29 June 2013

Romania: 5 Reasons

On my recent trip to Bucharest for the meeting of our international coalition, I was challenged by a local person to write a letter outlining five reasons one should want to go there. This is my answer to that challenge.

One: Beauty (natural)

It might be odd that I am illustrating my point about natural beauty with a paved bicycle path and sidewalk, but what can I say? I’m a city boy. My impression of Bucharest as green was probably helped by my having stayed in a hotel that was adjacent to a large green space. There are plenty of parts of the city, like any other, that seem to be wanting for trees, but there were some remarkable examples of urban greenery that I really appreciated. If you can have a large boulevard and succeed in integrating several strips of grass and trees, not to mention lovely shaded bicycle lanes and sidewalks on both sides, you have succeeded in making your city more pleasant. And if you can add a touch of whimsy by detouring your bicycle path around a phone booth, even better!

Two: Beauty (architectural)

There are some truly magnificent buildings in Bucharest that deserve a visit, even if only to see them from the outside. I illustrate this point with a photo I took that I like to call “Faded Beauty” — an obviously beautiful little home with lovely architectural details that could use a little work. Many buildings have had that work done, and many are waiting for that to start. Like many cities, there are some very utilitarian buildings (apartment blocks, for example) that date from a time where function trumped form, but I see even these as moving toward improvement and beautification.

I found it funny that our host organization described the building in which it is housed as being “Communist Architecture” (read grandiose and stern). I didn’t find it cold, but actually rather interesting, in that way that a bit of work would also improve it. I’ve been in much worse spaces in community organizations at home.

With more time, I would also have ventured forth to see Bran Castle (former home of Vlad the Impaler, aka Dracula) and other such historical delights that are distant from the city itself. Next time.

Three: Creativity

I asked about this podium for a statue out front of the press building and I loved the answer I got. The statue that had been pulled down was of Lenin, shortly after the end of the regime, I would imagine. The podium now receives a new sculpture each month from a group of artists, and I couldn’t have been more amused by the installation for the time that we were there. There’s more art, too: outside important buildings, in major squares, but also in front of some apartment blocks or seemingly just along the street. I love sculpture in public places, and there really is no shortage of it in Bucharest, and no shortage of variety in styles and content. Bravo!

Four: Language

I haven’t done a lot of travelling to places where most people don’t seem to speak either English or French, the ones in which I can get by. It was kind of a fun experience for me, and would have been more so if I hadn’t felt pressed for time in my various personal missions. I hear that Romanian is closer to Latin than is modern Italian, and perhaps closest to Portuguese among the modern Romance languages. I felt I could make out significant portions of the Romanian-only menu when we went to a restaurant, but the spoken language sounds to my inexpert ears like it has an overlay of Russian that isn’t as familiar to me.

As an aside, it was interesting to compare some notes with one of my sisters, recently back from a trip to China. When we lack to vocabulary to express ourselves, we often resort to gesture and pantomime, not realizing just how culturally specific some of those gestures can be. We each had a good chuckle about our respective incapacities to convey the image of tea or of an alcohol one might drink in shots, both of our efforts eliciting puzzled looks from the people on the receiving end of our efforts.

Five: Attitude

We happened to be in Bucharest for the gay pride march, although I was personally too tired to go participate (worst nap choice I ever made). Yes, there were people from a number of embassies present, an action that serves to help protect the participants from official or unofficial hostility, but it seems that the counter-demonstration of religious bigots was quite small and benign.

If you look at a map of how different countries stack up on this issue, you cannot help but notice that Romania seems to be a bit of an island of tolerance in its neighbourhood. Some countries nearby are passing actively anti-gay laws, and others are witness to violent counter-demonstrations that are either tolerated or encouraged by authorities. It doesn’t seem to be the case with this European Union member. I’m sure there are some very backward attitudes in some segments of the population, particularly on this issue, but I didn’t see those and I’m glad that the march didn’t see much of those either.

Bonus: Men

Okay, I was warned not to use this one (and have no original photo, but I’m slipping in Marian Dragelescu, gymnast, to make my point), and I consider it an accomplishment to have held off until the bonus reason to bring it up. No apologies here, though. I’m a proud gay man and I will always find the men of any place to which I travel to be interesting. Romania being in the general vicinity of what I like to call “The Great Olive Ellipse” (that area all around the Mediterranean that is home to various versions of olive-skinned people I cannot help but find attractive), it not only houses a population of such attractive people, but also draws them from the surrounding countries. So, exceptionally attractive to the point of outshining all the other countries? Not necessarily, but certainly worth investigating! ;-)

28 June 2013

The Bling Thing

It’s funny that we went to see this movie just after I came back from my vacation visiting family and had discussions with one of my nephews about brands and avoiding them. What I probably didn’t manage to clarify in those discussions was that my distaste is not for pretty things — I love those — it is for the name being more important than the substance of the thing. In this clarification, we will leave aside the food branding question, where so much of it is doubly objectionable, with nasty multinationals making crap into consumables. Back to the movie, maybe?

With a backdrop of outrageously expensive goods and a culture that seems to value those above all else, a group of young people discover just how easy it is to steal from the rich and famous, then turn around and emulate them with flashy and shallow lifestyles. Whatever. I really didn’t feel empathy for anyone in the movie, not the “kids gone astray”, not the “crime victims”. I didn’t care about them, I took pleasure in their getting caught, but I really didn’t care about the stars whose homes they invaded and robbed. People who are famous for being famous have no appeal for me, and most of their accumulated luxury goods just looked tacky to me.

Comparing the movie gang to the real life gang signals another step down into the shallow end of the pool. The choices of the players have only served to glamourize them, even if it didn’t seem to have that effect on me. That the caught and punished gang members could subsequently cash in on their “fame” and live the same kinds of experiences with the celebrity media and, through them, with the general public also seemed fitting. At least they did something to get their fame.

A moral to the story? There is endless room for more people in the shallow end of the pool.

17 June 2013

From Treatment Cascade to Treatment Two-Step

By now, you may have heard a lot about the HIV Treatment Cascade. If you haven’t, and you want to read about it from a source other than me, you can consult a couple of excellent articles on Positive Lite: one by Gus Cairns and another by James Wilton and Logan Broeckaert. My own interpretation of the ideal outcome, the goal for which to shoot, is somewhat different.

1 Starting point: HIV-infected individuals

The whole thing starts with the number of people infected with HIV, which we would all like to be as low as possible. We can take that as a given number and we can affirm our collective interest in keeping that number as low as possible, through all the means at our disposal. I would suggest that there might be some limits on the deployment of some of those means, but we’ll get to that later.

2 Testing and Diagnosis

The next step in the traditional treatment cascade is the number of people infected with HIV who are aware of their status: the testing/diagnosis question. I’m one of those people who tested too late, and I never miss a chance to tell people that it is really a good idea to get tested if you feel like you might have had a risk of HIV transmission, at least from the point of view of managing your own physical health and making good decisions about your own behaviour.

On the human rights side of this step, there are a few dangers that merit our attention. First, we always have to be sure that people are providing free and informed consent to their being tested. I cringe every time I hear the term “universal testing” and relax a bit when we clarify that to “universal offer of testing”. We’ll leave aside for now the question of whether universal offer of testing is an efficient use of our scarce resources (but you’re probably detecting a hint of my point of view on that because I am so subtle).

Other human rights considerations on the testing question include the impacts of being tested. If you are tested regularly, following public health recommendations, you might find yourself having to leap additional hurdles to get any kind of insurance, even if your tests all come back negative (insurance risk). That question on the insurance application should be outlawed in the interest of public health. If your result ends up being positive, you can probably forget about the insurance (I would suggest some new actuarial calculations are in order, given our long life expectancies with treatment), but you can start worrying about disclosure and criminalization. Is criminalization a disincentive to testing? We all think it is (we still need good data on this) and our society needs to consider whether it is more important to encourage testing or to reward ignorance. A subject too long to discuss in the context of this article.

3 & 4 Link to Care and Retention in Care

How many of those people who have found out their status have access to medical follow-up in a continuous manner? In the US, this is one of the big gaps (likely a product of their resistance to universal health care), but even here in Canada, where health care is generally freely provided to citizens and permanent residents, there are challenges to ensure the continued access and adaptation of medical care for more marginalized people and those who have some doubts about the professionalism and confidentiality of the system.

That means that we have to continue to work on ensuring that all people who are diagnosed have appropriate follow-up, including a broad range of medical and social services to respond to their needs. Those services need to be accessible, taking into consideration the particular challenges that some people face in dealing with the structures of our health care system, which are generally not very accommodating.

How are we doing so far?

So far, I am totally on board with the treatment cascade people: we need to minimize the infections, encourage all who are infected to be tested and to be aware of their status, and ensure that everyone who tests positive has appropriate ongoing care. I would add that everyone else ought to have appropriate ongoing care, too, especially if we want them to stay HIV negative, but that is also a subject too large for this particular article.

5 Anti-retroviral Treatment

Here’s where I have some dissonance with the cascaders. I do believe that everyone for whom antiretroviral treatment is indicated for their own health, including their mental health, should have unfettered access to that treatment. When I insist on mental health, I include people who might be very concerned about transmission and choose to go on treatment to reduce the risk for their partners. I don’t believe that everyone who is HIV-positive needs to be on treatment.

Some people will insist that the theoretical basis for the concept of treatment for all, whatever the state of their immune system, is sound. I would counter that the theoretical basis for asserting that sustained undetectable viral load (with all the conditions that implies) eliminates transmission is also sound, but I don’t see a lot of public health authorities jumping on that bandwagon. The truth is that there are studies underway to prove that earlier treatment is advantageous, but these have not reached their conclusion yet. If we are going to act on hard data, then we need to produce the hard data.

There is also a political aspect to this question. Apart from the informed consent to treatment aspect, there is also the rather poor track record we had with our last bout with “hit hard, hit early” in the 1990s. Show me a jurisdiction that addressed the emerging issue of lipodystrophy in an adequate manner at that time (or even now!) and I will show you the jurisdiction I would trust to recommend earlier treatment. Our system has to be ready to take charge of treating any possible emerging long-term side effects if we are going to charge ahead with earlier treatment.

My viral load: flat parts are undetectable, blips are blips

6 Undetectable Viral Load

Back to the non-controversial here. All people on treatment ought to have access to a treatment regimen that brings them to undetectable viral load. This is not as simple as it might seem, and for me includes access to all of the diagnostic and monitoring tests that are needed to find the most appropriate treatment, patient information that promotes active participation in the choice of treatment and all of the support that is necessary to help people follow their treatment and optimize its results. That includes a lot of adaptations and additional support for people who face greater challenges.

My Ideal

It may be due to the fact that I have always pictured myself as a cowboy, or that I have a long personal history of country dancing, but in looking back on this I see two steps: one where all who are HIV-positive are tested and aware of their status and have a regular medical follow-up adapted to their needs, and the next where treatment that is indicated for the health of the person, including mental health, is readily and easily available and accompanied by all the support necessary to ensure that it results in an undetectable viral load.

That, for me, is the Treatment Two-Step, and if you don’t want to go with the country imagery, you can foxtrot it (same rhythm).

15 June 2013

Hannah and Her Brethren

I’m not sure if I’ve ever seen so much smoking in a single film. Maybe it was about having returned from a recent trip to Bucharest, where smoking is everywhere, and still being shocked by its omnipresence, but this woman could barely utter three words without lighting up. Hardly the point of the movie, but I just wanted to put it out there. Oh, and did I mention yet again that I had recently been to Bucharest? ;-)

It had to have been a rather shrewd decision of the publisher of the New Yorker to choose to send a political theorist/philosopher to provide reflective coverage of a war crimes trial, instead of going with the obvious journalist approach. I suppose that is in the nature of the particular publication and the time…not news as quickly as you can get it, but more analysis of what the events in the world mean in a larger sense. I think this is probably something that we have lost, perhaps forever, in the immediacy of our means of communications. We still get opinions, but they seem to be the products of little reflection and even less thought.

It was fascinating to watch a group of German intellectuals in New York at the beginning of the sixties arguing about the significance of events and the meanings behind them. There are slight references to the political struggles of the time (the Nixon-Kennedy election), but so slight that it was clear that these lacked the weight of matters more in the forefront. The struggle between the intellectual and the emotional is interesting as well — the legal basis of kidnapping such a war criminal and trying him in a country that didn’t even exist at the time of the crimes, let alone have specific laws addressing the situation pitted against the horror of the holocaust and the need for justice of those who had managed to survive it.

I have never read Eichmann in Jerusalem, but I am sorely tempted to undertake that task now. If that is the measure of the success of the film, then it worked. The analysis that ended in her coining the term “the banality of evil” is brilliant (I’m sure she was waiting for my assessment of that) and worthy of consideration in the context of our own current governance issues. Hiding behind procedure as a means to avoid having to think and analyze seems even more widespread now.

I am particularly interested in the controversial part of the work that I hadn’t heard of in my previous peripheral awareness of it. She criticized the actions of some of the leadership of the Jewish community in Europe and how their actions or inactions may have led to more death — not a very popular analysis less than a generation after the end of the war, and probably no more popular now. I would like to wrap my head around that one, and the lessons it might afford to oppressed peoples today.

In the film, we see the strong negative reactions to that very short criticism: stacks of hate mail, lost friends, threatening colleagues. But we also see the steadfastness of the publisher and the loyalty of other friends to a brilliant woman applying a dispassionate analysis to a highly emotional subject. Very much worth seeing.

08 June 2013

Dining Out in Bucharest

Not my usual restaurant review. Do I have a "usual" restaurant review? The best I usually do is to be seen on my tumblr, particularly here and here.

Yesterday, we went out to find a restaurant where we might be able to find some typical Romanian food. Restaurants are not necessarily all that easy to find here, apart from the really obvious ones or the omnipresent fast food places that look the same everywhere you go. (One exception to that: I saw KFC here, while this is staunchly PFK in Montréal!) We started with a taxi ride (price range affirmed fist, which is always a good thing to do) to the neighbourhood of a concert hall. The concert being earlier than we thought it was, we decided to just find a restaurant instead and wandered around the near vicinity.

It was raining, so we opted for the interior rather than the extensive outdoor spaces, especially after getting some assurance that we would be in a non-smoking section. (It's rather difficult to get used to the smell of smoke indoors, especially after years without it at home and years after quitting smoking.)

The decor was fabulous. We felt like we had wandered into an extremely chic establishment, but chic in that old world luxury way, not the modern hipster way. Giant chandeliers, high ceilings, long fussy curtains, lovely tablecloths and napkins and such. And it was almost empty. The whole time we were there, I believe we saw two other tables occupied, and they were in the adjoining room. I regret that I only took a couple of photos, which you'll see below, and none of the ambiance.

So we started by staring at the menu. Entirely in Romanian, which was kind of fun. There were parts of it that I could sort of understand, as it seems to be close-ish to Italian (and as I found out this evening, actually closer to Latin than is modern Italian, and kind of similar to Portuguese). We asked for explanations of certain items, because we wanted to order from the Romanian section of the menu, not just have the predictable pasta, pizza or steak.

Speaking of which, I know that several of my friends and colleagues will be thrilled to know that Hawaiian pizza (ham and pineapple) IS available here. The other curiosity that I photographed was the Cowboy Steak. Now that seems rather ordinary or not quite so exotic, until you read in the explanation that it has been frenched. I almost ordered it just for that!

I started with a cocktail that turned out to be a little sweeter than I might have liked. With my penchant for the cocktail, however, I would probably have been able to down several of them in a vain attempt to quench my thirst. Good thing we switched to wine!

I actually ordered an entrée (no, this is not the name for a main dish!) from the antipasti section, opting for salmon bruschetta, which were quite nice. We stuck more closely to our Romanian theme in choosing the wine, an entirely drinkable Cabernet-Sauvignon. As I am no wine expert, we will take that for what it's worth, but I quite liked it and we didn't leave any of it behind, so that's a testimonial.

For my main dish, I ordered strips of lamb with polenta, which has a much more exotic name in Romanian that I cannot conjure up, even with Google Translate! I was a little surprised that there weren't a lot of vegetables or other elements on the plate, but we made up for that by my companion's eating a salad as her main course. Maybe the vitamins will rub off on me. Now polenta is one of the only forms of corn that I am willing to eat, so I quite liked it, and the lamb strips were quite nice, too.

Of course, I was the only one to have dessert! (After having eaten a salad for dinner, you can understand how my companion would have no room for more…) I have a very lovely mint-chocolate gelato and an allongé (a long espresso) with milk. Very tasty gelato, and very inexpensive, too. I am noticing that there is gelato everywhere here, so that alone should bring you stampeding to the country.

At the end, the whole production cost me the equivalent of about $35 Canadian, which should give you another reason to come stampeding here.


As a post script, I have just returned from the groups dinner at another restaurant featuring typical Romanian food. This time, in addition to being seated next to colleagues from Burundi (who were delightful dinner companions) I had the pleasure of the company of some locals, one of whom is a member of the Board of the host organization, and some friends. What a lovely time it was to chat and joke with them. Always nice to know that gay is gay everywhere and we can fall right into camp and casting aspersions on each other's characters with – what else can we call it – gay abandon.

The occasion, apart from our meeting, of course, was the gay pride parade. Embassy officials from many countries take part in the parade, partly as insurance against violence, and apparently the counter-demonstrators were well outnumbered by the revellers. Glad to hear that. (I didn't witness it directly because I was overnapping in my hotel room!) It's interesting to come with all the blasé attitudes we have a tendency to develop with respect to our own pride activities to a place where it's still clearly a political act to have our silly fin in public. The serious parts are not that far in the past here, even a little present around the edges. I should really have made myself go.