Quinceañera

As I write this – 22 December 2012 – I am marking the fifteenth anniversary of my diagnosis.

This anniversary thing is funny. It may be that the event itself is so marking of our lives that it will always stick with us, the moment when I went from "us" to "them" (or, more accurately from my current perspective, from "them" to "us"). It may also be that telling our stories is such an integral part of living with HIV that it would be unthinkable not to have a well-developed beginning to our stories.

22 December 1997 is the beginning of mine, the date when I went gasping to my doctor appointment and then with his note to the emergency up the hill. The date when I started discovering the solidity of my support network of friends and family, however geographically near or far. The date when I started to be dependent on the pharmaceutical industry for my life and health (and I must say they have done an excellent job so far).

The little new life that was born that day is now fifteen years old – who would have believed that? Now it is her time to come out and take her place, just like little fifteen year-old girls all over Latin America do when they take part in their quinceañera celebrations. So let me, with some concern for the cultural misappropriation and no small amount of irreverence, compare my experience of HIV to a fifteen year-old girl from somewhere south of here…

For many, the celebration begins with a mass. Okay, here I am going to have to diverge from the tradition right away: there won't be any role for the organization that just welcomed with open arms the Speaker of the Ugandan parliament who is pushing for the adoption of the latest incarnation of their new homophobic law. My celebration will have to begin, most appropriately, with gas. Yes, you would think I have been eating nothing but beans for the last fifteen years, as my intestinal fuel factory has been most productive since I started taking those meds.

At this celebration, we do find something with which I can get on board. The chambelanes, who accompany the debutante, put me in mind of those original four CD4+ cells I had when I was diagnosed. Yes, four, so you can understand why I might have doubted getting to this day all these years later. But my faithful chambelanes have stayed with me and multiplied, and I am all the better and more grateful for it.

Now the Quinceañera (the girl IS the event) receives some gifts to mark this occasion. A tiara! Handily, I already have one of those – bought years ago to attend a hat party in another city (surely a tale worth telling separately), so my adoring friends and family can steer clear of Swarovski this time around. A doll – my last doll as I enter into my adulthood? Not so sure about this one, either, as I tend to prefer my humanoids living and breathing. Maybe something to look forward to as I progress into my later teens? Any dolls out there willing to make the sacrifice?

The dress! If you have seen representations of this phenomenon in the movies, it really is all about the dress! Try this movie, which I am looking forward to watching as part of my celebration this year. I'm afraid I will be like the heroine and be forced to wear a hand-me-down dress and give up on my dreams of travelling in a Hummer limo. Unlike the heroine, I am not pregnant (just wanted to put that out there to squelch any rumours), but I am probably a little less chaste as well (sorry Dad: see above notes on dolls).

The other thing I have been told of is the cake. The cake! Apparently as tall and as overdecorated as it can be, but this is really not my style either. I tend to go for complexity in the flavour, but not in the look. And I don't want to be too cake-focused, either, given those pregnancy rumours I referred to above. So it's a simple looking, complex tasting work of culinary art for me, and you may also partake if you are kind to me.

This is also apparently a time of firsts: first make-up in public, first high heels…all those things that one might associate with a grown up woman. The Wikipedia entry on this notes that many of these "firsts" are no longer firsts in a world in which we all grow up so fast. It should be no surprise, then, that this fifty-two-year-old Quinceañera doesn't have a lot of undiscovered or unexperienced things left in life either. Are your visions of my purity dashed on the rocks of reality? Mine too.

All in all, I'm looking a little less like a the picture of purity and innocence on the cusp of adulthood and a little more like a drunken and gassy drag queen stumbling out of a taxi at 5 am. At least I have my dignity!

So raise a glass to me this week to celebrate my diagnosis' coming of age. And we'll see if we can't wring another Quinceañera out of the prequel – one doesn't arrive at 4 CD4+ cells without a back story – and yet another out of the sequel, as I show no signs of fading just yet.

A Modest Proposal

Today was the beginning of a trial in a case brought by voters from six federal ridings and supported by the Council of Canadians. The case is asking the Federal Court to set aside the election results because of widespread allegations of fraudulent automatic calls misinforming voters that their polling places had been moved.

There are other alleged shenanigans out there, too. The eventual winning candidate in Labrador supposedly overspent in his election expenses by many thousands of dollars. The Conservative Party settled a previous case out of court, paying a fine with respect to allegations of a large accounting scheme (the "In and Out" scandal) designed to charge certain national campaign expenses through local level campaigns, thereby allowing the national campaign to overspend.

In the current case, the court might decide to set aside the election results and call for by-elections in those ridings. The overspending case might end up in a fine being paid like the "In and Out" scandal. I'm wondering if we don't need to have some more serious penalties if we are to stem the proliferation of these infractions.

If you overspend, there should be a fine, but how about also reducing the spending limit of the candidate and the party by the same amount in that jurisdiction (riding or national level) for the next election? The advantage in one election could be compensated by the disadvantage in the next.

Or how about if you can't follow the rules, you get disqualified from running the next time around? If there's widespread abuse by a party that spreads beyond a single candidate's election race, order the party to be disbanded and its assets seized. Nothing to stop them from forming a new party, but they would have to do that from scratch.

In the spirit of how we are being governed these days, how about making some of these measures mandatory minimum sentences?

Or maybe law and order only applies to the things you're not doing yourself.

Je suis séropositif

On Thursday, 29 November, COCQ-SIDA (the Québec coalition of AIDS organizations) and its member groups held press conferences in Québec City, Trois Rivières, Montréal and Gatineau to launch a new campaign attacking the stigmatization of people living with HIV/AIDS. You will forgive my inordinate pride in this one: this is my organization, but I am not responsible for the campaign itself. I think that my staff and the volunteers who worked to bring this together did an amazing job.

Two previous campaigns, adapted from campaigns from the French organization AIDES, had recruited celebrities to encourage the population to reflect on whether the things they take for granted in their lives would still be there if they were seropositive. Thousands of Quebeckers joined the campaign through a Facebook application that made it possible for them to make their own posters with their images and their own reflective statements. Last year's campaign was covered here.

This year the focus shifted slightly, turning the spotlight on five Quebeckers living with HIV, talking about their lives not only in terms of HIV, but also highlighting the work they do, their leisure-time activities and the things they enjoy in life.



We get to learn that Bruno, very involved in the student strike this year by organizing a conference on the history of the student movement and participating in the "Pink Bloc" of LGBT activists, has committed to his studies for the next six years to obtain his doctorate and makes excellent desserts.



Jacques, who thought he was going to die, has committed himself to working with and for people living with HIV, shares his experiences and knowledge of HIV with people from many age groups and backgrounds through testimonials and is looking forward to watching his grandchildren and even his great grandchildren grow up.



Donald once worked in a government job, but was made to feel unwelcome to return to it after an absence of two years. He enjoys the good things in life: travel, food, humour and — he says with an obvious twinkle in his eye — even a good wine.



Emelyne works in prevention of substance abuse with youth and takes good care of her health so that illness won't interfere with her work or with her pursuit of her many dreams for the future. She has always been committed to destigmatizing HIV, in Canada and in her country of origin.





Yves lost his vision to an opportunistic infection, but he tells us that he is not blind to the rest of the world. He listens to two books a week, is committed to HIV/AIDS work at a national and a local level and has celebrated his 21st anniversary with his seronegative husband.

All of these spokespeople are contributing to the fight against HIV stigma by being themselves, only a little more publicly this time around. You can see their differences, but you can see in each their love of life and their commitment to making society a better place, with respect to HIV, yes, but in many other ways too. The approach of this campaign is to show some real faces, to show the humanity and the diversity of people living with HIV so as to sweep away the caricatures and the fear. These — and many others — are people who have something to contribute to our society and all of society loses when we exclude them.

The campaign is once again using classic paper-based materials like posters, print ads and bookmarks, but is also making extensive use of social media, with YouTube videos, a blog dedicated to the campaign and the issues of HIV stigma and the COCQ-SIDA Facebook page. The launch was very well received and covered by the media all over Québec.

The overarching message is clear and simple. HIV/AIDS is the problem, not the people living with it.

Le Défi de la divulgation

The English version of this article is published on PositiveLite.com, here.

Suite à la décision de la Cour suprême plus tôt en octobre, je suis à nouveau frappé par le peu de compréhension concernant la difficulté de divulgation du statut sérologique que peuvent avoir plusieurs personnes pour qui le VIH n'est pas une réalité quotidienne. Ceci est surtout vrai quand il s'agit de divulguer à des personnes dont on peut douter de leur éventuelle réaction. J'ai souvent trouvé l'acte de divulgation très difficile, même en tant qu'homme blanc et éduqué qui occupe un poste que je ne vais pas perdre à cause de mon statut sérologique. À partir de ma position privilégiée, je peux quand même apprécier le fardeau encore plus lourd que ce geste représente pour ceux et celles qui n'ont pas les mêmes privilèges que moi.

Premier sur la liste des résultats négatifs, le rejet. Il faut comprendre ici je ne revendique pas une obligation d'entrer dans une relation ou une activité sexuelle quand une personne ne s'y sent pas à l'aise, mais il y a plusieurs manières d'exprimer l'inconfort ou la peur. Certaines de ces manières sont plus respectueuses que d'autres. Vivre plusieurs expériences malcommodes de rejet sans aucune indication d'intérêt pour la compréhension ou pour l'apprentissage peut mener le plus consciencieux d'entre nous de conclure à la futilité de la divulgation.

Imaginez confier votre secret le plus difficile à quelqu'un. Lors d'une première rencontre, vous n'êtes probablement pas prêt pour ça, surtout dans l'absence d'indication de la réaction possible de cette personne. Il est vrai qu'au début d'une relation, vous avez moins investi dans la relation (ce qui devrait faciliter la divulgation — moins à risquer), mais vous n'avez pas non plus développé la relation de confiance qui peut vous mettre à l'aise pour divulguer. Si vous attendez que cette relation de confiance soit construite, vous vous trouverez peut-être dans la position d'avoir « trahi » cette personne en omettant de divulguer plus tôt. Tôt ou tard, on ne peut pas gagner sur ce front.

Mais qu'est-ce qu'on risque en divulguant son statut sérologique à une personne qu'on ne connait guère? Le droit de déterminer à qui va être communiqué cette information? Si je vous divulgue mon statut et vous me rejetez tout court, comment allez-vous réagir la prochaine fois que vous me verrez parler à un de vos amis? Des doigts pointés et des commentaires chuchotés m'indiqueront que vous avez pris l'initiative de partager avec plus de monde le secret que je vous ai communiqué en toute confiance. Oui, il y a des lois qui protégeraient mon droit à la vie privée, mais ce n'est pas l'état qui va faire respecter ces lois comme c'est le cas pour le droit criminel. Non, ça revient à moi de mobiliser les ressources, les connaissances et surtout le courage pour faire valoir mon droit à la vie privée. Ce n'est pas du tout évident, particulièrement quand j'aurais peut-être à sortir très publiquement devant les tribunaux avec mon statut pour protéger ma vie privée.

Bon. Mon secret est sorti. Quelles peuvent être les conséquences négatives pour moi? Il suffit de jeter un coup d'œil sur les réactions irrationnelles de plusieurs personnes dans notre société pour avoir une bonne idée de ce que je risque. Un sondage publié par l'agence de santé publique du Canada en 2006 a démontré que 44% des répondants n'acceptaient pas qu'une personne vivant avec le VIH ait le droit de servir le public comme dentiste ou cuisinier. Dans la même étude, 27% seraient très ou moyennement inconfortables à magasiner dans une petite épicerie locale sachant que le propriétaire était infecté au VIH.

Des données plus récentes? En 2011, le Centre en recherche sociale pour la prévention du VIH et la Fondation canadienne de recherche sur le sida ont collaboré à une étude que vous pouvez trouver ici. Il y avait une diminution modérée du nombre de personnes exprimant un inconfort dans des situations où il n'y a pas de risque de transmission du VIH, mais une portion significative de la population exprime toujours des attitudes clairement discriminatoires — 23% pour l'épicerie locale et 18% pour travailler dans un bureau avec un collègue séropositif.

Ajoutons à ces statistiques les expériences anecdotisés de personnes qui se sont vu refuser ou qui ont perdu leurs emplois — par coïncidence autour du moment où leur statut sérologique était divulgué, par eux-mêmes ou par hasard — et vous comprendrez peut-être le désir d'exercer un contrôle sur la dissémination de cette information. Vous m'excuserez si je suis réticent à confier mon acceptation sociale et mon employabilité à quelqu'un que je connais à peine. Si cette personne partage largement mon information personnelle et je perds mon emploi, le gouvernement ne viendra pas à mon aide et la personne aura réussi à détruire ma vie sans subir de conséquences.

L'affirmation qui me fâche le plus (et j'ai « défriendé » une couple de personnes sur Facebook pour ceci, donc on peut conclure que je le prends au sérieux!) est celle qui compare la non-divulgation du statut sérologique avec l'intention de faire mal aux autres. Pourquoi est-il si difficile à croire qu'une personne peut être à la recherche d'une vie aussi normale que possible, tout en appliquant les conseils du personnel médical et des intervenants communautaires et tout en confrontant la peur de transmettre son virus à autrui, et n'est pas comme on veut croire dédiée à l'infection malicieuse de tous et toutes? Qu'une personne cherche tout simplement à être aimée et acceptée sans avoir à lutter à tout moment contre la stigmatisation vécue, disons, à l'épicerie ou au bureau.

Je ne comprendrais jamais l'idée que l'entière responsabilité de la prévention du VIH soit l'unique responsabilité des personnes vivant avec le VIH alors que nous sommes également aux prises avec la stigmatisation et la discrimination venant d'une société qui manque d'information sur le VIH et ne cherche pas à s'informer. Nous ne poursuivons pas des activités sexuelles tout seuls (au moins on n'est pas poursuivi quand on le fait tout seul!), donc qu'en est-il du partenaire séronégatif ou de statut inconnu : aucune responsabilité d'insister sur le port du condom? Aucune responsabilité même de demander au partenaire son statut?

Si je suis piéton (avertissement de métaphore farfelue!) et j'arrive à un passage clouté sans feu de circulation, est-ce que je traverse sans regarder dans les deux directions? Serais-je si stupide sans porter la responsabilité pour ce qui m'arriverait? Je tends à penser que, voulant protéger ma santé et celle des autres, j'approcherais le passage clouté avec le degré de prudence attendu d'un piéton et je traverserais de manière sécuritaire au lieu de me présenter comme victime innocente de l'automobiliste qui aurait pu être à quelques petits mètres du passage quand j'ai décidé de sortir sans regarder. Après tout, c'est à lui de klaxonner pour m'avertir. Sans klaxon, je peux présumer l'absence d'automobiles sur une rue, non?

Oui, l'exemple est ridicule, mais pas plus que la réalité.

Nous aimerions tous vivre dans un monde où les gens pourraient divulguer leur statut sérologique et qu'il suivrait une discussion, de l'ouverture et de la compassion. Nous ne sommes pas là, et je ne vois pas beaucoup d'efforts pour y arriver, du moins certainement pas par un système qui criminalise un partenaire de danse tout en laissant l'autre danser sans soucis comme d'habitude.

Libération très conditionnelle?

Pensées préliminaires sur les jugements de la Cour suprême du Canada dans Mabior et DC.
The English version of this article is published on PositiveLite.com.

Permettez-moi de commencer en qualifiant mon niveau d'expertise. J'ai déjà été avocat, mais j'ai démissionné du Barreau il y a plus de dix ans, donc je lis les jugements avec un mélange particulier de formation en droit dans le passé, d'implication politique actuel et l'œil souvent paranoïaque d'une personne qui risque de vivre les conséquences de la décision. Si vous êtes prêts à avaler tout ça (je ne pouvais pas résister!) je vous invite à lire et à exprimer votre accord ou désaccord. Pour des analyses plus poussées sur le plan juridique, je vous suggère de consulter la Coalition des organismes communautaires québécois de lutte contre le sida ou le Réseau juridique canadien VIH/sida.

Contexte (version simplifiée)

La Cour suprême du Canada s'est prononcée sur la question de la réponse du droit criminel au VIH pour la première fois en 1998, dans l'arrêt Cuerrier. Les faits de cette cause sont importants, venant d'une ère avant qu'on connaisse les traitements antirétroviraux efficaces (donc avant de pouvoir penser à une charge virale indétectable) et tournant autour d'un homme qui n'a pas utilisé des condoms avec ses partenaires (ce qui limitait la possibilité du tribunal de se prononcer sur le niveau de risque avec utilisation de condoms).

La Cour a construit une interprétation des lois existantes par laquelle l'absence de divulgation du statut sérologique viciait le consentement du partenaire, et une relation sexuelle sans consentement est une agression sexuelle, ou au moins des voies de fait. Si on y ajoute l'impact d'une infection au VIH menant à des conséquences graves pour la santé de la personne l'accusation prend plus d'ampleur, comme agression sexuelle grave ou voies de fait graves.

Le test élaboré par la Cour dans Cuerrier se résume comme suit : si l'acte peut impliquer un risque important de transmission du VIH (lésion corporelle grave), la non-divulgation du statut sérologique constitue une fraude qui annule le consentement du partenaire et l'acte devient non-consensuel. On allait découvrir plus tard le manque de clarté concernant la définition du risque important. Est-ce que les condoms réduisent le risque à un niveau moins qu'important? La décision minoritaire écrite par Madame Justice McLaughlin laissait comprendre que ça pourrait être le résultat de l'utilisation de condoms, mais ce raisonnement n'avait pas la force de droit parce que M. Cuerrier n'avait pas utilisé des condoms et une majorité de la Cour suprême n'a pas signifié son accord avec ce point de vue.

Plus récemment, nous avons commencé à s'interroger sur l'impact d'une charge virale indétectable. Peut-elle aussi avoir l'effet de réduire le risque au-dessous du seuil d'importance, particulièrement dans un contexte où les autorités de la santé publique de plusieurs provinces commencent à prôner le traitement comme moyen de prévention?

L'incertitude s'est manifestée dans la forme de décisions contradictoires de divers tribunaux à travers le pays, se terminant par les deux causes décidées par la Cour suprême le 5 octobre.

Les causes Mabior et DC (également simplifiées)

M. Mabior a été accusé de neuf chefs d'agression sexuelle grave pour la non-divulgation de son statut sérologique à ses multiples partenaires. Ce qui était intéressant d'un point de vue juridique, attendu les questionnements dans la communauté, est qu'il a parfois utilisé des condoms et sa charge virale était parfois indétectable, ce qui devrait permettre aux tribunaux de mieux clarifier les questions. Aucune des partenaires de M. Mabior n'a été infectée. Trouvé coupable de six des chefs d'accusation, il a porté la décision en appel à la Cour d'appel du Manitoba, qui l'a acquitté sur quatre des chefs, où il a utilisé un condom ou a eu une charge virale indétectable. La Couronne a porté cette décision en appel à la Cour suprême du Canada.

Mme. DC a été accusée de voies de fait graves et d'agression sexuelle grave concernant une seule relation sexuelle avant de divulguer son statut sérologique à son partenaire. Cet homme a déposé sa plainte quatre ans après l'incident dans le contexte de son propre procès pour violence conjugale lors de leur séparation. Notons que les deux ont poursuivi une relation pendant quatre ans après le divulgation du statut sérologique de la femme. (Notons en plus que le plaignant a été trouvé coupable de violence conjugale, mais a mérité une absolution inconditionnelle après avoir exposé la plainte qu'il avait déposée à l'égard de sa victime. Je pourrais poursuivre cette question, mais je me retiens pour ne pas perdre le fil du sujet actuel.) Elle a dit qu'il y avait utilisation d'un condom et il l'a nié. Il n'a pas été infecté au VIH. Trouvée coupable suite à un exercice extraordinaire du juge pour conclure qu'il n'y avait pas de condom, la Cour d'appel du Québec l'a acquittée, citant sa charge virale indétectable lors de l'incident, mais maintenant la conclusion du juge de première instance quant à l'absence du condom. La Couronne l'a porté en appel à la Cour suprême du Canada.

Réactions à la décision de la Cour suprême

C'est tout un spectacle de témoigner la publication d'une décision de la Cour suprême et la grande variété de réponses que ça peut provoquer. Les médias, étant informés d'avance du dépôt de la décision, étaient prêts à interpeller tout genre de porte-parole pour leurs interprétations de la signifiance du jugement. Les interprétations étaient très variables.

Quelques personnes vivant avec le VIH (PVVIH) et quelques experts en santé publique ou médecins spécialistes en VIH ont salué le jugement comme un pas en avant. La coalition des groupes communautaires intervenants devant la Cour suprême l'ont traité d'injuste, l'appelant « un grand pas en arrière pour la santé publique et pour les droits de la personne. » Comme on ne trouverait pas une réaction plus mixte que ça, je pensais que ça pourrait être utile d'examiner le jugement de près pour identifier les bons et les mauvais coups, du point de vue de quelqu'un vivant avec le VIH et engagé dans la défense de nos droits, avec toutes les limites à mes capacités d'interprétation que j'ai notées au début.

La réaction publique à ce jugement, mesurée par le déluge de commentaires sur les sites des différents médias, n'est pas facile à lire. (Cœurs sensibles s'abstenir!) On y retrouve une grande incompréhension du VIH et de ses modes de transmission, ce qui ne serait que triste si ça ne faisait pas peur.

Un nouveau test

La Cour suprême n'a pas désavoué la règle de Cuerrier, mais elle a reconnu qu'il y avait des problèmes de clarté et a proposé une nouvelle façon d'évaluer le « risque important de lésions corporelles graves. » Le jugement propose un test de « possibilité réaliste de transmission du VIH » comme moyen d'assurer que la barre ne soit établie trop haute ni trop basse, considérant la nature sérieuse de l'infection au VIH. Ce qui est proposé est une évaluation du degré de mal et du risque de transmission, qui sont en relation inverse : la plus sérieuse la maladie, le plus bas le niveau du risque de transmission qui engagerait la responsabilité de divulguer. Tout en insistant sur le fait que les causes devant le tribunal n'impliquaient pas d'autres infections transmises sexuellement, le tribunal a quand même suggéré que la plupart de ces autres infections ne sont pas aussi sérieuses que le VIH, donc le niveau de risque de transmission nécessaire pour engager la responsabilité de divulguer serait plus élevé.

Toujours trop vague? Le tribunal offre des balises plus claires. Le paragraphe 94 du jugement dans Mabior nous informe que la possibilité réaliste de transmission du VIH est écartée lorsque la charge virale est faible (par opposition à indétectable) lors des relations sexuelles ET le condom est utilisé. Le jugement précise qu'une charge virale est faible au-dessous de 1 500 copies par millilitre. Avec ces deux éléments, il n'y a pas de responsabilité criminelle de divulguer son statut si la question n'est pas posée.

Quels sont les bons coups?
 
Nous avons au moins un peu plus de clarté. Une charge virale faible (moins de 1 500) avec l'utilisation du condom élimine l'obligation de divulguer son statut sérologique à un partenaire qui ne le demande pas. (J'ajoute moi-même la partie « qui ne le demande pas » parce que mentir face à une question de son partenaire constituerait en soi une fraude viciant son consentement.) Ça veut dire aussi que la Cour suprême du Canada reconnaît que dans une telle situation le risque de transmission du VIH n'est que spéculatif et non pas réaliste, ce qui est un geste de reconnaissance, même minime, à la science concernant la transmission et la prévention du VIH.

Tracer la ligne à une charge virale de 1 500 était un choix intéressant. Le tribunal a clairement compris qu'une charge virale détectable, mais basse, réduit le risque de transmission et que le concept d'indétectable peut évoluer (au Québec, nous avons passé d'un test sensible à 500 copies à un autre sensible à 50 copies en 1999 pour ensuite passer à un autre sensible à 40 copies en 2010). La ligne telle que tracée évite que le fardeau des PVVIH devienne plus lourd avec le développement de technologies de plus en plus sensibles, et elle dédramatise aussi (du moins aux fins de la responsabilité criminelle) les « blips » qui peuvent arriver de temps en temps dans la mesure de la charge virale.

Un autre bon coup se trouve dans la décision dans l'affaire DC. Le jugement dans Mabior décrit le test de « possibilité réaliste de transmission du VIH », mais le jugement dans DC a un mot à dire sur la qualité de preuve d'absence du condom. La seule preuve présentée au sujet de la présence ou absence du condom dans DC venait des parties, qui se contredisaient et qui étaient toutes les deux qualifiées de « peu crédibles » par le juge de première instance. Il a dû trouver une autre source de preuve pour corroborer l'absence du condom, ce qu'il faisait en lisant le dossier médical de DC où elle a posé une question sept ans plus tôt sur l'impact d'un condom brisé. Le juge tirait la conclusion qu'elle aurait menti à son médecin pour cacher la non-utilisation du condom à l'époque et donc mentait aussi au sujet du condom lors de sa rencontre avec le plaignant. La Cour suprême nous dit que « [l]’échafaudage de conjectures sur lequel se fonde le juge du procès n’équivaut pas à un élément de preuve indépendant qui corrobore le témoignage du plaignant. » Ceci peut avoir un impact sur les éléments de preuve pour des futures accusations de PVVIH, mais il se peut aussi que cette situation soit si unique qu'elle n'aura pas d'effet au-delà de cette cause.

Et des moins bons coups…

Pour le dire ouvertement, nous voulions un jugement disant que l'utilisation du condom OU la charge virale indétectable écarteraient l'obligation de divulguer, mais le jugement nous a donné un « ET ». Il se peut que la Cour suprême ait voulu être très conservatrice par rapport au risque de transmission et dramatique par rapport aux impacts du VIH en 2012. Je ne manque pas de prudence moi-même et je ne sous-estime pas l'impact du VIH sur une vie, même aujourd'hui, mais je vois ici un surplus de protection que je caractérise en anglais comme l'approche ceinture ET bretelles (j'aborde le sujet ici). Tout ça pour dire que je trouve que le jugement laisse la plupart du fardeau sur les épaules des PVVIH et probablement à cause des craintes de la population générale. La réponse du public aux reportages qui mettent l'emphase sur les situations où la divulgation ne sera pas requise est surtout négative, ce que je trouve déprimant.

Le jugement devra causer un peu d'inquiétude chez les autorités de la santé publique et ceux qui travaillent en prévention. Après 30 ans de messages nous incitant à « utiliser le condom » la Cour suprême semble dire que le condom tout seul ne suffit pas. Comme j'ai déjà indiqué, je trouve que l'approche en est une d'une prudence excessive, et je me demande quelles seront les conséquences pour la prévention.

Le tribunal ne prend pas connaissance d'office de l'efficacité des condoms. Prendre connaissance d'office veut dire qu'un fait est tellement bien reconnu qu'il n'est plus nécessaire de le prouver devant le tribunal. La Cour suprême accepte que le virus ne traverse pas la barrière du latex, mais accepte également le témoignage expert du procès de Mabior à l'effet que l'erreur humaine et les bris de condom réduisent l'efficacité à un taux autour de 80%. L'efficacité des condoms dans une situation particulière peut être très difficile à prouver, et l'évaluation du taux d'échec à 20% a probablement contribué au jumelage de la charge virale basse avec le condom dans la décision.

Un autre danger que j'anticipe est l'évolution possible de l'approche « traitement comme prévention » vers le traitement obligatoire. Pour ceux et celles qui ne sont pas sous traitement dû à des niveaux de CD4 qui ne le justifieraient pas selon les lignes directrices actuelles, la charge virale basse que cherche la Cour suprême n'est pas nécessairement actualité. Ils ne vont pas pouvoir échapper à l'obligation de dévoiler en utilisant le condom, mais se trouveront avec le choix de dévoiler dans tous les cas ou d'embarquer sur le traitement précocement avec utilisation du condom en sus.

Ce que je n'ai vu nulle part dans le jugement c'était la responsabilité du partenaire de la personne vivant avec le VIH. Pas que j'attendais le voir : le droit criminel ne s'apprête pas à la responsabilité partagée qui fut depuis le début de l'épidémie centrale aux messages de la santé publique et qui est bien connue au droit civil. Encore une fois, l'entière responsabilité de la prévention du VIH repose sur les épaules des PVVIH. J'imagine que ces autres personnes attendent être protégées par le droit criminel et non pas en ajustant leurs propres comportements.

Je suis certain qu'il y a des gens qui vont lire ce texte qui ne vont pas comprendre la difficulté de la divulgation du statut sérologique. Comme j'ai déjà trop écrit pour un seul billet, je vous promets de revenir sur le sujet de la divulgation dans un prochain billet.

La Cour suprême nous a tracé une ligne plus claire. Malheureusement, cette ligne ne se trouve pas à l'endroit où nous l'attendions.

Spoiler alert: she dies of opera!

To launch the new season of the Opéra de Montréal, a lovely production of Verdi's La Traviata, featuring Myrtò Papatanasiu as Violetta, Roberto De Biasio as Alfredo and Luca Grassi as Giorgio.

As I am not a musical expert — I just know what I like — I will not attempt to critique the musical talents of the cast. I will say that the music itself is lovely and they did good service to it. The first act is really loaded with the tunes that are more popularly familiar, while the second features a lovely gypsy song (while I do not personally use that term to describe the Roma people, Verdi did) and a bullfight song and performance that was quite nice too. In the third act, I was surprised by Violetta's speaking the contents of the letter she received (who knew she could do something other than sing her words?!), and there were some more spoken words by the character later on as she draws near to death.

The plot, as usual, is very entertaining. Violetta is wooed by Alfredo, but cannot return his love. She does, however, invite him to return the day after the party, and relishes the state of being loved. My favourite line was something about being free to race from joy to joy, which is a delightful way to live if you can.

We skip to Violetta's house in the country, where she is secretly having her maid sell her Parisian possessions to maintain the country lifestyle she is living with Alfredo, and she seems after all to have become rather attached to him. Alfredo feels awful that she is selling everything to support him and secretly steals off to Paris to try to rectify that situation. While he's gone, his father Giorgio pops in to share the news that everyone thinks Alfredo is squandering his family's fortune on her and imploring Violetta to leave him to save the family honour. She reluctantly agrees but, of course, doesn't really come clean with Alfredo and leaves him on the sly with an ambiguous letter delivered to him later.

Meanwhile, back in Paris, Violetta's friend Flora is having a fabulous party. There is the Roma people song (!) that I mentioned earlier, and the performance that goes with the bullfighter song involves the killing of four mock bulls, the last seems to have been killed with a withering glance. There were supposed to be five bulls, so one of the guests obliges and does a bad job of being the fifth bull without the bull outfit.

Who knew that Alfredo would show up at this party?! He is incensed that Violetta seems to be there with the Baron and, after decimating the Baron's fortunes by gambling and winning against him, he throws his winnings at Violetta's feet in payment for past favours. How insulting! And adding injury to insult he seems to have challenged the Baron to a duel as well.

The next time we see Violetta, she is on her deathbed. The doctor tells the maid that she probably only has a few hours to live. The mail arrives! It is a letter from Alfredo announcing an impending visit, and Violetta perks right up to the point that we think she might survive. But alas, she is stricken by opera (an inoperable form) and is doomed to leave us. She does have time, however, to offer Alfredo a small bedside portrait of herself for him to give to his next lover (she has an odd sense of occasion, I must say!). She dies in a flourish as her visitors freeze in position and her spirit gets up and sings and dances before finally collapsing to the ground. Everyone is sad, but satisfied.

Some of the most entertaining spectacle of going to the opera is the hierarchy of applause at the end. The curtain rises and the minor characters are there to receive applause. In a surprising departure from custom, enough people leapt to their feet at this point that we all had to get up in order to be able to see! Kind of takes away the impact of leaping to one's feet for the more substantial stars!

Then we get waves of groups of characters building gradually to the leads, who lead the group in rushing forward to take collective bows, interspersed with individual accolades. The conductor joins them on stage and draw attention to the orchestra, which does not move, but receives its due. A couple of non-costumed people come out, likely the director and stage director, maybe the accountant (?) (I kid), and we embark on another frenzy of bows and applause until the curtain comes down and the lights go up.

The Opéra de Montréal, fresh from some live blogging experiences last year, has fired up the Twitter machine this year. I obliged by tweeting during the intermissions and pauses, and only some of my cleverness was frustrated by the autocorrect on my phone (bulldog for bullfight…really?!!). I thought they might have taken it too far when it looked like Violetta's bedside portrait was the Twitter egg (the one that is assigned to your profile if you don't upload a photo), but it might have been failing eyesight on my part combined with the distance from a rather small picture. They did, however, retweet one of my tweets (alas, the autocorrected one).

A delightful evening in delightful company, and a good start for the new season. Next up: Le vaisseau fantôme (The Flying Dutchman) by Wagner, in November.

Clap Off Your Hands!

From the time I started to discover Walk Off the Earth via YouTube (their channel), I suspected that they would put on a very good show. When I discovered that Montréal was on their tour roster, I knew I had to see them. Not having actually gone to a concert as such in a long time, I made two friends accompany me. (Images, except those of my ticket and the bad far away ones I took with my phone, stolen from their Facebook page.)

Those friends might not forgive me for the warm-up act, who were probably not as bad as we thought they were last night (allow me to be charitable here, will you?). They didn't really announce their name, or at least not clearly, but I gather from the end of their "performance" (I guess the charity's gone!) that it was something like Trouble Your Daughter, or Warn Your Daughter Not to See This Band, or something like that. I kid. They have a lot of development of their act to do, and the WOTE performance they warmed us up for only served to drive that point home.

From their entry onto the stage to a deafening roar of the crowd, Walk Off the Earth gave us a really polished and entertaining performance. Little things like some choreographed moves and what looks like a real group spirit make all the difference to a show. I knew from their videos that I could expect a ukulele or two to be tossed around, but I was rewarded with thrown trumpet, harmonica and guitar as well!

I probably started liking this group because I think Marshall is as cute as a button. You'll be able to pick out which one he must be because I'm not all that unique in my tastes. But the best thing for me has been coming to appreciate the individual talents of the whole group, as well as what seems to be their excellent group dynamic. You'll be in awe of their multi-instrumental talent, but most of all, you'll feel good after listening to them.

I'm not going to be able to do an adequate job of describing the concert, so I'm going to have to share a couple of videos with you. The thing about this is that the live performance is even better because it is just as polished and you know it isn't having a bunch of re-takes. Imagine their performance of Gotye's Somebody That I Used to Know with five of them on one guitar. Here's my fuzzy picture of them doing it live, followed by the YouTube video that has now been seen over 135 million times.

 
The funniest thing I have to note is the incredible change in the behaviour of concert-goers over time. I went to a fair number of concerts in the time of the lighter held high, burning a message of "we love what you're doing" into the air. You can see in my fuzzy photo the cell phones recording, and it was impressive to see all the phones get lifted simultaneously at certain points in time. And to further demonstrate how old I am (we did figure that we were among the oldest people there, but not the only ones our age), it was lovely to see a concert in a space that was not full of smoke. The kids won't understand what that might have been like.

I haven't gone on nearly enough, so I'm going to do that by sharing a couple more videos. One of their newish songs really got the crowd going: Summer Vibe.



It's a calm and almost lazy song, but the crowd was involved as we were invited to sing along and provided with lyrics printed on big pieces of cardboard like flashcards.

It worked, too, as this was a refrain taken up by the crowd to incite the first of two encores.

And in the encores, one of my personal faves. It's a mocking of an auto-tuned news story that you may or may not remember from the past year, and it didn't look exactly like this video. It was very well translated to the stage and gave me occasion to whoop my approval and enjoyment from my balcony perch.



All in all, I'm very glad I went to this concert and I'm looking forward to this group's talent and creativity being around for a long time.

Remembering David

It's always hard to put into words what we feel about the death a family member, of a friend, even of an acquaintance. Not being a believer (not having any imaginary friends?), I don't take refuge in notions of "better places" or reuniting with lost love ones. I prefer to focus on the things I remember, little incomplete snippets of a life lived that brought shared pleasure or maybe a little learning.

David McCombs died recently. He wasn't my really close friend and he lived in another city, but I'm going to miss him, fondly remember some shared history, and regret the last visit we didn't have because he wasn't feeling up to it at the time.

 

David was a gay man living with HIV and Hepatitis C. When he lived in Montréal, he was a member of AIDS Community Care Montréal, of which I had the privilege of being the Executive Director for a time. This is where I met David. Volunteering for the ACCM Buyers' Club, participating in a number of the organization's activities, and finally getting involved in representing the organization in various ways, including at the Canadian AIDS Society AGM and Forum and at the International AIDS conference when it was held in Toronto.

We had some shared moments at those events, as we went out for breakfast a few times in Ottawa at the CAS events (our choice of "guilty pleasure" — so as not to have to say it out loud [McDonald's] — or somewhere we could admit to having gone). We were roommates in the dorm space provided at the Toronto conference…way out on Finch East…and even invented a line of fashion items for people with bodies misshapen by lipodystrophy (dazzling elements designed to draw attention away from the unwanted lumps and bumps).We never made them, just laughed about how clever we were to have thought of them.

You might say that we shared a sense of humour, too. I remember David searching high and low for a copy of Diseased Pariah News in order to scan a faux ad for his presentation to the HIV/AIDS course at Concordia University. Yes, it was the ad for AIDS Barbie and her Dream Hospice. Because there's really nothing better to laugh at than your own predicament, and in the face of what could sometimes be horror, laughing was really the best response.

The other good response is what David was doing at the Concordia class: sharing his experiences. He did it there in that ephemeral way that speaking to a group tends to be, the traces left only in the minds of those present. But he also did it by talking about his experiences on a blog that you can visit here. I'm going to keep it linked in my blogroll, and fully intend to go back and read and watch David talking about the things he was doing and the things that frustrated him.

The last time I saw David I happened to be in Toronto for a meeting, so I arranged to leave a little later than usual and went to brunch with him. He was in Casey House at the time, after a rather severe acting out of his liver, which upset the balance of his HIV treatment as well (or was caused by it!). We had our brunch and we went for a walk to visit his apartment before returning to Casey House. We sat on the porch there gabbing and laughing and undressing the construction workers across the street with our eyes (okay, and our words, too). We were there for so long that the staff came out a couple of times to make sure everyone was okay. It was a nice meeting.

The next time I was there I had managed to get tickets for The Normal Heart at the Buddies in Bad Times Theatre and was looking forward to sharing that experience with David, too. Alas, he wasn't feeling up to it that day, so I didn't get to share that with him.

And while it was not in person, we shared a lot of things on Facebook. A few months ago, I saw something that made me think immediately of him and I tried to share it with a mention of him so that he would see it pop up. I couldn't find him, like he had vanished from Facebook altogether. I timidly asked his sister if he was okay or if he might have defriended me (surely not!). The reply was that he had closed his Facebook account, saying that no one would miss him if he wasn't there.

It was wrong then (and corrected), and it's certainly wrong now. Too bad we have no way to correct this new absence.

We Had An Election

 

Aislin cartoon from 1976 election

Well, that was interesting. An election that has left us with a new government that is nine seats short of a majority, an old government that lost about a quarter of its share of the vote, but only a fifth of its share of the seats, a new third party that did about two-thirds better than the old one it swallowed, and a fourth party that doubled its representation, albeit from one to two. The Premier lost his own seat, but only four other cabinet ministers lost. 74.6% participation this time, after a scary low of 57.43% in 2008.

The former government went from 42% of the vote last time to 31% this time. The new government also lost in percentage of the vote, from 35% to 32%. This reminds me of an election we had some years back where the leaders of both the major parties (there were really only two in contention then) lost their own seats (one of them may have gained it back by a hair in a recount). A fine comment on the public's appreciation of leadership at the time.

I played with the numbers a bit — because I'm a geek that way — and took a look at what might have happened if we had a strictly proportional system and everyone voted the same way they did yesterday. The flaws in that are obvious (knowing how the system works is a part of what makes us make the decisions we do), but this form of proportionality is practiced elsewhere, sometimes with a "threshold" as low as the vote percentage represented by a single seat. That's how I calculated it. They don't add to 125 because of rounding.

We have our first « Première ministre »! (First woman in this position in Québec.)

And after the vitriolic campaign, some recognition by each of the leaders of the contributions of their adversaries to public life, which was really gracious. Even their crowds of supporters were gracious in acknowledging the opposing parties with their applause.

When Pauline Marois spoke, she said some of the things I wish she had said during the campaign. She talked about setting aside differences and working together to improve our society. She reached out to the English-speaking community with a sentence in the best English I have ever heard her speak, affirming that the English-speaking community is a part of the history of Québec and of its future. She reached out to the first nations communities with a promise to work with them as equals. She has a very tough job to do trying to govern with only 54 of 125 seats. It would be nice to see all of the parties manage to work together and compromise to find solutions to problems: it would be to all their credit.

And then it happened.

Madame Marois was just reaching the end of her speech when two bodyguards appeared beside her and whisked her off stage. The audience, the media, the people like me watching on TV were all dumbstruck. What was happening?

From later reports, we pieced it together (still light on many of the details). A man had entered the back door of the club where the Parti québécois was having their victory rally. Inside, he shot two people who were working as sound technicians backstage (one dead, one in critical condition), then fled, lighting a fire at the back of the club (outside, I believe). He was rather quickly apprehended by the police. I know nothing about this man and the wheels of justice will take their course. So no speculation on my part about his level of sanity or his motivation.

Let me just say that the level of rhetoric in this campaign reached heights of shrillness we haven't seen for a long time. Yes, the Parti québécois was founded 42 years ago to lead Québec to independence, but no one has ever suggested that this would be done without its being an expression of the will of the population. Yes, there are real problems in a lot of people's attitudes about minorities (see my post on secularism), but there are significant actors fighting that xenophobia, too.

We have had a couple of referendums (yes, I know the proper Latin plural is referenda) on different versions of separating from Canada and we have had a whole lot of elections. Since it was founded in 1970, the Parti québécois has been the government several times, and even a majority government most of those times. So I really don't understand the over-the-top rhetoric I am hearing from people about being afraid to come here or planning to move away. Because of an election result?

Whatever the population decided yesterday (and the jury is really out on that one), we still have all of our democratic values. Not perfect, but there are people working on things like limiting even more the amount of money an individual can contribute to the political process, introducing some form of mixed or proportional representation and other issues. But those are the kind of changes that we vote on, or that we ask our duly-elected representatives to vote on.

We don't settle our differences with guns.

J'ai voté - I Voted

We have ten candidates to choose from in my riding of Sainte-Marie-Saint-Jacques in the Québec election, including eight from among the twenty officially registered parties and two independents. That's my official reminder card above, with my red square to remind me what some of this is all about.

No candidates from the following parties in my riding:
• Bloc pot
• Coalition pour la constituante
• Équipe autonomiste
• Mouvement équité au Québec
• Parti conservateur du Québec
• Parti égalité/Equality Party
• Parti équitable
• Parti indépendantiste
• Parti nul
• Parti unité nationale
• Parti vert du Québec/Green Party of Québec
• Québec – Révolution démocratique

The only surprise there is no Green Party candidate, especially considering they scored over 5% last time around.

I ended up voting in the advance poll, because for some odd reason it was closer to my house than the regular poll, and my mind was made up anyway. For the last week, I have not been influenceable, but I don't seem to attract a lot of attention from the parties anyway: unlisted phone number, odd little part of the neighbourhood that doesn't draw a lot of flyers, and I have a "no flyers" sticker up anyway that, even if it doesn't apply to political tracts, seems to discourage them anyway.

So now I get to sit back and, nerd that I am, watch several TV stations and even more web sites for live election results, starting at 8 pm. It looks like it's going to be even more interesting than usual.

If you live in Québec…have you voted yet?

Colonoscopy

I'm officially an old man, now that I'm having old man medical tests. This week, it was a colonoscopy, for no reason other than that I have reached a "certain age" and ought to have one.

I was quite nervous about this one. I had a brief visit with this doctor a few months back for some kind of related exam that turned out to be only preparatory. Still, at that time I had to do two enemas beforehand and then worry that I might embarrass myself by not having done a good enough job. I guess I did okay on that measure and the visit went okay, but I had several little bumps burned from my insides and that caused a swelling that made me feel constipated for a couple of days. You can see, then, how I might be nervous about a test that seemed more complicated.

The preparation was awful for this. Stop eating at 10 am the day before, with dosings of laxatives at 2 pm and 6 pm and then the next morning at 7. The instructions I got from my doctor and the ones on the inside of the Pico-salax warned that it might become hot when mixed with the cold water (kind of scary), but it didn't for the first dose. Friends had warned me that the product would work really quickly, so I was quite anxious when nothing happened until more than an hour and a half after drinking it! I dutifully consumed plenty of clear liquids, including some blue G2 (Gatorade product) and lots of my own iced herbal teas. I was convinced that I was washing out my bladder more than anything else.

I need not have worried. Things loosened up quite nicely and, by the end of the evening, all was liquid and even a little blue (which is disturbing). The morning dose of half a bottle of magnesium citrate solution acted similarly, to the point that I thought I might be late, as I was hesitating to get into the shower not knowing whether I might have to leap out to sit on the toilet. Yes, liquids from some sources are okay in the shower, but I can't wrap my head around what I was picturing there…

I got to the hospital early enough to update my hospital card (I have three of these from the different installations of the McGill University Health Centre, which seems wasteful, but I digress). I got some quick instructions from the person renewing my card about how to get to the place I needed to get to (the Royal Victoria Hospital is a crazy Victorian structure with odd tunnel and bridge connections between a bunch of buildings, so the help was total needed!). I made it to the clinic!

Upon check-in I had a hospital bracelet attached to me and waited. When called, you go through to the patient area and change into two hospital gowns (one each way…why don't they just rethink the design of these things?) and wait again. Little intravenous thingy installed on my right arm (the vein that usually manages to be the only one findable for blood tests), wait again.

When I went in to have the colonoscopy, I was installed on the bed, hooked up to the blood pressure and pulse monitoring machine and the nurse asked if I had sleep apnea. When I said I was beginning to suspect I might, she gave me oxygen (tube with little nostril inserts) for the duration. Then I got a dose of something explained as something to relax me and something for the pain. The next thing I knew I was waking up in another room in the same bed!

If I hadn't been in the hospital, I would wonder if I had been roofied! Knocked right out and someone doing things in my anal passages! But, like I said, I was in the hospital, so no such shenanigans.

They left me a lovely printout describing the procedure and its outcomes, with some delightful pictures of my inner passageways. To my great relief, it also said "The quality of the preparation was good." Phew! I got up, sat for the required few minutes and then got dressed and went home for a much-needed lunch.

On the whole, the preparation was way more intimidating and difficult than the test itself. But I'm still not sure how I feel about the recommendation to repeat in 7 to 10 years.

Secularism in Québec

Oh, high election season, when we all come together to throw the minorities under the bus! You might be able to detect a certain frustration I have with how Québec relates to its minorities, especially its religious minorities.

Now, I am no fan of religion. I am, however, a fan of respecting people's rights and their freedom of expression up to — and not including — the point where those rights and that expression encroach on those of others. If people want to believe fairy tales and wear cute little items of clothing or jewellery to show those nutty beliefs, they can go ahead and do it. They just can't use their fairy tales to stop anyone else from accessing a service or exercising a right.

How do we guarantee the secularism of the state? By ensuring that its institutions are not identified with any religion, including the formerly dominant one that Québec society all but abandoned more than forty years ago. Crucifix in the National Assembly or in a courtroom? Out! Prayer before the debates in the National Assembly or a City Council meeting? Out! These are almost invariably the expressions of the formerly dominant religion. They are not a part of the secular society in which we live.

I draw another line, though, at the level of the individual. I don't see the harm in someone's wearing their little cross around their neck, their kippa or their hijab on their head. Not even in the context of government services. I will confess that the niqab (face covering) still jars me a bit, but if a public being served must see the face of the person acting as an instrument of the state, there are surely adaptations that can be made to accommodate someone who (for the sake of their fairy tale) must cover the face. This might be a position that is not dealing with people face to face, and there are plenty such positions in the public service.

If, on the other hand, we must always see the faces of all people acting as instruments of the state, there are some modifications to be made to the visors and gas masks worn by 'our' riot police to protect themselves from their own weapons.

Where the line is clear for me, however, is in the actual delivery of services to citizens. Nobody gets to cite his or her religion to refuse to do a duty outlined in the job description. We keep hearing stories from the US of people resigning from their positions rather than registering same sex marriages and to that I would say "Yes, that's exactly what should happen." If you are unwilling to do your job because of the fairy tale you believe in, find another job.

I was in a courtroom once a few years ago to hear a sentence being delivered. When we arrived, we all noticed that the court clerk was wearing a hijab. My first thought was "Wow! Cultural diversity reaches the judicial system in Québec." Some of my companions, on the other hand, were outraged, which I will never understand. This woman did her job and her religion didn't seem to impact any aspect of that other than what she wore to work.

The variety of fairy tales that people believe in, and the quaint customs they observe in the name of those fairy tales, are a part of a society open to the world. We are all in agreement that public services (including commercial services offered to the general public) in Québec must all be available in French. As much as we can, we ought to strive to reach people in other languages, too, without excluding people from the workplace when we don't offer support for them to acquire those additional language skills. Beyond the commonality of French, our government should look like our society, in all its diversity.

The institutions and the services provided must be neutral, but the individuals who provide them ought to be as diverse as the population they serve.