Gilda in her man drag and she is stabbed from behind by our dangerous hitman.
Sparafucile delivers the body to Rigoletto as arranged and collects his final payment. Rigoletto is unable to resist looking at the corpse — especially after hearing the Duke in the distance singing La dona è mobile — and discovers his daughter, who seems to come back to life for a bit to sing (this is opera after all), and then sings as an angel from atop the city walls. The philandering Duke has doubtless moved on to his next conquest.
I liked the sets, also as usual. Great walls in a state of disrepair, cutaway views of courtyards, and very little disruption of the action for the changes. In one spot, Rigoletto and Gilda are singing in front of the scrim and the curtain, allowing for a quick set change that is discreet and well-executed. The lighting also bears mentioning, as the thunder/lightning storm that unfolds while we are looking into the courtyard at Sparafucile’s wayside inn continues through the aforementioned scene change — we see flashes of light at the bottom of the curtain. Very clever.
To recap: lovely opera, horrible story, beautiful voices, nice sets and good lighting effects.
To go off on a tangent, I think it might be time for the conductor to update his profile photo (he looked significantly older in person!) and it might be time for me to invest in some opera glasses (I’m looking at you, Vartan Gabrielian!).
24 March 2018
What a lovely evening I just spent. Delightful company and an extremely engaging première performance of Svadba by the Atelier Lyrique of the Opéra de Montréal.
When I invited my friend, I described the performance as an a capella Serbian hen party. Not far off in terms of the content, but I sold it short in omitting what I couldn’t have known at the time — a multimedia experience, an exposure to voices that reminded me of a Bulgarian women’s choir with which I and my colleagues were completely obsessed at the end of the 1980s/beginning of the 1990s.
Let’s start where I know my way: the story. It is a group of women who are preparing their friend for her wedding. The go through all manner of things…grooming, hair dyeing, discussing how the proposal came about, the qualities of the groom, their reminiscences of childhood games, and what a marriage means in terms of separation from family and reconnection with a family to be. It ends with the bride and her five friends, all bridesmaids, lined up for the wedding.
It’s really all about the voices, and they were beautiful and strong, wrapping around each other in amazing melodies, swooping and curling into strange and sometimes jarring sounds. I know that some of these were just nonsense syllables, one trip took us through the Serbian alphabet, but also words and phrases, sometimes sung in the round and slightly out of synch (intentionally) like some modern music on loops of slightly different lengths that phases together and apart. I was amazed at the capacity of the six women on stage to maintain a nonstop performance through multiple changes in cadence and tone, notes that took us to the mystery of the foreign by seeming to sour at the end, just slightly. Strikingly beautiful.
As if the challenging singing were not enough, the women also contributed sounds, whether by stomping, clapping, slapping their thighs, or with instruments like a little whistle deftly played into birdsong, cylinders manipulated into rain or shower water, a drum. These combined seamlessly with the vocals to create a very impressive performance.
The set was very simple, with thin white curtains/blinds “hiding” the bridesmaids’ dresses, but also serving as surfaces on which words and syllables and nonsense sounds were projected, floating up organically from the singers. One of those blinds turned out to be more like a circus silk, as the bride sat in it like a swing. A few chairs, a white sheet and a table on wheels completed the props, transforming smoothly into what they needed to be.
At the end, after all the applause (and how refreshing that every person joining them on the stage in the various supporting and directing roles was also a woman!) two guys with traditional wedding-type instruments (a big bass and an accordion) came out as plates of cake were set out. I don’t know if the traditional wedding follow-up of cake and dance will follow every performance; we had the honour of sharing our experience with the Serbian Ambassador and the Honorary Consul in Montréal.
Let me know if there’s cake on the other nights. And that — in case it wasn’t already clear — means DO go, and then report back on the cake situation.