Islamic religious leaders in Somalia are increasing efforts to reduce stigma and discrimination against HIV-positive people in the country, IRIN/Plus News reports. Religious leaders in the predominantly Muslim country are encouraging people to treat HIV-positive people with respect and are becoming involved in HIV prevention efforts, according to IRIN/Plus News.

Sheikh Mohamed Haji Mahamoud Hersi, who is part of a traveling organization of Muslim leaders, said, “As religious leaders we feel it is one of our main duties to be kind and helpful to the less fortunate members of society,” adding, “Islam is about compassion, and people living with HIV deserve to be treated with kindness.” IRIN/Plus News reports that Hersi was one of the first religious leaders in the country to advocate for better treatment of people living with HIV/AIDS, who face “constant stigma, are ostracized and often even thrown out of their homes.” According to Hersi, people in Somalia “really listen” to religious leaders and might “accept” HIV-positive people if they see leaders engaging people living with HIV/AIDS. Talowadag, a coalition of nongovernmental organizations that provides care for people living with HIV/AIDS, recently held a meeting with 24 religious leaders, and all but one agreed to provide counseling to HIV-positive people, according to Gulleid Osman, executive director of the group.

IRIN/Plus News reports that the United Nations Development Program and UNAIDS have trained religious leaders to help local residents change their behavior toward HIV-positive people. UNDP is also partnering with the Somaliland AIDS Commission, local NGOs and Muslim scholars to agree on the formal role of religious leaders in HIV prevention (IRIN/Plus News, 3/27).

Johns is leading talks with not-for-profit centers and leaders of safe houses in other cities in an effort to garner funding and the social services needed to operate the center. “Many of these women are prostituting because they are addicted to drugs and need the money,” Chief Richard Biehl said, adding, “We need to get them into an environment where they see the benefits of being clean.” According to Johns, he hopes that talks will generate funding ideas and Dayton is considering applying for federal stimulus funds to start the center. “It’s a problem that has to be addressed because prostitution affects the entire community,” Biehl said, adding, “There is a quality of life issue here, along with the general welfare of citizens in areas where prostitution is a problem” (Sullivan, Dayton Daily News, 3/14).

The lawsuit filed in Brooklyn federal court on Tuesday by Ilya Dall tells of how Roberto Alomar allegedly refused to take AIDS tests, even though it was obvious that he was very sick.

Dall is suing for $15 million, contending that Alomar insisted on having unprotected sex with her even though he had to know that he had full-blown AIDS. Dall claims that, along the way, Alomar said that the Tampa Bay Devil Rays — with whom he signed in 2005 — tested him for HIV and cleared him to play. And, of course, it wouldn’t be a baseball story without some mention of steroids. Excerpts of the complaint, which was obtained by the Smoking Gun:

16. Dr. Joseph Mace advised Defendant, Roberto Alomar, to have an HIV test performed and the Defendant, Roberto Alomar, refused to have said test performed, stating that he was tested by the Tampa Bay Devil Rays and was clear of HIV.

17. In March, 2005, Dr. Joseph Mace prescribed steroids for the Defendant in order to rebuild his blood platelets, and on or about March 17, 2005, after suffering back and vision problems, and fatigue, the Defendant retired from his employment as an active professional baseball player.

66. That the Plaintiff is under the care of a doctor and other medical personnel in an attempt to recover from the serious, severe and permanent emotional, psychological and mental injuries as a result of the negligent infliction of emotional distress by causing Plaintiff to be exposed to HIV and developing AIDS, which is also commonly known as “AIDS Phobia.”

Is Alex Rodriguez thanking the fates that this story came along when it did, or what?

Of course many are wondering what John Hirschbeck has to say about all of this; he’s the umpire on whom Alomar spit during their infamous argument in 1996 when he was with the Orioles. From Staten Island Live:

He had a borderline Hall of Fame career, but is probably best known for spitting in the face of American League umpire John Hirschbeck after an argument, then bizarely saying that Hirschbeck was under stress due to his son’s death after the game. After the incident, fellow umpire Al Clark said that Hirschbeck should insist Alomar take an AIDS test.

In the report, Hirschbeck said he holds no ill will toward Alomar and is not concerned for his health, quoted as saying “You’re telling me something I’m shocked at. I wish him nothing but the best.”

Anyway, if you have time to take a look at the complaint, you’ll also find that Dall says the two had sex at Alomar’s parents’ home during the Christmas holiday. Now that’s just sick.

One of the most important tools that you have in fighting HIV disease is your relationship with your doctor. It’s worth spending time looking for the right doctor, and being ruthless about changing doctors who don’t work for you. Studies have shown that a person with HIV whose doctor treats lots of other HIV-positive patients lives longer than a person whose doctor only treats a few HIV patients. In other words, if at all possible, find a doctor who specializes in treating HIV!

If you don’t know where to go or who to ask for advice on finding a doctor with lots of experience treating people with HIV, then try contacting your local AIDS service organization—they usually have a list of recommended doctors in your area. You can get the name and number of your local AIDS service organization by calling the CDC National AIDS Hotline at 1-800-342-AIDS.

Talk to your doctor—see if you feel comfortable with him or her. If you don’t feel comfortable discussing your most personal stuff with the doctor (your sex life, your bowel habits, the weird growth in your groin, or your recurrent yeast infections) then maybe you should change doctors. Remember—your doctor works for you. Would you hire a plumber who made you feel uncomfortable discussing your sink?

What are T-Cells?

A T-cell is a type of lymphocyte. Okay, so what’s a lymphocyte? Lymphocytes are a type of white blood cell. About 15 to 40 percent of your white blood cells are lymphocytes. And they are some of the most important cells in your immune system—protecting you from viral infections; helping other cells fight bacterial and fungal infections; producing antibodies; fighting cancers; and coordinating the activities of other cells in the immune system.

The two main types of lymphocytes are B-cells and T-cells. B-cells are created and mature in your bone marrow, while T-cells are created in bone marrow, but mature in your thymus gland (T for thymus). B-cells produce antibodies. Antibodies help the body destroy abnormal cells and infective organisms such as bacteria, viruses, and fungi.

T-cells are divided into three groups:

	Helper T-Cells (also called T4 or CD4+ cells) help other cells destroy infective organisms.
	Suppressor T-Cells (also called T8 or CD8+ cells) suppress the activity of other lymphocytes so they don’t destroy normal tissue.
	Killer T-Cells (also called cytotoxic T lymphocytes, or CTLs, and are another kind of T8 or CD8+ cell) recognize and destroy abnornal or infected cells.

What is a T4 Cell Count?

T4 cells. CD4+ cells. T-helper cells. No matter what you call them, these cells are important to know about if you are HIV-positive. (Note: whenever we generically refer to “T cells” on other pages of this web site, we are specifically referring to T4 cells). Knowing how many T4 cells you have—which is determined by blood tests ordered by your doctor—can tell you how healthy your immune system is and how well it is holding up in the fight against HIV. Your T4 cell count will also be helpful in figuring out when to start anti-HIV therapy and whether or not you should start taking medications to prevent AIDS-related infections.

T4 cells are responsible for signaling other immune system cells to fight an infection in the body. They are also the prime target of HIV, which can cause the number of these cells to decrease over time. Too few T4 cells means that the immune system will no longer functions like it is supposed to.

The normal T4 count is somewhere between 500 and 1500 cells per cubic millimeter of blood (a drop, more or less). In the absence of anti-HIV treatment, the T4 cell count decreases, on average, about 50 to 100 cells each year. AIDS-related diseases (opportunistic infections) such as Pneumocystis carinii pneumonia (PCP) can occur if your T4 count falls below 200. And a large number of other infections can occur if it drops below 50 to 100 cells. Because of this, drugs to prevent these infections (prophylactic treatment) are started once the T4 cell count falls below certain levels, such as 200 in the case of PCP.

Used in combination with viral load testing, your T4 cell count will also help you figure out when to start anti-HIV therapies. Most experts agree that anti-HIV therapy should be started when the T4 count is 350 or lower. There is considerable debate about whether to start therapy before then. For a complete review of this question of when to start treatment, click on the following lesson link:

What is the T4 Percentage?

If you look at your lab report, you will also see something called your CD4+ percentage (%). This is an important number for you and your doctor to know. In healthy adults, the number of T4 cells make up between 32% and 68% of the total number of lymphocytes—a large group of white blood cells that include T4 cells, T8 cells (see below), and B-cells. In fact, the lab uses the T4 percentage to determine the number of T4 cells in a sample of blood.

The T4 percentage is sometimes a more reliable measurement than the T4 count because it tends to vary less between measurements. For example, one person’s T4 count may vary between 200 and 300 over a several month period while their T4 percentage remains constant at, say, 21%. Provided that the T4 percentage stays at 21% or higher, the immune system still appears to be functioning properly, regardless of what the T4 count is. At the same time, a T4 percentage at or below 13%—regardless of what the actual T4 count is—usually means that the immune system is damaged and that it is time to begin prophylactic treatment (drugs to prevent diseases) for opportunistic infections like PCP.

What is a T8 Cell Count, and the T-cell Ratio?

T8 cells, also called CD8+ or Suppressor cells, play a major role in fighting infections such as HIV. A healthy adult usually has between 150 and 1,000 T8 cells per cubic millimeter of blood. Unlike T4 cells, people living with HIV tend to have higher-than-average T8 cell counts. Unfortunately, nobody fully understands the reasons for this. Therefore, this test result is rarely used in making treatment decisions.

Lab reports may also list the T-cell (CD4+/CD8+) ratio, which is the number of T4 cells divided by the number of T8 cells. Since the T4 count is usually lower than normal in people living with HIV, and the T8 count is usually higher, the ratio is usually low. A normal ratio is usually between 0.9 and 6.0. Like the T8 cell count, nobody really knows what this low number means. However, most experts agree that once anti-HIV therapy is started, an increase in the T-cell ratio (i.e. a rising T4 count and a falling T8 count) is a telltale sign that drug treatment is working.

What Does a T-cell Test Look Like?

You will usually find your T-cell counts and percentages listed under “Lymph Subset” or “T-cell Panel” in your blood lab reports, which refers to a listing of your various lymphocyte cells (CD3+, CD4+, and CD8+). See below for what a typical T-cell test looks like. Click on a test name in the left column to view an explanation of its significance & meaning. (note: to see and/or print a complete list of test name explanations, click here.)

Introduction

Deciding when to start HIV treatment—and figuring out which drugs to start with—is, perhaps, one of the most difficult decisions you will need to make. And, depending on which way you look at it, the fact that everyone has different opinions regarding these issues can be either helpful, frustrating, or a combination of both.

Learning all you can about the pros and cons of your various treatment options is your best weapon in the fight against HIV. The following questions & answers (Q&A) are intended to provide you with the necessary information you need to communicate effectively with your doctor as you discuss these options.

Why is treatment necessary?

If HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

This does not, however, include people who take HIV drugs. Clinical trials—studies in which new and old drugs are tested in humans—have repeatedly shown that HIV drugs can keep HIV-infected people alive longer. Treatment, therefore, is a very important option, and people living with the virus should consider starting treatment before HIV has had a chance to do serious damage to their immune systems.

Why is treatment necessary?

If  HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

Why is treatment necessary?

If HIV is allowed to reproduce, or “replicate,” inside the body, it will cause damage to the immune system. Ultimately, the immune system gets so weak that the body becomes vulnerable to other diseases. This is the point at which a person is usually diagnosed with full-blown AIDS, and the other diseases they get can eventually cause death. For adults who live in wealthy nations—such as the United States—the average time between becoming infected with HIV and the development of AIDS is 10 years.

This does not, however, include people who take HIV drugs. Clinical trials—studies in which new and old drugs are tested in humans—have repeatedly shown that HIV drugs can keep HIV-infected people alive longer. Treatment, therefore, is a very important option, and people living with the virus should consider starting treatment before HIV has had a chance to do serious damage to their immune systems.

When will I know that it’s time to start treatment?

There’s really no right or wrong answer—it all depends on the individual. Working closely with your doctor, you can determine when the best time is to start treatment. This will largely depend on two factors: your physical health and your mental readiness to start therapy and stick with it.

In terms of physical health, your CD4 cell count, how you feel and your medical history all play major roles when figuring out when to start HIV treatment.

CD4 cells—also known as T-cells, T-helper cells, or T4-cells—belong to a group of white blood cells called lymphocytes. These cells have the double distinction of not only being the primary target of HIV, but also carry the responsibility of coordinating the way in which the immune system responds to disease-causing infections. When the CD4 cell count—the number of cells in a cubic millimeter or milliliter of blood—drops below 200, the immune system is considered to be “compromised” and you are at a higher risk of experiencing an AIDS-related opportunistic infection, like Pneumocystis pneumonia. In turn, experts suggest that HIV treatment be started before the CD4 count drops below 200; it is generally recommended that antiretroviral therapy be started once the CD4 count falls below 350.

I’m not going to pull a Pollyanna and say how great it is to be poz (HIV-positive), but in point of fact, in some ways becoming poz is one of the best things that ever happened to me. I’m not so sure I would have said that when I first had to face living on disability. But in the interim I have traveled and done things that would never have been possible otherwise.

I was probably one of the best (i.e. most psychologically) prepared and best received individuals when I got my diagnosis. I was in the company of virtually every one of my dearest friends, as well as two of my deepest teachers, and was staying at one of the radical faerie sanctuaries in Oregon when I got the news. They immediately formed a healing circle around me and did a laying on of hands. My Native American teacher actually did a “fleshing” with me, which was an incredible thing given that I was trying to come to terms with the idea that my sperm and my blood were now toxic. He actually cut pieces of my flesh (small ones, very small ones…didn’t hurt a bit) as we sat and smoked a sacred pipe and all prayed together.

Nevertheless, I would have to say I was probably clinically depressed for the first two years of my diagnosis and was busier preparing to die than I was preparing to live. Among the things that woke me up was my dear friend David, who was also diagnosed about the same time as me and with whom I was traveling a good deal. We were taking the same meds, but he was having a hard time with his (I have never had a hard time with my meds.) Four years into his diagnosis David was walking with his sister and nephew in San Francisco and, as they were crossing the street, a car ran a red light and David, pushing his sister and nephew out of the way was struck by the car and killed. There are no guarantees. We can’t even guarantee that you’re going to die from HIV. I used to go to a discussion group with a lot of HIV+ men and I would listen to them talk about how they discovered that they were now poz and now they’re going to die….like they weren’t going to before? No one gets out of here alive. And there are other diseases that are a great deal more debilitating than HIV is anymore. If you’re afraid of dying, figure out why and do something about it. If you’re afraid of living, that’s going to have some ramifications, too. Do something about it.

Here’s what I know in no particular order:

	We’re all lab rats in this experiment with HIV. No doctor has the magic pill and no one knows what’s going to happen next. We’ve barely been taking these meds long enough to know the long-term effects or benefits. Get used to that. That said, we’re all a helluva lot luckier than our dear friends who were diagnosed in the first years of this epidemic. It still gives me pause to think of how many of my friends might still be alive if they’d just lived another month or two for the first protease inhibitors to come out. Be thankful, grateful for the meds we have. It’s a whole lot better energy to be grateful for meds (and even their side effects) than the waste of energy to complain about all the side effects and worry about dying. Don’t worry about dying—we’re all going to do it no matter what.
	Because an HIV diagnosis is NOT a death sentence….Life is. Stop looking for Life to be “fair”…it isn’t. You CAN, however, figure out how to write the story you want. If you need it to be a big drama, it will be. Life and HIV are more than capable of providing you with LOTS of drama. But if you need your life to be wonderful and filled with meaning and experience and joy and happiness….go for it! Life with HIV can do that, too. Here’s the question I keep asking myself: Who would you be without the struggle? Me? I’m tired of the drama. I have better things to do with my energy.
	It isn’t a choice between EITHER western medicine OR complementary or “alternative” medicine….it’s an increasingly vast buffet table and you should pick and choose from all of it and take care of yourself and do what makes you feel comfortable and good. Listen to your doctor as your advisor, but YOU are the final arbiter about what is good for you and what isn’t. There is no all-powerful, all-knowing person out there who knows what’s best for you. You do. I do HAART, exercise, yoga, meditation and have traveled to the Amazon, for example. It’s all good.
	Get healthy. Work out. Stop putting off going to the gym and start eating right. There’s a direct positive correlation between lean body mass and survival rates. This isn’t a bargaining chip, either. It’s just about choosing to live—and living means taking care of yourself. Smoking is suicide. That’s OK if that’s what you want to do…crystal, drinking all night, irresponsible sex? Same thing…just don’t lie to yourself or me about it. Make your choices and the consequences will follow like night and the day.
	I may not have achieved “enlightenment” but here’s a flash light: a word about “Either/Or” versus “Both/And” decision making. “Either/Or” choices come from a view of the world that sees scarcity….not enough time, not enough of everything to go around. “Both/And” choices come from a view of the world that sees abundance…there’s enough for everyone. When presented with a problem or a situation I can choose the Either/Or way of looking at it or I can pick the Both/And way of looking at it. It’s about learning to live with life’s contradictions. I’ve found that when I frame a problem in an Either/Or way it usually leaves me in a trapped place and if I can find the Both/And re-framing of the problem it tends to create options, open doors. I prefer that, i.e. “I can either have HIV or I can be healthy” vs. “I can both have HIV and be healthy.” I’d venture to say that almost every challenge can be changed in this way.
	There are people out there who can love you even if you are poz. They can be poz themselves or not. Being poz in not a barrier to intimacy unless you want it to be.
	Ignore alarmists and those who would tell you that, for example, HIV doesn’t cause AIDS. In a word: horse pucky. Or that the government is part of some vast conspiracy to infect us all…the government is barely capable of pounding sand into rat holes much less undertaking a conspiracy that would have been this vast. If this disease had anything to do with humans it was more than likely out of error than intent.
	Don’t postpone joy. This is critical.
	You can’t take care of (love) anyone until you learn to take care of (love) yourself. Learn how to ask for what you need and what you want. Learn now to say “No.” Learn how to say “YES!”
	Learn about gratitude. In the final analysis this, for me, was the greatest lesson, the greatest spiritual awakening that was brought to me by HIV. It’s easy to be grateful when things are easy. Like human relationships, it’s easy when it’s easy—it’s when things get hard that you get the measure of the man. Learning to be grateful for all the lessons, especially the hard ones, will teach you more about Life and living than any other single thing, in my humble opinion. Life has a funny way of returning to the point, returning to the lesson until you learn it. Once you’ve heard it, embraced it and learned it, you and Life will move on to the next thing. Because Life is not a destination, it’s a journey. Let Life surprise you and it will. I can make it a hard journey and suffer (god knows there are a lot of pay-offs in this society for being a victim and you can waste a whole lot of energy on righteous anger or righteous self-pity, but after a while it gets tired and so do you) or I can dive in and suck the marrow out of it all and live until I die.

I just re-read this and I realize there are some bumper sticker thoughts in here. Sometimes the truth can sound kind of tired and trite. But then again, so does all the fear and loathing I hear everywhere I turn. Given the choice I’ll choose the positive thought. And that is a given. That, in the end, was how I came to be positive about being positive. Remember when “positive” was a good thing? It still is. It’s all about the choices you decide to make. It always has been and it always will be. You can’t control Life, but you can control your choices in it and your responses to it.

Credits

Bo Young is the Publisher and Editorial Director of White Crane, a quarterly journal on spirituality for gay men (www.whitecranejournal.com). He has written for POZ magazine, RFD, Fine Cooking and other publications. He lives in Brooklyn where is working on a biography of a contemporary Shoshone medicine elder and Two Spirit.

Introduction

You’re HIV positive (HIV+). You’ve only just learned about your status. OR you’ve known about it for sometime. Whether it’s still fresh news that you are beginning to absorb or it’s something you have been living with for a while, there are bound to be many situations in your life in which you will be faced with the decision of whether or not to disclose your HIV status – to tell others that you are infected with HIV. In a number of circumstances you will find yourself trying to balance honesty with protecting your right to privacy.

Whom do you feel you need to tell? Is there someone you want to tell, but aren’t sure what or how much to say? Is there anyone you feel that you must tell like a spouse, a partner, or perhaps someone whom you’ve been dating? What about informing any sex partners you’ve been with about your status? Perhaps you’re having surgery or you’re going to be seeing a dentist. Do you have to advise these or other healthcare providers that you’re HIV positive? Do they have a legal right to ask you about HIV status or to deny you care if you are HIV positive? Are there any circumstances when you’re legally required to disclose that you’re HIV positive?

Along with the many thoughts and feelings you will experience while coming to terms with your HIV infection, these are some of the questions and concerns that may arise with respect to disclosing your HIV status. As with so many of the issues about HIV, or many important life decisions, there are no absolute answers that are right for everyone.

It takes time to adjust to being HIV positive. With that in mind, it’s a good idea to not rush into disclosing your status without first giving it some thought. Wanting to share this knowledge with someone else is a perfectly natural reaction, especially when it’s new to you and you’re feeling overwhelmed, vulnerable, and uncertain about your life and your future. The reality is that people with HIV need to be selective about disclosing. They need to be selective about who they tell and when they tell them. This process of selection often involves uncertainty and can sometimes be an anguishing experience.

That old fashioned maxim, “easy does it” is a good approach to consider when thinking about disclosure. Even if you’ve been living with HIV for a while, you’ll likely find situations continuously arising in which you may be forced to think about having to disclose your HIV status. Wanting to tell family members, employers, fellow employees, and friends is very natural. However, the truth of the matter is that it can also create new problems for you. Over the past twenty years of the HIV epidemic, there have been some significant improvements in the general public’s awareness about and understanding of HIV issues. Unfortunately, there’s still a stigma attached to the whole subject of HIV and to those who have it. Yes, there is more understanding and wider acceptance than in the past, but unsympathetic and prejudicial reactions are still not uncommon in some families, in the workplace, and in social situations.