Aging & HIV/AIDS Neurocognitive Sequelae and Functional Consequences

chers—

keep an eye peel for this.

namaste

—rk

Summary

Condition / Disease

Study Outcomes

• Neuropsychological Status

Description

Sponsors

Behind the Story: David France Discusses New York Mag Aging Story; Casts Doubt on NYC HIV Statistic
by HOUSING WORKS
November 16, 2009

“Being an AIDS journalist makes me one of the loneliest journalists around,” David France lamented. “I know how difficult it is to get an AIDS article published in this day and age. Everyone thinks AIDS is over.”

Despite the fact that the mainstream media isn’t focused on AIDS issues, France keeps plugging along, doing work that he thinks activists are neglecting. His most recent article Another Kind of AIDS Crisis in New York Magazine about the health complications of aging with HIV hit a nerve with readers.

The article is the first mainstream feature article focusing on the health issues people aging with HIV face. Three weeks after its publication, it still tops NYMag.com’s list of most e-mailed articles.

France, a veteran writer and AIDS activist (and former Housing Works board member), said the story came about when he noticed his friends with HIV and AIDS developing a myriad of health problems, including memory loss, osteoporosis, stuttering, kidney failure and cancer.

“A friend of mine was diagnosed with cancer. He just thought he was a man with bad luck. Like another bus that came out of nowhere. It’s exactly the same bus. It’s not an ill-fated course through life,” France said. “I wanted to look at these specific health complaints in context with one another and in progression of AIDS itself.”

That friend, writer Joe Westmoreland, ended up featured in the story, along with Housing Works client Cesar Figueroa and a dozen other people with HIV or AIDS over 50.

Just the Tip of the Iceberg

France noted that while people with AIDS are living longer thanks to antiretrovirals, AIDS is still a death sentence, albeit one with an incubation period. “A person who seroconverts at age 20 has a life expectancy of age 60. That’s a reduction of a third,” France said. “That means there’s still a problem. That means there’s still fatalities.”

Some studies suggest that in order to avoid cognitive decline, people with HIV should go on treatment as soon as possible. And while many doctors recommend this (and France’s longtime friend Housing Works President and CEO Charles King advocates early treatment for HIV in general), France, said he’s not sure early treatment is the answer because of the lack of long-term research about people with AIDS on medication.

“It’s a trade-off,” France said. “Before you can argue that everybody with HIV should be on medication, you have to find out what the impact of these drugs are.”

France, a veteran of ACT UP New York, said he thinks he needs AIDS treatment activism to focus more on these issues and less on negotiating with drug companies.

“We need activism to lead this. Treatment activism has taken a whole new form in the last few years. Where’s the pressure of looking at the treatment itself?” France said.

More PWAs in NYC Than We Think?

The aging and HIV problem will only get worse. Although there are 109,000 known cases of HIV and AIDS in New York City, France took a closer look at the numbers, including looking at other stats, such as estimates that a quarter of people are undiagnosed, and concluded that at least 144,000, if not more, New Yorkers actually have HIV. The Department of Health stands by its numbers.

France said he doesn’t think the under-counting is deliberate but notes that the only way to tell for sure would be with universal testing. “You’d have to get rid of some of those issues of HIV exceptionalism and know the identities of people,” France said.

France said whatever the headcount though, problems with HIV and aging are going to become more profound as people with AIDS continue to age. And by 2015, the average age of people living with AIDS in New York, the center of the epidemic, will be over 50. “It’s a huge balloon of illness and medical need. Even for that 20 year old who seroconverts today, there will be assisted living and general life issues. The last ten years aren’t going to be pretty ten years.”

To read more of France’s work check out davidfrance.com

This article was provided by Housing Works. It is a part of the publication Housing Works AIDS Issues Update.

David France photo credit: Karine Laval

To celebrate the 15th anniversary of the Channel Tunnel, former F1
champion John Surtees has become the first person to drive a private
car from Folkestone to Coquelle.

Source:
http://www.euinfrastructure.com/news/channel-tunnel-surtees/

To celebrate the 15th anniversary of the Channel Tunnel, former F1
champion John Surtees has become the first person to drive a private
car from Folkestone to Coquelle.

Source:
http://www.euinfrastructure.com/news/channel-tunnel-surtees/

In the spring of 1996, I was heavily entrenched in a “life stage” transition from high school to college. My mom and I were traveling up and down the east coast for soccer recruiting trips to figure out where I would be spending the next four years of my life.

Penn State, UPenn, Tufts, St. Mary’s, Maryland, Lehigh, Colgate, Bucknell…these were a few of the places that were scouting me for soccer. They were a range of schools. Some were big (100,000 students), while some were small (1,200). Some were highly recognized for their academia, while others were acclaimed for their sports programs. Some were Division III programs, and some were Division I. Some were offering scholarships, and others were offering a warm hand. But what they all had in common was that they were claiming to want ME.

I had been accepted to every program (over a dozen) except for one. My heart was set on UPenn, but they were claiming that I needed 20 more points on my SAT’s in order for them to get me in. At the time, Penn State and Maryland were top tier Division I soccer programs, but I knew that if I went to play for them, I would likely sit the bench. They wouldn’t even guarantee that I would make the team.

In the end, it came down to two schools - Lehigh and Bucknell. It was a great feeling to know they were fighting over me. They had both claimed that I was their #1 recruit, and they were both Division I programs. They weren’t a top 20 program for soccer, but at least I would be starting as their goalkeeper. Academically speaking, they were on par with each other, and while they weren’t technically an Ivy League school, they pooled from the same caliber of students each year. So I had a tough decision to make. Bucknell or Lehigh?

What made the difference was their confidence in me. Bucknell wanted me more, and it felt good to know that I was what they wanted. But that didn’t last very long. The honeymoon was soon over after the season started 6 months later. I was their #1 recruit, and I did start over a senior goalkeeper my freshman year, but that quickly ended. Playing Division I college ball was bigger, tougher, faster, and meaner than I had ever imagined, and I was in for a rude awakening.

I went from starting and playing the whole game, to barely playing 10 minutes by the sixth game of the season. Some of it wasn’t my fault at all. Apparently the fourth year goalkeeper had a lot of political clout with the head coach, and despite the strong support of other players and even the assistant coach, it wasn’t enough to get me playing time. But if I were to be completely honest, I simply didn’t live up to the expectations of the Head coach. I was a disappointment…or at the very least, not quite as good as he had hoped for.

It was a fair assessment though. I certainly wasn’t any worse than the other goalie, but I wasn’t unbelievably better either. So when push came to shove, everyone was disappointed with the result – including myself. I wasn’t quite the superstar that everyone expected me to be, and I wasn’t the superstar that I was used to being.

But four years later…I was ranked #1 in the country for a Saves Per Game stat amongst the NCAA’s Division I goalkeepers, achieved Defensive Player of the Week in the Patriot League, and helped to lead Bucknell into unprecedented wins against rivals such as Lehigh and Colgate. At one point, we had even placed in the Top 25 NCAA Division I men’s soccer rankings, upsetting a couple Top 10 programs in the country.

The reason this all came to mind is because I feel as though I’ve been experiencing a bit of Déjà vu. The past 17 months of my career at Immersion Active have been a steady uphill battle of finding my mojo, chi, or in layman’s terms, my confidence. And although everyone has been extremely supportive and patient (as well as invested in my success) at Immersion Active, I haven’t quite lived up to the hype of someone with a Director of Business Relationships title.

So, it has been decided (and I can’t say I fault them for it) that I am no longer a “Director”.

So last week, I didn’t want to continue reflecting myself as this position, despite their insistence that the changing of my title could wait until business cards had arrived, so I logged onto my account on LinkedIN and edited my title to “Business Relationships Manager”. Within 24 hours, I had received a warm note from a client which I found to be quite humorous and ironic:

Lol. Little did she know, I had just been DEmoted, not PROmoted (in title only).

Even though this story doesn’t have a happy ending (yet), I know that the story is still waiting to unfold. The book of my life is still being written, and I’m anxious to see the story that God will write for me.

As we near Thanksgiving this year, I am reminded of how thankful I am, of how far I’ve come, and how much I’ve accomplished. I may have had my share of disappointments and unexpected outcomes, but I’ve also had my share of things to be thankful for as well. Pastor Steve wrote something that “stuck” with me a couple of weeks ago,

When you face an enemy, obstacle, or setback, you can either see it as a wall or a door.

As he explained, the Israelites chose to look at Goliath as a wall…and they waited for 40 days hoping it would go away. David, on the other hand, saw things differently – and God blessed him for it.

Every champ has his/her chump moments. But they’re a champ because they never stay a chump.

This chump is moving on.

Congrats to those who rolled to F.O.S.S (Feats-of-Strength Saturday) this week.  Everyone who came participated in a modified version of an infamous Crossfit workout called “fight gone bad” where every rep of work is a point with the goal being to score the most points.

Nico Schlanger continues his run as the F.O.S.S champ, who will be the next to top him?  Come on Saturday to give it a shot!

If you are new to F.O.S.S and want to come see what we are all about, we will be having introductory workouts an hour after the main ones.  They will give a nice easy taste of this style of fitness and are a great way to learn about Crossfit.

New EACS guidelines address co-morbidities and diseases of age
Gus Cairns
Monday, November 16, 2009

The 2009 Treatment Guidelines published by the European AIDS Clinical Society (EACS) are considerably longer and more detailed than the last set, published in 2007. The 80-page booklet adds a number of guidelines for treating 14 different co-morbidities and co-infections.

Dr Nathan Clumeck of Brussels University, presenting the guidelines at the 12th European AIDS Conference, commented that most of the co-morbidities included in the new sections were diseases associated with age.

The last guidelines were published in 2007 - see this report- and their new sections on management of metabolic issues and on hepatitis co-infection were innovations in HIV guidelines at the time.

The new co-morbidity section includes guidelines on cancer screening, cardiovascular disease prevention, high blood pressure, diabetes, bone mineral loss, depression, hyperlactataemia, renal toxicity, lipodystrophy, and diagnosis of high liver enzymes. It also adds a section on HIV therapy for patients with TB, expands the section on hepatitis B, and adds a section on delta hepatitis infection (HDV).

The antiretroviral (ARV) guidelines, as well as including a new TB section, add a section on switching therapy in patients who are virologically suppressed.

They also add at the beginning an algorithm, already included in the internet version of the 2007 guidelines, for ensuring that patients are ready to start therapy.

Most other changes in the ARV section are ones of emphasis rather than substance. Treatment is now ‘recommended’, rather than ‘may be offered’, for patients with CD4 counts between 350 and 500 if they have hepatitis C, active hepatitis B or HIV-associated kidney disease; and treatment ‘should be considered’ in patients with viral loads over 100,000 copies/ml³, with a CD4 loss of more than 50 cells/mm³ a year, or who are pregnant, have cancer, or have a high cardiovascular disease risk.

Boosted darunavir and atazanavir have been added to recommended starting regimens and boosted fosamprenavir and raltegravir as alternatives; the guidelines were written before the European Medicines Agencylicensed raltegravir for naive use in September.

The ‘HAART and TB’ section recommends that TB patients with CD4 counts under 100 cells/ml³ should start ARVs straight away but that patients with CD4s between 100 and 350 can wait till completing two months of TB therapy.

The new section of switching in virally-suppressed people covers switching for drug interactions, toxicity and simplification. It recommends that switching under these circumstances should only be considered for patients with no history of treatment failure.

When asked if this was unduly restrictive, Dr Anton Pozniak of the Chelsea and Westminster Hospital, London, commented that the guidelines were intended for a variety of resource settings and that baseline resistance tests were not available to guide clinicians in many European countries.

As reported elsewhere, the guidelines suggest that protease inhibitor monotherapy “might represent an option with intolerance to NRTIs or for treatment simplification, but only applies to patients without a history of failure”.

Dr Clumeck, commenting on the addition of ‘generally’ to the sentence that therapy should not generally be offered to patients with CD4 counts over 500, said that nearly all of his patients who had asked for early therapy had been in couples.

“If they have a partner and they are ready to start, why shouldn’t they?” he said, “Of course, for the patient themselves, but also in order to protect transmission – though I am aware this is a hot issue.”

Dr Manuel Battegay of the University of Basel commented that requests for early treatment were rare; in general patients wanted to put off treatment. Anton Pozniak added: “If we get more data that untreated HIV will lead to physiological ageing, then the message that HIV treatment will keep you young will be a powerful one”.

Dr Jens Lundgren of the University of Copenhagen introduced the co-morbidity guidelines. He described them as “preventative or management principles other than the use of ARVS and other anti-infectious agents”.

Cancer screening recommendations cover breast cancer in women aged 50-70, cervical cancer in sexually active women, anal cancer in gay men, colorectal cancer in patients between 50 and 75, and prostate cancer in men over 50.

The section on prevention of cardiovascular disease previously just covered heart disease, but sets tighter restrictions on when to switch therapy for CVD risk.

The list of recommended statins is changed in cases of high cholesterol, and in the absence of evidence that anything works well, there is now no recommendation for a treatment to manage high triglycerides.

Diabetes management recommends metformin as the first drug of choice if lifestyle changes cannot control blood sugar.

The guidelines now recommend that all patients should receive baseline screening for kidney disease and recommends specific treatment protocols for different rates of impairment.

For bone mineral loss, it recommends the use of an online algorithm called FRAX which calculates the 10-year risk of fractures in a way similar to the Framingham heart-disease 10-year risk algorithm.

Depression is the first psychological condition to be included as a co-morbidity and the guidelines recommend a simple two-question test on mood and motivation which has a 60% sensitivity for depression.

Nathan Clumeck commented that the co-morbidity section is “now the most important part of guidelines. We now recommend ART for the long-term and for most patients; now we have to manage long-term toxicity and conditions of ageing”.

Jens Lundgren said that “In the general population, if you follow these simple guidelines you can reduce the risk of cardiovascular disease by 70-80%. It does however require action by both doctor and patient”.

Alexey Kruk, a physician from Russia commented that the guidelines “will be a way forward in my country, persuading physicians to treat patients well”.

For the hepatitis section Sanjay Baghani of the Royal Free Hospital said that the guidelines now recommended that all HIV patients should be screened for hepatitis C at diagnosis and then regularly according to risk. “Acute HCV is increasing by leaps and bound in HIV-positive gay men,” he said.

The guidelines now include a section on hepatitis delta (HDV). This parasitic virus can only infect people who have chronic hepatitis B (HBV), but the 5-15% of HBV patients who do have it suffer an eightfold higher rate of fibrosis progression. All HIV patients should be screened for HDV antibodies and it should be especially suspected in a patient who is developing fibrosis despite having a low HBV viral load.

The guidelines now recommend that patients with chronic HBV should start a tenofovir-including ARV regimen at a CD4 count of 500 cells/mm³.

There were a few criticisms. Dr Giovanni Guaraldi from Modena, Italy said he felt that the standard Framingham algorithm might underestimate the risk of HIV-related inflammatory processes which cause damage to blood vessels.

Cancer specialist Dr Mark Bower welcomed the inclusion of anal cancer screening but said that there was a worldwide shortage of specialists in anoscopy to perform the tests.

And bone specialist Christophe Fux said that the algorithm to estimate fracture risk may underestimate risks in people with HIV for the same reasons as the heart attack algorithm.

But patient representative Simon Collins commented that since most of these areas relate to conditions of ageing, we will see more evidence accumulating.

“A lot of work went into these guidelines,” he said. They’re a really impressive attempt to normalise and standardise patient care over Europe.”

For the Guidelines, see www.europeanaidsclinicalsociety.org/guidelines.asp

Surviving to die of something else: AIDS is a rare cause of death in old people with HIV
by Gus Cairns
Wednesday, November 18, 2009

chers—

the findings of this report raise as many questions about the influence of stigma in attributing the causes of death for elder HIVers as it does about the epidemiological/medical demographic significance of those deaths. in other words, is it “better” to die of pneumonia or heart disease than it is to die of AIDS?

namaste

—rk

A French study of a group of people with HIV aged over 60 has found that over a four-year period, one in seven of the group died – but not a single death was attributable to an AIDS-defining illness.

The findings from the French COREVIH Cohort, presented at last week’s European AIDS Clinical Society conference in Colgne, underline the increasingly strong realisation in HIV medicine that as patients with HIV on antiretroviral therapy age, the medical problems they face will have much more to do with diseases of ageing than AIDS-defining illnesses. The latest revision of the EACS Treatment Guidelines acknowledges this – see this report.

Other cohort studies of people ageing with HIV have tended to take 50 as their minimum age, but starting this early may dilute the prevalence of age-related conditions.

The COREVIH Cohort is as yet a relatively small group, starting in 2004 with 149 patients drawn from six HIV clinics in the Paris area. Their average age at the start was 65. Fourteen patients in the baseline group (9%) were in their 80s, the oldest being 86. The average time since HIV diagnosis was 8.5 years, but this ranged from two months to 19 years. Over a third had had an AIDS-defining illness in the past.

The group is well-balanced in terms of population groups, with just over three-quarters being male, just over half heterosexual, and two-thirds of French and other European white background. The other third were mainly composed of equal numbers of sub-Saharan Africans and of patients from the Maghreb (North Africa), reflecting the ethnic mix in France.

By the time of follow-up in 2008, the group’s average age was 71. Seventeen patients (11%) couldn’t be traced. Of the others, 21 patients (14% of the cohort) had died. Eleven – more than half – had died of various non-AIDS-defining cancers; four had died of cardiovascular disease; three had died of end-stage liver disease; and three had died of other causes including one of dementia.

In terms of morbidity rather than mortality, many cohort participants had multiple health problems. Half of the remaining patients had some manifestation of cardiovascular disease. A quarter had kidney disease, one in five had arthritis or bone problems, one in six had cognitive or neurological problems, just under one in six was dealing with cancer of one form or another, 15% had diabetes, and 9% had liver problems.

In contrast to this picture of often multiple health problems, those classically related to HIV were minimal. At the start of the cohort, 70% had a viral load under 50 copies/ml, but this had now increased to 96%, and their average CD4 count was now 494 cells/mm³, having increased from 372 at baseline.

Notably, no cohort member developed a new AIDS-defining condition over the four years of follow-up and only two saw the return of a previous condition (Kaposi’s sarcoma of the lung in one, Castleman’s disease in a patient with previous non-Hodgkin’s lymphoma in the other).

“Clinical and immunological improvement was continuous in these aged patients,” the researchers comment, “but co-morbidities are frequently observed.”

Reference

Flexor G et al. Long-term evolution of a cohort of HIV-infected patients older than 60 years (COREVIH-IDF-Ouest, France). 12th European AIDS Conference, Cologne. Abstract BPD2/5. 2009.

the title says it all.

The tweed Fender Champ is a 5 Watt Class A amplifier.  What exactly does it mean when an amp is called Class A?  Class A amplifiers operate over the entire input cycle.  This means that the output signal is an exact scaled-up replica of the input with no clipping.  From an exhaustive discussion of various amplifier classifications over on Wikipedia -

Class A amplifying devices operate over the whole of the input cycle such that the output signal is an exact scaled-up replica of the input with no clipping. Class A amplifiers are the usual means of implementing small-signal amplifiers. They are not very efficient; a theoretical maximum of 50% is obtainable with inductive output coupling and only 25% with capacitive coupling.

In a Class A circuit, the amplifying element is biased so the device is always conducting to some extent, and is operated over the most linear portion of its characteristic curve (known as its transfer characteristic or transconductance curve). Because the device is always conducting, even if there is no input at all, power is drawn from the power supply. This is the chief reason for its inefficiency.

If high output powers are needed from a Class A circuit, the power waste (and the accompanying heat) will become significant. For every wattdelivered to the load, the amplifier itself will, at best, dissipate another watt. For large powers this means very large and expensive power supplies and heat sinking. Class A designs have largely been superseded for audio amplifiers, though some audiophiles believe that Class A gives the best sound quality, due to it being operated in as linear a manner as possible which provides a small market for expensive high fidelity Class A amps. Many recording studios use equipment such as preamplifiers that are considered Class A designs. In addition, some aficionados prefer thermionic valve (or “tube”) designs instead of transistors, for several claimed reasons:

• Tubes are more commonly used in class A designs, which have an asymmetrical transfer function. This means that distortion of a sine wave creates both odd- and even-numbered harmonics. The claim is that this sounds more “musical” than the higher level of odd harmonics produced by a symmetrical push–pull amplifier.^[7][8]
• Though good amplifier design can reduce harmonic distortion patterns to almost nothing, distortion is essential to the sound of electric guitar amplifiers, for example, and is held by recording engineers to offer more flattering microphones and to enhance “clinical-sounding” digital technology.
• Valves use many more electrons at once than a transistor, and so statistical effects lead to a “smoother” approximation of the true waveform — see shot noise for more on this. Junction field-effect transistors (JFETs) have similar characteristics to valves, so these are found more often in high quality amplifiers than bipolar transistors. Historically, valve amplifiers often used a Class A power amplifier simply because valves are large and expensive; many Class A designs use only a single device.

Transistors are much cheaper, and so more elaborate designs that give greater efficiency but use more parts are still cost-effective. A classic application for a pair of class A devices is the long-tailed pair, which is exceptionally linear, and forms the basis of many more complex circuits, including many audio amplifiers and almost all op-amps. Class A amplifiers are often used in output stages of op-amps; they are sometimes used as medium-power, low-efficiency, and high-cost audio amplifiers. The power consumption is unrelated to the output power. At idle (no input), the power consumption is essentially the same as at high output volume. The result is low efficiency and high heat dissipation.

1959 Fender Tweed Champ

text follows jump

thomas carlyle

first use of the term “fourth estate.”
On Heroes and Hero Worship (1841)

“burke said there were
three estates in parliament;
but in the reoporter’s gallery yonder,
there sat a fourth estate more important far
than they all. it is not a figure of speech
or a witty saying; it is a literal fact . . .
[a journalist]
speaking now
to the whole nation
becomes a power
a branch of government
with inalienable weight
in law-making,
in all acts of
authority.
it matters not
what rank he has, what
revenues or garnitures.
the requisite thing is that
he have a tongue
to which others will listen;
this & nothing more
is reqisite.”

the term fourth estate refers to the news-reporting community — print, broadcast & internet — both in its explicit capacity of advocacy and in its implicit ability to frame political issues.

how shall we be free?
(LOS ANGELES, POSTED JUNE 13, 2005)

how shall we be free?

—moi

gay pride 2005 in los angeles. the parade on sunday.

eleven o’clock sunday morning. i am preparing to march with aids-dot-org. there are nine of us, eager and restless and proud and ready as we wait in our assigned parade staging area. we mill in a whirling colored poppingcorn carnival of paraders.

inspiration is a thunderbolt in our staging area, and i recognize the omen: it’s one of the twenty tools of enlightenment that gwan yin holds in her ten pair of hands when in her goddess form.

gwan yin achieved enlightenment by listening. she is the buddha of compassion. she always hears. she always knows. she guides my spirit.

i need to be on my toes.

how shall we be free?

first i cry out. then i compose myself.

the aids-dot-org contingent is gathered around a rented white 2005 chrysler sebring convertable. my friend peter and his friend gary, the director, sit high in the back seat, practicing their parade waves. they’re wearing matching beige-on-black hawaiian shirts. the aids-dot-org banner is suspended over their heads on a white, pvc-pipe frame which rests atop the trunk lid behind them.

my journal and my pens are inside the trunk.

alan, an old flame i haven’t seen in fifteen years, drives the car. jerry, a curly-haired goateed blonde, mans the bullhorn in the passenger seat next to him. jerry is covered with a collection of the most unusual tattoos i’ve ever seen. the world trade center on his back. a war in iraq memorial on his right calf. on his forearm—a gwan yin angel. i should have spotted gwan yin’s energy when i saw his tattoo the first time. jerry’s tattoo artist trained at juliard.

ramone is the walker posted at the left front bumper. we have two rainbowflag-waving bicyclists—matrix and gipetto. gipetto is linked arm-in-arm with steve, and the two of them practice parading together slowly at the right rear bumper. one walking, one riding. matrix is right front. i’m behind the car.

gipetto has a dark canvas bag over his shoulder, and i see a tidy collection of ink sticks in it.

“quick—give me one of your pens,” i say.

eyes wide with surprise, he does.

“i need something to write on,” i tell him.

steve hands me a black matchbook that says “midnight bar and grill.” their motto: “it’s a new day at midnight.”

clearly, my brothers in infection are more used to collecting phone numbers than journaling on the go.

but it’s a place to start. i am resourceful.

i take the pen and write on the inside of the matchbook cover, in gold glittery letters:

we are all in the parade

being gay is not a spectator sport

good. i’ve written down the obvious stuff, so it’s out of my system and i don’t have to worry about it any more. on to the real work. i close the cover and put it in my pocket.

before striking.

how shall we be free?

“pop the trunk!”

“pop the trunk!”

“pop the trunk!”

“pop the trunk!”

“what!?

”“pop the trunk!”

“richard needs his journal!”

“pop the trunk!”

“richard–!?!”

“pop the trunk!”

they pop the trunk, even though it means partially dismantling the banner pipes.

peter is amused. “it’s the intrepid aids-dot-org reporter covering the 2005 christopher street west celebration,” he says, sounding like dick clark or somebody cutting to commercials.

what can i do but grin back at him? i am scribbling notes, weaving a verbal web to bind these images to my memory.

how shall we be free?

the fierce pride lgbt buddhists wait in the staging area behind us. there’s a great name for a rock band in there, somewhere.

behind the banner sit two fiercely proud lesbian buddhists on color-coordinated italian scooters, bathed in emerald serenity. their names are sheila and denise.

“these are called ‘vespa’s’” they tell me. made in italy by piaggio. one black, the other “teal,” they say. (it’s not really teal, that’s just what piaggio calls it. it’s more a mint green with a fair amount of yellow in it.) a stunning combination—sheila and denise took the scooters apart and swapped various color panels.

i recognize the tao. the harmony.

how shall we be free?

i feel the footfalls of all my fellow marchers, pounding the tarmac under my feet.

tarmac, short for tar-macadam, fascinates me.

macadam road is a mixture of crushed stone and tar or asphalt that’s pressed flat and smooth for a road surface. e pluribus unum as an engineering concept. as important as the roman invention of cement.

it is named after its inventor, John Loudon McAdam (1756-1836), a scottish civil engineer and british loyalist who fled the united states after the revolutionary war and returned to great britain, where he spent the the first thirty-six years of the nineteenth century perfecting the invention of his roadstuff. (he was not gay.)

creator of the modern road.

“tarmac” usually referrs to the substance of airport runways.

tarmac. i never knew it was a sounding board before. today it is behaving like a quartz crystal.

the heartbeat of the tarmac. the song of the road. through my feet up to my heart, reaching out through my hands, rising up through my head and into the sky, taking off. landing again with every step.

santa monica boulevard is singing to me, and i’m taking notes. we are a river.

crushed and flattened between tarmac and footsole:

glitter.

tinsel strips.

ghost ribbons.

dismemberd audio cassettes, their shiny guts spilled out across the fauxbrix crosswalks.

indecipherable blue spray-painted glyphs and arrows.

green gum wrappers.

i kick a wrapped pink transparent candy along the road and it unwraps itself and rolls into pieces that scatter in arcs recalling rainbows.

planet out key rings.

flattened nylon lei flowers.

thick double yellow stripes.

thick white crosswalk stripes.

fresh red curbs.

empty water bottles and post cards resting in the gutters.

tobacco trash: cigarette butts; empty cigarette packs; not-quite-disposed lighters.

a blue-patterned face-down playing card, one corner ripped.

on either side, a shoal of watchers, many of whom wear red feather boas. they are living aids ribbons. they remember.

wet tears are now underfoot, not all of them mine.

a breeze dries our faces.

i can feel the rumbling of twirling-brush streetsweepers in my feet, as they follow miles behind us.

how shall we be free?

once we move further down santa monica boulevard, we lose the fierce pride riders, who are replaced by marching gay christians from christ chapel. they are an army of red signs atop ten-foot-tall wooden spears led by a red convertable that is covered in sprays of yellow roses.

pilgrims heading for the holy city.

how shall we be free?

we cross la cienega and pass by the caged faux-chrixtians there. they carry signs that say god hates. and i thought i was a blasphemer.

how shall we be free?

i get hooted for my fake marijuana lei. it’s an instant hit as a medical marijuana badge.

then the crowd quiets down.

jerry springs into action.

he hits the siren on his bullhorn and says, click, “c’mon people! this isn’t a funeral! let’s hear it for aids-dot-org!”

how odd.

we are at a funeral. mine. yours, if you are lucky.

i would march like this, in joy, in my own funeral procession. unknown. unrecognized.

what a relief—it doesn’t make any difference who i am or what i think. i remember this from the first time i walked a labyrinth.

here is how i want to quit the planet.

after i die, i want my body cremated, and the ashes placed in fireworks that will go off in a distant and hot summernight sky.

defying stars.

no traces left.

gone completely.

how shall we be free?

we are all marching to the one true city, wherever it may be.

to mount mckinley. to jerusalem. to mecca. to akka. to india. to tibet.

to somewhere between fairfax and robertson on santa monica boulevard.

up the mountainside to the roof of the world. following kokopelli. following coyote. pursued by fire and flood and madness.

on the pressed gray tarmac in west hollywood.

heading for the citadel.

migrating.

journeying.

heading home.

how shall we be free?

together.

cultural crisis: what better chains bind us?
by richard kearns
(LOS ANGELES, POSTED JUNE 8, 2005)

i am an aids shaman. i am an artist. i am a creator of culture. i am political. film in later installments.

— moi

i ran into a remarkable book early in 2004, right after i’d been released from cedars-sinai.

at the west hollywood public library, of all places.

inbetween the poems and pieces of fiction, the anthology of canadian native literature in english editors daniel david moses and terry goldie have pulled together some very engaging and articulate texts about art, culture and politics during the indigenous american cultural renaissance that is currently thriving in north america.

be a shaman/artist with me here for a sec. listen metaphorically.

“cultural development as a political strategy is a viable vehicle for change,” says poet, painter, first nations political activist and journalist duke redbird, in an essay titled “modern métis consciousness,” an excerpt from his interdisciplinary dissertation at york university, “we are métis.”

in it, redbird recalls “the fifth annual convention of the native council of canada. the spokesman for the british columbia delegation, disturbed by the inclusion of cultural activities at a convention whose theme was unity and aboriginal rights, stated: ‘our homes are going to be torn up by pipelines, hydro developments, and various other things, and we’re fiddle-farting around with jigging contests. i just don’t understand.’ another delegate from alberta responded immediately: ‘as for jigging and contests—i’m for that. i’m a jigger. i’m a fiddler, and i don’t want any sucker to tell me that i can’t do that any time, any place. that’s part of my culture and i’ll fight anybody that says it’s not part of my culture.’”

redbird argues the case for “those who believe that active political posturing can only make things difficult”:

“if you take the establishment head-on,” he says, “you are just indicating to them ways of making better chains for you. to meet them head-on is just suicide. what you have to do is approach the whole thing obliquely. you have to change people’s ideas, and the only way you can do that is through the media. you have to attack on a cultural, rather than political level.”

what did you hear?

i ran with what i heard.

the first thing i was reminded of was the anger, disbelief and frustration in the voices of the rationalists among us, when they called for the closing of bathhouses in the mid-80s. in particular, i recalled randy shiltz and larry kramer.

i thought of the silent response of the hedonists among us, who are nameless and legion.

together, we struggled with issues of cultural motive, principled behavior and self-determination. we behaved as a community sharing an indistinct but unrepressable cultural identity. a cultural ethos.

what is the character of our recent history? more ironic, i think, than tragic or paradoxical.

there was a time when i hoped for a cure. many of us agitated for a cure.act up—larry kramer, again—was recently rated by readers and ediors atinthefray.com as one of the top ten most influential crusaders for social justice in the united states during the past thirty years. act up defined aids as a political issue, not merely a medical issue, not not somebody else’s quiet problem. act up used a strategy that martin luther king jr. once called “direct action” political confrontation to foment for accesssibility to medicines and agitate for a cure.

in what condition do we find ourselves now? what better chains bind us?

• in the united states, among those wealthy enough to be able to afford insurance, hivers live (when they do live) in a suspended state of sickness, serviced by an industry whose own economic self-interests are more important to it than the saving of our lives.
• outside the united states? you can’t buy, you die. and die. and die. and die. ownership of intellectual property is far more important than keeping third-world riff-raff alive. and they’ll all probably want to eat if they’re going to be alive anyway—one thing just leads to another.
• a vaccine for all of us? we don’t care. we can’t be bothered. nobody cares.

to our great shame.

actually, i think of larry kramer a lot when i think of the creation of culture as a political strategy. i think of larry kramer when i think about shaman/artists mythologizing experience as part of a legitimate, powerful political response to injustice and foolhardiness.

faggots.

thenormal heart.

just say no—a play about farce .

reports from the holocaust: the making of an aids activist.

we must love one another or die: the life and legacies of larry kramer.

i still want to read the tragedy of today’s gays. i read a transcript of kramer’s speech in november of last year, right after bush has been re-elected. i’m sure that speech forms the core of his new book. i just haven’t been able to afford a copy yet. maybe this weekend.

art creates culture. art is also inherently political. in both ways, art generates new ideas. it doesn’t simply educate us, or make our surroundings decoratively niftier. more on that later.

i cannot reconcile myself to dual citizenship in a gay community on the upscale west side of town, an aids community in the trashy east side of town, and a chasm for my heart inbetween. i am one person. i live in one place. a single spirit moves my heart and yours, and lends us strength.

as gay persons, how can we fail to be anything other than simultaneously proud and horrified at the rich, extraordinary and contradictory actions—deeds—of our brothers and sisters in infection? those qualities are in us every one, our grist and our pig-headedness, all at once. look upon their exploits and recognize yourself.

own your reality, there on the inside.

know the truth of it.

of course it’s painful.

it’s hard to know what hurts more, the greatness or the folly.

as a gay person, with or without aids, how can my home be elsewhere? is this not the city where i struggled to grow up all my life? the city that raised me? are you not my brothers and sisters and sons and daughters and mothers and fathers and neices and nephews and aunts and uncles and grandparents? if you are not my kith and kin, where are the people my heart remembers?

i have not fled. i have not become invisible or untouchable. you have. and you brought your pain with you when you ran—didn’t you?

come back to me.

i may be your weakness, but i am also your strength. i might be your fear, but i am also your courage. i am your death. i am your medicine. i am your cure. i am your journey. i am your life in life.

i believe in you. we are mutually empowered by our belief in one another. this is faith—belief in god has nothing to do with it.

save yourself. save us both. believe in me.

and let us welcome each other home.

are we a palpable cultural entity? are we a body politic? do we live in a common cultural territory? should we?

what is the relationship between identity, culture and political activism? is it possible to be a fully-realized gay person without political activism (as opposed to being a fully-realized homosexual)? do we believe it’s important to be engaged politically in order to define ourselves culturally? can you live a gay life and be unaffected by aids? can you live a human life and be unaffected by aids? can you catch aids by talking about it?

yes. yes. yes. yes. identity, culture and political activism are facets of the same gem. no. i do. no. no. i don’t know—maybe.

at least, like sash, that’s what i think right now.

how shall we be free?

another time.

my name is richard kearns. i am a 55-year-old gay man alive with AIDS in los angeles for more than 20 years. i am a medical cannabis patient & advocate. a citizen journalist & poet. i speak today in favor of regulating medical cannabis. this is my open poem calling for a city that’s a good place to die [5-15-2007].

to the self-appointed
hall monitors with
machine guns
uninformed about the law
sure about the criminals
killing us with pretense
& to all their many poisoned ears

who are you
to tell me how
to sing the blues?
i am the blues
i ring the blues out loud
for you: hear me now
these are the 1983
denver AIDS principles
in song: we are persons
with AIDS, we are, we must be
expert voices hearkened to
in all public health
policy dialogs about
our lives & deaths & our disease
the refrain is the same for
medical cannabis

here are the blues
i sing to you
our city must be
not only a good
place to live
but also also a
good place to die

this day’s challenge? to
create a greater good
with our land use wisdom

who are you
to tell me how
to sing the blues?
listen to my song
medical cannabis
saves lives
medical cannabis
can save more lives
medical cannabis
is the single most significant
in-place but unaccessed
AIDS treatment option
available today
in los angeles
for the more than
60,000 persons
livng here with
AIDS & HIV disease
& we represent
only 25 clandestined percent
of the medical cannabis community

i’m here
i’m queer
i medicate
here is my song
the time is ripe
to regulate
help us create
livable lives & deaths
who are you
to tell me how
to sing the blues?
i am the blues
song & singer
tap your foot & hum & listen
before i’m gone

namasté

—richard kearns
poet-secretary, patient advocacy network
citizen journalist, http://aids-write.org

Ahoy!

B&W session, avec un petit stock de très vieilles pellicules qui ne demandaient qu’à être développées. En attendant de la nouveauté.

Bien à vous.

A.

[tuesday, November 3, 2009] good morning
president garcetti, distinguished council
members. i have given the clerk copies
of my prepared remarks.

my name is richard kearns. i am a 58-year-old
gay man with AIDS, a long-term survivor & activist,
a medical cannabis advocate, a poet & journalist.

i am here this morning to suggest a
plan B for medical cannabis in LA

please empower a special high-speed
ad hoc medical cannabis team, who,
starting with the text of the city’s
legislative analyst submitted to the
plum committee september 25th
can finish translating the whereases
to section numbers inside a month
(sort of like going from iambic pentameter
to dactylic hexameter) &
not to “correct” them, but
to produce a good faith
medical cannabis ordinance,
one that spells out fees & enforcement protocols
one that includes storefront dispensaries
(not just your LA garden variety)
one that captures legislative intent
one that respects voter intent
one that incorporates community input

mr trutanich would have us believe that
changing the law is against the law

so i thought i’d review with you
why we want to change the law,
in the hope that
• by reaffirming the broad
vision of our mutual intent
• by recalling the urgent &
compelling reasons for
creating medical cannabis
dispensaries in california
in the first place
we make it clear
what the city attorney
left out in his version:
he left out saving lives.

medical cannabis clinics are an example of an
“extraordinary response” to the global HIV/AIDS
pandemic called for by UN-AIDS (the Joint UN
Programme on HIV/AIDS) former executive director,
dr. peter piot, who characterizes mr. trutanich’s type of
failing-to-keep-pace-with-a-liberalizing-
society-shut-them-all-down-i-don’t-care-
how-drug-warrior
attitude as “the new denialism.”

let’s start here: the chances of my survival
as a person with AIDS increase 330%
when i add medical cannabis to my
treatment regimen. i can’t take care of myself.
don’t tell me i can grow it myself.
don’t tell me i can eat cake

it would be nice if mr trutanich would join
the 21st century & contribute to this city’s
extraordinary response rather than wrecking it
but it’s not going to happen

please move ahead with plan b

namasté

richard kearns
rk@aids-write.org

AIDS requires extraordinary response
UNAIDS policy statement
An emergency is a situation that threatens the lives and well-being of large numbers of people and requires extraordinary action to ensure their survival, protection and adaptation. Emergency situations are caused by both natural disasters such as earthquakes and droughts and human conflict such as warfare and civil unrest. A complex emergency is a humanitarian crisis with a significant breakdown of authority and security, requiring an international response beyond the mandate of one single agency. In such situations, people in all sectors – soldiers, rebels, humanitarian workers, displaced persons and others – are at greater risk of exposure to HIV. Women and children are often the most vulnerable.

http://www.unaids.org/en/PolicyAndPractice/SecurityHumanitarianResponse/default.asp

7 December 2006 – The head of the main United Nations agency dealing with HIV/AIDS today said the global threat posed by the disease requires an extraordinary response.

“We are already witnessing a new form of AIDS ‘denialism,’ which maintains that AIDS must be treated as simply one of many public health crises,” the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS) Dr. Peter Piot said, opening the agency’s 19th board meeting in Lusaka, Zambia.

http://www.un.org/apps/news/story.asp?NewsID=20885&Cr=HIV&Cr1=AIDS

rk—mission statement

everything. all things. all loves. all knowledge. all
expressions. all passions.

as long as i have breath.

this day.

all ways.

in strength and weakness and joy and sorrow.

past the end.

around the bend.

Rich and I getting ready to feed breakfast

Each week the Morning Show “Rich and Mary’s Morning Mess”  on 101.3 Champ the two personalities, Rich and Mary,  do their football picks for the week in a competition and the loser has to do something odd.  Recently when Mary has lost she has had to go to a busy intersection for a period of time wearing Red Sox pjs (she is a Yankees fan) and go trick or treating through a neighborhood wearing a bo-peep outfit in the middle of the day.  Rich who seems to lose more times has had to go to a bar wearing a Yankees outfit and even go on a date with a transvestite.  Well, Rich lost again and the station was looking for ideas of things for Rich to do.  I called in on Tuesday with the recommendation that Rich come help me clean out the goat barn.  On Wed. I found out that Rich and Mary’s Morning Mess would be coming to Vivian Acres to broadcast their morning show so Rich could help me around the farm on my morning chores.  This was fantastic news as I was planing to clean the barn anyway before winter set in.

They arrived at Vivian Acres before 6am and quickly set up their equipment to broadcast.  The idea was that Mary who won the bet was to stay inside in my kitchen where it was warm and Rich was to go outside where it was not so warm (27 degrees) and help me with my work on the farm.  They brought along a friend of theirs “Mike the Mechanic” to make sure Rich accomplished  his tasks.

Mary enoying the fruits of victory

So while the three of us ventured outside to provide the goats with their breakfast, Mary was sitting pretty keeping my cats company.  I am not sure if Rich has been around a lot of goats, but he was very brave, even when I left him inside the pen alone while Mike and I  searched for my camera.  I think the Goats thought that Rich had their breakfast and began to swarm him.  He kept telling them that he had nothing for them but since goats don’t understand they continued to show how friendly they can be as they swarmed him.  As i have said, goats are very food driven and they certainly knew that it was breakfast time.  He seemed very relieved when we showed back up but I am sure he made some friends along the way.  He especially seemed to take a liking to Courtney Love.  Go figure.

Me feeding, Rich being swarmed

Well, there was the usual swarm at breakfast as I put out different bowls for each goat but they seem to want what is in everyone else’s bowl.  I am only thankful that Rich didn’t get knocked over during the process.  Mike thought it was pretty funny but then Mike is a strange guy.

After breakfast was over, it was time to put Rich to work.  The barn had not been cleaned for a while so after giving Rich a pair of nice gloves and a pitchfork and under the complete command of Mary from in the house, Rich was made familiar with the not so glamorous side of goat farming.   He really “Dug in”  with a lot of complaining i might add and went to work.  I think his new friend Courtney was somewhat offended by his references to the smell.  As those of us who raise goats know the smell is minimal, but like I said, Rich does not know goats.

Rich making himself useful

Rich really digging in

We finished our cleaning chores early and Rich was itching to find out more about goat farming.  There is always something to do at Vivian Acres and Mary was not going to let Rich off easy.  Hoof trimming was next on the agenda.

Rich learing the fine art of hoof trimming

Rich did not do so good at this.  Well like I said it is kind of an art.  What he did learn was about goat hypnosis.  After grabbing Billy Joe and putting him on his butt, he was amazed at how the goats can go to sleep so fast so you can handle them.

Later, he even held Ozzie who is a bit under the weather, for a shot.

Rich and Mary were both very good sports about coming to Vivian Acres.  As always I enjoy visitors and I enjoy help even more. Both Rich and Mary were really a blast.  Even Mike, although he was more of a spectator than anything else.  Although he did try to interview Momma and even got a kiss from her.    I really enjoyed having them all here.  They were a blast and the fact that I was able to provide Rich with some meaningful employment was a bonus.  Vivian Acres would certainly welcome them back whenever they can come around.  I know that Courtney would be  happy if Rich was to visit again.

Mary still enjoying her victory

Mike the Mechanic interviews Momma

La mare au diable est l’un des romans les plus célèbres de George Sand paru en 1846 mais aussi de la littérature française.
L’histoire a été adaptée au théâtre, au cinéma, à la télévision, plus récemment en bande dessinée et enfin en livre audio. L’histoire peut paraître “ simplette”  mais elle est très bien écrite et nous ramène également à des scènes traditionnelles de l’époque .

George Sand dès le début de l’ouvrage,  nous emmène à la campagne, celle du Berry, ainsi elle nous parle du labour, de la charrue et des bœufs. L’histoire de son roman La mare au diable met en scène, Germain, jeune laboureur, veuf  et père de trois enfants qui accompagné de Marie, jeune fille qui travaille dans une ferme voisine, part à la conquête d’une nouvelle épouse.

Dans le premier chapitre intitulé « l’auteur au lecteur », George Sand guidera votre étude du livre sur :  la condition du travail paysan contrasté à la vie du « seigneur », en quelque sorte, de celui qui en fait le plus et qui s’enrichit le moins ! Un siècle et demi plus tard la conclusion serait-elle si différente ?…
Par ailleurs, on découvre donc la rencontre de Germain et de Marie, et,  sans suspense, dès le début,  on connait le dénouement de leur histoire. Toutefois, l’ensemble est très bien écrit et l’ouvrage porte également des idées importantes sur la femme du 19^e siècle.

En conclusion, on appréciera la précision de l’auteur qui déjà dans un souci de préservation des traditions, décrit admirablement et nous fait ainsi partager la fête traditionnelle du mariage de Germain et de Marie.