Stigma is a barrier to so many things: getting tested, disclosing your status, accessing care, getting funding to support education, prevention, research and treatment, even getting the presidential candidates to discuss the topic of HIV/AIDS. Especially before I disclosed my status publicly, and to a degree, even afterwards, stigma has played a huge role in the decisions I've made about living with HIV. It made me run out of the hospital waiting room where I was getting labwork done when I saw people I knew. It made me leave the drugstore without getting my meds because I knew people standing in line at the pharmacy. And it made me live a life of shame, isolation and fear for nearly a decade.

What has helped me escape stigma is releasing myself from it. I have realized that I made a choice many others do every day: I had sex without a condom. The only difference is that when I made that choice, HIV was present. When others made (or make) the same choice, HIV wasn't (or isn't) there. But the fact that HIV was present when I made the same choice as almost all others on the planet doesn't make me a "bad" person. It just makes me an HIV-positive one. There is no shame in living with the disease and while I understand all too well how fear of being stigmatized makes those of us living with the virus want to sometimes hide our status, the time has certainly come for the world to have a different attitude towards people who merely harbour a retrovirus.

When people living with HIV come forward unapologetically, without shame, and speak about having HIV, it allows them to get rid of the mantle of shame some people want to place on them. Disclosing your HIV status isn't for everyone, and you have to do it when and if it's right for you. But the more of us who come forward and matter-of-factly discuss our serostatus, the more the rest of the world will be likely to understand that those living with HIV are only "extraordinary" in a good way!

I've thought a lot about how we can fight stigma...and I'm still working on developing tactics that might change the way people see those of us living with HIV/AIDS for the better. This summer, at the International AIDS Conference in Mexico City, POZ will gather some of the world's top thinkers to strategize ways we can diminish the stigma around HIV/AIDS.

In the meantime, I've come to the conclusion that one of the most impactful ways to change people's perceptions of HIV/AIDS is to introduce the wide world face-to-face to the HIV community. I think it's easier to fear, dismiss and discriminate against something, or someone, you don't know. So, in the spirit of introductions, I invite you to meet some truly extraordinary young people living with HIV and other who are not who joined this game to support those of us living with, and affected by, HIV/AIDS.

I'd love to know what you think!!!

Play the game:

In this era when we discuss things like whether too much U.S. money is being spent on AIDS overseas (it is not, we just simultaneously need additional funding allocated to prevent AIDS in America and to help Americans living with AIDS) or whether spending millions to raise millions to fight AIDS is a viable equation (it is, if it raises money that would never have been raised otherwise), I think it’s interesting that money can be doubly-purposed—in this case, to sell fashion and to open minds.

Everyone in the campaign has an amazing story to tell of overcoming a different challenge. What was interesting was that my challenge—HIV—was hard to show. One woman, Aimee Mullins, is an incredible athlete with artificial legs. A young man, Sonny Caberwal, dresses in the traditional clothing of a practicing Sikh while speaking out against racial profiling. People can see the obstacles they had to overcome. But HIV? How to best show that?

We decided on a faux-tattoo on my arm because I once was going to brand myself, visibly, with “HIV+.” In the early days of living with HIV, I knew the importance of telling people that I was positive, but it was so hard. I was so afraid of rejection. I thought if my body said it, then my lips might not have to. But, I also thought there may come a day when they’d cure HIV and then I really wouldn’t want the tattoo. I decided that I would just summon the courage to speak up.

I didn’t always, at first. So I left a lot of people confused about why I would suddenly just vanish from their lives. It was just that when I met someone new, I wasn’t sure how they’d react and if I got the sense that they would reject me, I’d just skip disclosure all together. But, of course, when it came to potential sexual partners, this wasn’t an option (I didn’t want to expose anyone to the virus with or without their knowing, even if everything was protected) so, I walked away from a bunch of people never really knowing what they’d say if I told them.

Now in my 11th year of living with HIV, it’s gotten easier to disclose. The funny thing is, I still have to do it all the time. I thought after spending the last two years taking openly in public about HIV, I’d get to the point where I wouldn’t have to disclose. But there are lots of people who don’t read POZ, don’t watch Oprah and still haven’t seen the Kenneth Cole campaign. So, when I say I work for “POZ” they hear “PAWS” and think I write about cats and dogs.

It’s been an incredibly liberating journey for me. A little over two years ago, I was in shock waiting for the April 2006 POZ cover to hit the streets and waiting for a story about my appointment at POZ to break in the New York Times newspaper. Then, I was scared out of my mind about what would happen. A little over two weeks ago, the day that the Kenneth Cole campaign came out in the New York Times newspaper, I was surprisingly calm. I realized I’ve become so matter-of-fact about disclosing my HIV status that I have to remind myself that it is still shocking to people.

I guess the point is that even the most shocking news becomes banal when told over and over. And, as someone once said to me in my early days at POZ, “Don’t worry, you’ll be yesterday’s news soon enough.” That was a relief, then. Now, I hope lots of people see this campaign and I hope it shocks them into the reality that while people discriminate against other people for all sorts of things, AIDS is the ultimate equal opportunity offender and it can, and does, happen to every sort of person in the world.

Oh yeah, and I’m rethinking that tattoo. The creative director, who calls the people in the campaign “non-uniform thinkers,” said I was a “non-uniform inker.” I like the ring of that. I think it might me time for my body to make a statement that my lips are all too familiar uttering.

Let me know what you think of the campaign…and the ink!

To see the YouTube teaser ad, click here:

http://www.youtube.com/watch?v=xT3DL6ng8EA

To see the print ad and the video on kennethcole.com, click here:
http://www.kennethcole.com/thinkers/bio5.asp

We have done our best to debunk the hysteria around MRSA (stay tuned for the next issue of POZ!), and I am well aware that it can be treated (though it is virulent, quick-spreading and potentially deadly if untreated). BUT I still found myself wondering whether my cat was a carrier of MRSA, and if so, whether I'd be its next victim.

The vet treated my cat (he had a bite wound that did have a bacterial, but not MRSA, infection) and assured me that the biggest danger I faced from my cat was his teeth, which he would surely brandish when I tried to shoot the liquid antibiotic into his mouth with the tiny syringe she gave me.

The fact that my irrational fears overcame what I knew to be the medical facts around MRSA made me feel guilty. Was I no different from the international journalists who fell prey to MRSA's hypnotic power to invoke terror? The difference, I consoled myself, is that I kept my irrational fears to myself (and my vet), while other journalists riffed off MRSA's fear factor to sell newspapers and magazines and to keep eyeballs glued to the TV set.

The latest drama on the MRSA front is a press release issued recently by researchers from the University of California-San Francisco (UCSF) about a study conducted in Boston and San Francisco that found that "men who have sex with men in San Francisco are 13 times more likely than other city residents to get drug-resistant staph." The study, reported in the journal Annals of Internal Medicine and its accompanying press statement, invoked a level of fear that caused one British tabloid to ask whether MRSA could be "the next AIDS."

A hubbub ensued as gay rights advocates responded to UCSF's press release and as the press coverage it created.
Click here for a link to AIDS activist Michael Petrelis' blog entry about three editors of gay publications questioning the way the UCSF study was covered in the mainstream media. As a result, the parties responsible for issuing the release offered a formal apology. Click here to see coverage of UCSF's press release and apologies in the New York Times on 1/20.

What amazes me about the situation is how quickly the press, jumped on a story about gay men being dangerous carriers of yet another serious transmissible disease. It might be a story if gay men were the only one who could contract and/or spread drug-resistant staph. But, as is true with HIV, anyone can and will get diseases if they are exposed to them in a way that allows a disease to enter their body. Just as HIV has no idea whether the body into which it enters is gay or straight, MRSA has no idea about the sexual orientation of the skin it contacts and infects.

The fact is - and the Centers for Disease Control and Prevention (CDC) agrees - that MRSA is not a bona fide sexually transmitted infection limited to a certain population. It passes from one person to another via skin-to-skin contact or when a person touches a contaminated surface. It is widespread in hospitals and among hospital workers. Anyone who comes in contact with it can get it. And, there is nothing about gay men that makes them more, or less, prone to skin-to-skin contact.

The danger of linking certain biological agents in certain ways to certain subsets of the populace (like men who have sex with men) is that it gives too many people who are actually at risk for being exposed to a given biological agent an excuse to think that they need not worry about coming in contact with it. Imagine if, from the beginning, the international press had properly positioned HIV as a virus that anyone, in any circumstance, of any age, race, gender, sexual orientation, nationality or religion could contract through even a single act of unprotected sex or the sharing of a needle? How differently would the world have responded to HIV if it had not tried to portray as one affecting only the gay community? How many lives - gay and straight - would have been saved? How many infections could have been prevented if all people understood the truth - that everyone is at risk for contracting HIV if they have unprotected sex or share needles?

If we want to arbitrarily "assign" drug-resistant MRSA to groups of people that are believed to have more skin-to-skin contact than other groups, why don't we consider communities beyond the gay community? What about college kids at fraternity parties? What about high school kids across the nation on prom night? Married and monogomous couples on Valentine's Day and their anniversaries? (Or any other especially amorous night?) Couples on their honeymoon? I bet these folks all have lots of skin-to-skin contact. My point is that I am tired of the media, and the larger public, acting like gay men are the only ones who get naked and touch each other and that they are therefore at greater risk than other people for having bacteria and viruses spreading among them.

Instead of demonizing any part of society by connecting them to unsavory notions like infectious, drug-resistant bacteria or deadly viruses, let's broadcast the truth: that a teenage football player in the American heartland who shares towels or walks barefoot on wet tiles or touches countertops in the gym locker room is as likely a candidate for contracting drug-resistant MRSA (if it is present) as is a gay man in Boston. And if that same teenage football player has unprotected heterosexual sex, he is also at risk for contracting HIV (and numerous other STDs). Yes, the frequency of sex ups the risk for any given person getting an STD, as do the number of partners, the type of sex and whether or not there is excessive friction that could cause condom breakage or tears in the skin that could make it easier for biological agents to pass from one person to another. BUT consider this: who's to say that they can accurately generalize a whole segment of the populace's sexual behavior? I know gay men who have had one partner for years and straight guys who can't count the number of women they've slept with in the last 12 months. Sexual orientation is not necessarily a fair indicator of sexual habits and therefore relative risk for contracting sexually transmitted diseases or diseases that pass from one person to another via bare skin.

So, please, let us stop trying to force a connection between any given group of people and any given disease (where one does not exist). It is arrogant of us to think that simply by labeling a disease as the sole or primary property of any given group that we can keep it from affecting us, too. Nature knows no bounds. If we want to fear something real, we should fear the dangers of mistakenly thinking that we are immune to certain diseases because of our gender, color, religion, political beliefs or our sexual orientation. AIDS, and drug-resistant MRSA, are equal opportunity offenders and they will continue to find all potential hosts, with complete disdain for artificial rubrics assigned to them by society.

Oh, to be a cat.

So I got up this morning and as I carved out a sizeable wedge of my Entenmann's raspberry twist danish, I realized that the box was covered with pink ribbons and messages about breast cancer awareness. And thinking back to my last visit to Shoprite, as I piled my food onto the beltway to check out, I noticed that the coffee cake was not the only edible vehicle of breast cancer awareness. My bread and my M&Ms were also emblazoned with pink-lettered messenging. Heck, the M&Ms themselves were pink and white. So were the Tic Tacs. I have to give it to the girls behind breast cancer--the Susan G. Komen Foundation has really gone beyond the pale to ensure that everyone - EVERYONE - knows that October is National Breast Cancer Awareness Month. All over America I'm sure women are plowing through their pink chocolate covered candies while waiting to be screened for cancer.

As I ate my cake, I had to wonder, why is there no National AIDS Awareness Month? I know we have World AIDS Day, coming up on December 1st. And there's National HIV Testing Day each year in June, but why does AIDS get only two days and breast cancer gets 31? The answer is that there's no organization in the AIDS community pushing for public, month-long awareness the way Komen does. And it's a shame. Because the stats for women (people!) contracting HIV are certainly dire enough to warrant such a month of focus.

At my previous magazine, I wrote our annual feature story about breast cancer for three years. The final year I wrote about it, I was invited to a "Survivors Ball" held at a swanky hotel in northern NJ. I remember that a wealthy, and anonymous, patron had donated hundreds of the most beautiful pink peonies I have ever seen. The whole ballroom was awash in fuschia and 800 women came together that night to celebrate their survival - and remember the ones who had been lost to the disease.

At one point, a Latina woman who knew I was writing the story approached me and said she wanted to show me something. She led me to the ladies room, lifted her blouse, opened her stuffed brassiere and showed me two horrific circular scars where her breasts had once been. She'd had a double masectomy in the 1960s and had not been given the option to reconstruct her breasts. It looked like they'd been removed with a chainsaw. I steadied mysef and after redressing she said, "Only you and my husband have seen what they did to me. I have been ashamed of myself for 45 years. But tonight, I am no longer ashamed. I am proud I have lived and I now know that I am still a complete woman even without my breasts. I just wanted you to know that."

I think I staggered out of that bathroom. 45 years of shame. I'd had 10 with my HIV. I knew was she had felt, but I wasn't about to let my HIV cat out of the bag, not that night, not in that setting. I wasn't ready then.

I thanked her for sharing her story with me and returned to my table. The evening was coming to a crescendo - the band fired up Gloria Gaynor's "I Will Survive" and 800 women danced and sang out at the top of their lungs and cried and waved handfuls of peonies about. I was so grateful that so many people were crying because it seemed perfectly normal that water would be running down my face - I was the compassionate journalist, right? Caught up in the moment, totally empathisizing with a throng of incredible women who cheered for their tenacity and cried for the inevitable casualties of a deadly disease.

I cried for all that, but I also cried for all those living with HIV/AIDS and all those who'd died from it. And I cried because it seemed so incredibly wrong that a group of AIDS survivors couldn't have a similar ball, in a fancy ballroom, with big red flowers on the table. Since that night, I have hoped that someday those of us living with HIV will be able to celebrate as openly as those women who had beaten breast cancer.

I think it's reasonable to expect that if people can be sitting down to breakfast, slicing up sweet, sticky pieces of coffee cake that remind them to get tested (early! early detection equals survival!) for breast cancer, that we can do the same thing for AIDS. Personally, I think AIDS can become as socially acceptable a disease as breast cancer. And I think the messaging should be similar: take control of your life - know your status.

I look forward to the day when I'll be eating my Entenmann's AIDS coffee cake, grateful for the survival of many, paying tribute to those who have passed, and feeling calmer knowing that people all across America are thinking matter of factly about the need to get tested for HIV.

Maybe I'm naive, but I think that if the companies who support breast cancer would do the same thing for AIDS, it would help to normalize the disease. Putting AIDS out into the open, and onto, say, a bag of bite-sized Snickers bars, might go a long way towards helping people understand that this is just another disease that can affect everyone - a disease that is best fought if addressed as early as possible.

I think I'm gonna call a few of those companies and see what they'd say...

I'd love to hear your thoughts on the matter!

We left Australia Sunday morning (Aussie time) and flew through two sunrises, one sunset, across the international dateline from today into yesterday and from the southern to the northern hemisphere to arrive in Los Angeles four hours before we left Sydney. We then sat trapped on the departure side of security at LAX (LA’s international airport) for 16 hours while two planes we were supposed to ride home were deemed unsafe to fly. I don’t know what’s worse: the surreal jet lag (amplified by massive fatigue and a slight hangover…because after thirty hours of travel, you have to have a glass of wine…) or the culture shock of re-entry to the U.S.

Don’t get me wrong. I love America. I practically kissed the ground at JFK when we finally touched down in New York. But it is amazing how loud and disheveled we can seem compared to people in cultures overseas. Also, we are so out for ourselves. Sean and I were not seated together on the last leg of the trip, so we asked if people minded reshuffling. One old man wagged his finger disapprovingly and said no way was he giving up his window seat. Another just ignored us completely. Finally, a young Asian woman offered her seat…

When our second plane was canceled, and it was announced that we had to go to customer service to try to secure the next ride home, people stampeded past one another. One guy was screaming into two cell phones at once while he elbowed past a young mother trying frantically to steer a baby carriage laden with siblings while she sprinted through the airport. I wanted to help her out—but I also didn’t want to spend another 16 hours at LAX. The phrase “kill or be killed” kept flowing through my mind. In the end, for all the high-speed dialing and rude maneuvering, the guy with the tandem phones took the same plane—hours later—that we were on. As he walked down the aisle past us, I secretly hoped that they’d sat him next to the two little kids who, like the rest of us, were completely at the end of their ropes. I have to admit, I missed the Zen-like flow of the crowds on scooters, motorcycles and bikes in Viet Nam who deferentially swerve around you as long as you don’t stop suddenly, or accelerate wildly. If I learned anything on this trip it’s the importance of patience and the power of forging ahead smoothly through life without trying to stand your ground, or run anyone over in the process of trying to get where you are going.

We saw our third sun-up sans sleep (because the red-eye from LA actually took off a.m. time in Australia) while on the final plane. Watching the edge of space turn crimson from 36,000 feet is a life-affirming sight. The glow of first light above the clouds is so different from the one we see from earth. It seemed fitting to close out the life-changing 22-day trip watching a new day break over the bow of the planet. It reminded me of a blast of morning light I saw several years ago. I was traveling to see my family and had survived a particularly nasty take-off in stormy skies around Houston. As the plane pitched and bucked, I remember feeling that I’d be so disappointed in myself if I died before fulfilling my promise to myself that some day I’d do something about AIDS. When the plane pierced the bright sunny sky that always sits above the darkest rain clouds, I told myself that as soon as I could, I’d get on the activist wagon. It took a little while, but I did it. And the peaceful pink dawn we saw days ago seemed a sign from nature that I was on the right path.

Okay, enough Hallmark.

Let’s talk witches and virgins.

Two reasons I am glad (and proud) to be an American: 1) we do not call people living with HIV witches, and hunt them down and kill them and 2) we do not believe that sleeping with a virgin will protect you from HIV.

Just before leaving Australia, I read the report that more than 500 HIV-positive women have been beaten or killed by mobs of people in Papua New Guinea (PNG) who claim the women are witches who have “cursed the Pacific island nation’s younger generation with AIDS.” The main evidence, according to one report, is that the HIV-positive women “walk differently from others.” After having spent several days listening to local authorities in Australia brag about how they have minimized the rate of HIV infection in Australia and how they intend to play a pivotal role in supporting Southeast Asia keep their AIDS epidemics under control AND having talked personally with Maura Elaripe Mea an HIV-positive woman from PNG (see the interview on the IAS conference coverage page), I was flabbergasted to hear that HIV-positive women are being murdered on an island so close to Australia.

Last Thursday night, I was a guest on ABC Radio National’s “Australia Talks,” a national radio show, along with Australia’s Minister for Foreign Affairs Alexander Downer (who recently upped Australia’s AIDS funding from $400 million to $1 billion), Bill Bowtell, director of the HIV/AIDS Project at the Lowy Institute for International Policy and Dr. Patricia Fagan. Dr. Fagan commented that there have been no reported cases of HIV in the Torres Straits—the body of water filled with tiny islands that sits between Australia and PNG. It seemed from her report that the HIV infections on PNG were going to stay contained there. There was no mention of the witch-hunts nor reference to the supposed threat of micro-chipping that HIV-positive Papua New Guineans currently face (Is this insane? Human Rights Watch we need you!). During the show, two of the live callers furthered my fear that what the top brass was saying about HIV prevention in Australia (and the surrounding region) might not dovetail with the realities there. One caller suggested government prevention campaigns should not be focusing on messaging about condoms but rather, focusing on how to teach and help people be monogamous. Another caller reminded the live listening audience that there are many in Southeast Asia who believe that HIV can be prevented if you sleep with a virgin. When I hear comments like these, I know we have a lot of work to do, even in parts of the world where the HIV infection rate seems, for the moment, to be contained. While Australia has unquestionably done a great job on the prevention front, I wonder whether what has worked on that continent will translate to cultures near in geography but far away in terms of cultural similarity. It also struck me that no matter where you are in the world the same issues continue to rear their heads as impediments to good AIDS prevention. There are the religiously conservative who thwart condom distribution and education about real-world safe sex, there are massive power imbalances that make it difficult for women (both with and without HIV) to protect themselves, and there are superstitions and deep-seated cultural beliefs that fly in the face of science-based evidence.

We need a team of cultural specialists who can find the root source of these grossly incorrect notions (AIDS witches and anti-AIDS virgins) and get on an informational and diplomatic cultural mission to clear up these heinous misperceptions and thus protect women-who-would-otherwise-be-seen-as-witches and people-who-would-like-to-remain-virgins.

While I am duly impressed by Australia’s track record so far with controlling AIDS, I fear that they are in an era of AIDS complacency that could lead to a surge in new infections (particularly in groups who don’t think they’re at risk). Ask an Australian on the street whether he or she thinks they’re at risk for HIV. They’ll likely tell you it’s a disease that only gay men and IDUs get. This amazes me. I am morbidly fascinated that people think whole segments of the populace live in bubbles. As if gay men and IDUs never came into contact with people outside their social/sexual arenas. This naïve thinking is the very reason that AIDS has spread into every element of western society. It’s all too convenient to say “I’m not gay and I’m not an IDU so therefore I don’t have to worry about AIDS.” Even with vigilant and widespread testing it can take time for the reality of who is infected to synch up with the stats about who has HIV. I’m not entirely convinced that any nation knows the extent of its real AIDS caseload. Australia’s Prime Minister John Howard has plans to keep HIV out of Australia by keeping HIV-positive people from coming into the country. While this is one way to try to minimize the load of HIV-positive people on Australia’s national healthcare system, it doesn’t account for those who are positive and don’t yet know it in Australia, nor Australian citizens who travel to Southeast Asia and may bring HIV back with them. I think this is part of the reason why Australia is committed to fighting HIV in the region—and that’s great. But before they start micro-chipping HIV-positive people in Papua New Guinea, perhaps they should consider setting up some consequences for those who hunt witches and pay top dollar to sleep with children forced into the sex trade by the demand for their virgin bodies as protection against AIDS. Or at least launch an educational campaign directed at busting those myths.

I was also on two other radio shows while in Australia, and while I was glad for the airtime and the opportunity to spread the word that HIV can happen to anyone, I was a little disappointed that the questions were so focused on the personal, prurient details of how I contracted HIV and my diagnosis. I wonder why people need to ask, “How did you FEEL when you found out you had HIV?” “Were you afraid you would die?” (Answers: Terrified, of course. Yes, of course.) It was all so very 1982. I know that many mainstream media people aren’t that up on AIDS 2007, but come on now—can’t we stay in the present and not always go back and harp on two days in a lifetime of HIV? (Namely, the day I got HIV and the day I found out I had it.) It peeves me a little that media constantly wants to focus on the dark side of HIV. I get that there aren’t that many people out there speaking so publicly about having HIV—but I wish we didn’t have to talk about the details of my life as opposed to what POZ is doing to combat AIDS. Let’s talk a little less about how people got HIV (unless we’re talking prevention) and more about how they can survive it and thrive in spite of it. So much of the media coverage perpetuates the stigma. By remaining ensconced in stereotypical images of HIV, we fail to paint a more up-to-date picture. There is drama throughout a positive person's life--and there is much more to my life than HIV.

The final day in Australia I met with an incredible group of men who represented the Who’s Who of AIDS in Australia, from Rob Lake, who is the CEO of People Living with HIV/AIDS (New South Wales) to Michael Badorrek, the media and communications manager from the AIDS Council of New South Wales (ACON) to Glenn Flanagan the editor of Talkabout--POZ's Aussie equivalent, among others. We were also joined by Craig McClure who is the executive director of the International AIDS Society (they put on the international AIDS conferences).We chatted about how to better link people living with HIV, both in Australia and around the world, and I shared what POZ has been doing. We commiserated about the challenges of finding funding to get our information out to as many people as possible and they asked a lot of questions about how we manage our relationships with pharma advertisers. (Did you know that the pharmaceutical companies can’t advertise directly to Australian consumers?) It was so great to know that we can support each other—and our readers—by linking everyone via the web. Stay tuned for some links to Australia…

Finally, it was time for one more walkabout before leaving gorgeous Australia. Sean and I headed to Watson’s Bay by jet cat (a high-speed ferry) and walked along, and beneath, the massive cliffs that flank the main entrance to Sydney Harbor. We saw rainbow colored lorikeets (bright, wild parrots) drinking the nectar of flowering trees, pretty tide pools with sea urchins, fish that glinted like tiny shards of silver in the shallow pools, and weird starfish and snails that wait patiently for the tides to return. I found the remains of a long-nosed bandicoot (a creature that looks like a cross between a rabbit and a squirrel and that is, technically, a marsupial about the size of a cat) and resisted my urge to add its skeleton to my collection. Not only would I have been stopped at customs; I was worried they might think I was a witch.

(Pictures of Bondi Beach, including safe sex messages amongst the graffiti)...

As the International AIDS Conference came to a close this past Wednesday I sat out on the docks of Cockle Bay trying to resist feeding my French fries to the seagulls while reflecting on news I’d heard in one of the final sessions. I’d just seen a presentation of the latest data on testing for a high sensitivity reaction to Ziagen/abacavir, given by the drug’s manufacturer GlaxoSmithKline. To reduce a half-hour presentation into several sentences, scientists have determined that it is now possible to very accurately predict whether or not a patient will have the high sensitivity reaction to abacavir that they have seen in some who take the drug—without having to expose a patient to the drug itself. It’s big news. Even though the high sensitivity reaction happens only in a very small number of patients it can be dangerous, even deadly, if patients stop taking the drug and then restart the drug later. The mere possibility of this has kept people (many unnecessarily) off the drug. The new tests (done via blood or oral swab) would be conducted before a patient went on the drug; the results would help doctor and patient know whether abacavir was a viable option for that patient. I clearly remember talking with my doctor about the potentially adverse reaction that could occur from abacavir. I decided to take the risk (because I understood that it was only if I failed to follow directions and take the medication again after stopping it—if I had been highly sensitive to the drug and that had led to a rash and fever or other less quantifiable side effects—that the drug might hurt me). Still, my doctor and I were really rolling the dice, even though the odds were in my favor that the drug would help me without any adverse results.

I think it is amazing that developments like these are made, but I get frustrated when I hear pharmaceutical companies say that they’re going to focus their marketing efforts around the news of this test only to the physicians. Why not also tell the patients? How about a little direct to consumer messaging, in the form of advertising in print or online to make people aware that their fear of a high sensitivity reaction to abacavir might be unnecessary? Why not let them know that there are tools that can help them make sound decisions about their own healthcare? Looking back on my own apprehension about taking a drug that might have serious side effects and knowing how long it took me to decide to try it, I can’t imagine how much better it would have felt to know whether or not the new drug was going to help me without hurting me.

I’ve heard some of the marketing teams at the pharmaceutical companies (and people at the advertising agencies who work on marketing AIDS meds) explain that direct-to-consumer ads are less necessary now that many of the drugs have been in the market for some time (the thinking is that most people know what’s out there, or, if they’re newly diagnosed their doctor will tell them.) But I think as the pharma companies continue to evolve and improve formulations, there’s even more need to get this news directly to the patients whose lives will be affected so that they can influence the choice of the drug their doctor prescribes them. People living with HIV—especially those on first-line treatments who are not resistant—have many treatment choices. That’s all the more reason to continue talking with patients directly about care. I trust my doctors very much, but ultimately, the choice on how best to fight HIV should be a combination between his recommendation and my well-informed opinion. I think AIDS patients are among the savviest patients in the world. Pharma ads that address the ongoing evolutions and improvements with their products could have a huge impact on my choice of drug. And the advertising campaigns should be redesigned to speak more clearly about the advantages of their product. If the FDA bans this type of advertising, then we must find other ways to reach out through consumer vehicles like POZ and AIDSmeds to get the info to people living with HIV (as well as to those who choose to support them).

Many of the medical journals received embargoed information from pharmaceutical companies prior to the IAS conference so that the latest news could hit their pages first. I think that’s fine, but it’s my goal to encourage pharma to also give POZ the same embargoed information so we can get it as quickly as possible to those who are actively using—or who are imminently considering using the drugs—like you, our readers. One final observation about the state of AIDS information dissemination: I encountered (well, overheard) some journalists in the media center who were still getting up to speed on their “reporting on AIDS” skills. One guy from Bloomberg asked what a viral load was. Actually, as the world of AIDS reporting has been largely monopolized by a few select (albeit terrific journalists) I am happy to see other reporters tackling the disease even if they’re still in the learning curve stage. It’s hard to believe, but important to remember, that may of the young budding journalists today have no personal experience with the early days of AIDS in America.

I could go on about what we learned from (and what you’d find most interesting about) the conference, but there’s no need for me to rehash what Peter Staley, Tim Horn and our wonderful video interview subjects have so brilliantly outlined about the latest treatment updates (so please, if you haven’t, read the conference coverage on POZ.com and AIDSmeds.com). One treatment issue I’d like to vent about: I find it frustrating when certain key studies fail to produce results that are dramatic enough to be “conclusive” because by providing all the necessary support that we must when testing, for example, PrEP or the efficacy of a diaphragm in women to block HIV infection (did you know that most HIV infection in women happens via the cervix rather than the vaginal walls? That was news to me!), we end up preventing the HIV infections (a good thing of course!) in the control arm. If infections in the control arm were un-prevented, we might see more dramatic results—the kind that show efficacy. The ironic thing is for these trials to work, they must show some failure in the control arm and that’s less likely to happen when you also provided people with education, condoms and other appropriate measures to ensure their safety. What a twisted up system: in trials designed to prove that PrEP and diaphragms work, we need to show that people get infected when they don’t use PrEP, or diaphragms, but it would be inhumane to allow people in these trial not using the prevention measures the study is set up to test to become infected, so we reduce their potential risk of infection with education, therapy and condoms, and, as a result, most participants stay healthy and we can’t say that we have conclusive evidence about whether the new prevention methods work. It’s a dilemma for sure. I’m sure I sound so naïve but couldn’t we do away with the control arm, and just give everyone in the trial PrEP or diaphragms or condoms or whatever we’re testing and see what, if any, the natural rate of failure for that test might be? And if no one fails, and no HIV infections occur, wouldn’t we have gathered an answer without risking new infections?

With the conference over and my head spinning from reading so many posters and abstracts and listening to great scientists TRY to break down their nuanced and complex findings into lay person’s language, I tossed a few potato chips to the gulls and decided to check out famous Bondi Beach with Sean. Few places in the world look exactly like a postcard. Bondi, even in winter, is one of them. It’s a huge, yellow, sickle-shaped beach—a new moon of sand—curving from rock cliff to rock cliff. There are two breaks at Bondi—one that looked a little ride-able and the other an option only if surfing is your life. Black-rubber-encased bodies bobbed on the water; some sat, some lay, on their surfboards. Surfing seems all about the timing and somehow, though the incoming swells never looked different to me as they entered the mouth of the cove, the seal-like men and women read the surges of water with expert eyes, never wasting energy on dud waves, saving their exertions for the waves that rose up majestically, only to curl back on themselves like a closing centipede. We walked the length of the spectacular cliffs down to Clovelly. There are no barricades to the sheer drops of up to 80 feet into the clear blue water. We ended our stroll back at Bondi’s Swim Club where even in winter brave Aussies do laps in the unheated seawater-filled pool abutting the ocean. As swimmers crawled up and down the lanes at sunset, the waves broke over the pool’s stonewall adding a constant supply of fresh ice water that spilled out over the far end. We had cocktails high above the water daring each other to go for a dip. In the end, we decided our constitutions weren’t acclimatized. I was totally intimidated by the strong-backed girls doing pushups down on the exercise mat and couldn’t imagine how they’d snigger at my white, welterweight body. The people in Australia—both men and women—are oversized. Many are taller than six feet. In comparison, I would have looked like Olive Oil.

We went to bed watching “Bra Boys” a movie about a special brotherhood of surfers who grew up on the point break at Maroubra (get it? ‘bra boys?), south of Bondi. It’s a great film, narrated by Russell Crowe, and it gives an inside peak at those who take some of the greatest risks in surfing, traveling the world to face nearly un-surfable waves, even when they’re bleeding and even when the sharks are circling. I started my day feeling very courageous for having once faced the potential side effects of a drug I thought would be a good one for trying to save my life. I ended my day wondering whether I would seek ways to test my mortality if the reality of my mortality weren’t such an integral part of my every day. I envied the carefree nature of the Bra Boys. One of the best Bra Boy surfers—who faced jail time for allegedly obstructing justice in a local court case—used what could have been his last few weeks of freedom to fly around the world and rip down the face of a wave so big and deadly it is called “Jaws.” It wasn’t that he wanted to die to avoid a possible prison sentence. It was that he wanted to be sure he’d lived as fully as he could in the event that he got locked up. I feel this sometimes, that I’d better do it now as there may not be a tomorrow. It’s a fine line between accepting that you have health and embracing the fragility of life. I just love the notion of not letting the uncertainty of tomorrow keep you home, worried, today. The spirit of pushing your boundaries to feel really alive is so important, especially for those of us who are often weighed down by the struggle to just get through the day. I’m not going surfing anytime soon (I swim like a one legged duck). But I hope to find a way to get a little of that Aussie-devil-may-care-Bra-Boy-brotherhood-spirit into my life.

More pictures from Bondi...

I’ll take you back again in time, to Vietnam, a week ago last Thursday, when we awoke in the port city of Hai Phong. There is a lot of HIV infection in Hai Phong, much of it in the IDU and sex worker communities. I’d been sent to speak at the Dong Khe Ward in the Ngo Quyen district to about a 100 people living with HIV/AIDS, their families, people from their support groups and local ASOs and NGOs. Both the people and the local government in Hai Phong are working hard to control the AIDS epidemic there. As Vietnam is a recipient of PEPFAR funds, we were really curious to speak with local people at NGOs to see if the funds we being put to use in a way that would benefit those living with HIV.

Quyhn picked us up in the van and we drove to a locked courtyard around a string of saffron-colored buildings that housed both a community center (where local officials of the communist government convened) and a kindergarten. We’d been told that it was a new thing for an American to be invited to speak in such a setting and that the local government had to approve my visit. Throughout my time in Vietnam, given America’s history with the country, I feared feeling unwelcome. The opposite was true. The Vietnamese, if largely unfamiliar with Americans (as few travel there, especially into the hearts of the cities—most who come head to the gorgeous beaches or backpack or bicycle through the rural areas), are very open to having us in their country. Partly, this is because most of the population is young (many of the people who would be older today were killed in the Vietnam war) and partly this is because the war with America was only one of several wars waged in past centuries. Still, as the daughter of a U.S. Marine and the niece of two uncles who fought in Vietnam, it was strange to be, for example, sailing across Ha Long Bay, near the Gulf of Tonkin, knowing that a mere thirty three years ago we still had troops stationed in Vietnam. Maybe I was just projecting, but despite the friendliness of Vietnam’s youth, I did feel that some of the few older people I encountered were, understandably, not too thrilled to see us walking their streets.

Something I’ve felt over and over on this trip is how important it is for Americans—who, because of the nature of our large country that borders only two others—must make a significant voyage to get far enough away geographically and culturally to reflect back on our culture. It’s so helpful to travel away from our country—and our press—to get a different perspective on who were are and how we’re perceived in the world. I know I had an American-centric view of the world; that view has been totally obliterated by this trip and by weeks of watching foreign press, from the truly independent BBC to arguably less independent mass media vehicles in Vietnam and Australia. (Just last night, we were watching the local Australian news coverage of the American news coverage of Beyonce’s tumble down the stairs. They were making fun of how prevalent the story was in the American evening news. Personally, I think Beyonce’s great—and she’s a supporter of people with HIV/AIDS so I was just really glad she didn’t break her neck. I agree, however, that there are probably more critical stories we can focus on in the news.)

To make a gross over-generalization of how people in the three countries we’ve visited on this trip see us, the Taiwanese seem to want to be like Americans, the Vietnamese aren’t aware of who or what we are and the Australians seem far less enamored with Americans than we are with them.

Taiwanese people strive to be more western, particularly American, in their dress and attitudes. They re-create the “best of America,” giving it a modern feel and a good scrubbing up. “New York” is the name of one of their biggest shopping malls in the heart of Taipei’s shopping district and the luxury boutiques in Taiwan 101 (the world’s tallest building) simulate a mini Madison Avenue. The Vietnamese are cautiously open about the many changes that are happening around them and I think have little awareness or care for the west. They’re too busy making a living and trying to improve the quality of their lives. Some efforts made by the communist government to facilitate the burgeoning development in that country (like giving the control of individual plots of rice—and the harvests they produce—back to their owners) feel strangely capitalistic to the people who (whether, given the choice, they would have initially have chosen to do so or not) are used to the government dictating much of their lives. We were told that further south, in places like Ho Chi Minh City (still called Saigon by those who live there), the Vietnamese people are more progressive and more interested in adapting to more modern ways of living. Australia seems a utopian society. Once societal outcasts (many of Australia’s original settlers were members of the penal colonies established here by the British), the Australians have created (at least if Sydney is any indication of other parts of this continent/country) an incredible lifestyle and culture. I will admit I perceived the Australians to be a rogue-ish, rugby-playing, surf-riding, outback-loving wild crew. No one drinks Fosters here. Both the rugby and the Australian rules football are fast-moving, highly strategic games that make American football look thuggish, and the culture (and architecture and physical setting) of Sydney combines what feels to me like the best parts of New York, London, San Francisco and Hong Kong, in a fastidiously clean, well-organized, highly civilized and indescribably beautiful urban setting surrounded by deep blue crystal clear water. Americans are not well-loved the world over and it is very enlightening to know that we are not the still center of the moving world and that there’s much we can and should learn from people and cultures that are so different from ours. Frankly, it’s humbling for this American to see how we are seen by others in lands far away.

In Hai Phong, we were ushered into a room that had no windows and several slowing circulating ceiling fans. There was a low glass table with what looked like a child’s porcelain tea set, surrounded by low leather couches. Several serious looking men came in and were introduced as members of the local communist government. With the help of our wonderful translator and interpreter (those are two distinct skill sets), we thanked the officials for hosting the meeting. There were incredibly warm and cordial. They were eager to talk about fighting HIV/AIDS in their city of Hai Phong (the third largest in Vietnam) and after leading me to a large room filled with people living with and affected by HIV/AIDS, gave me a lovely introduction and listened intently while I talked freely about fighting HIV/AIDS stigma and discrimination. As I spoke, five- and six-year-old children who were playing at recess in the neighboring courtyard crowded around the window, screeching and laughing and pointing at the big blonde American woman talking about sex and condoms…

The questions were pointed and tough and the audience really wanted to know the U.S.’ impetus for granting Vietnam PEPFAR dollars. They questioned whether it was merely a P.R.-move on behalf of America or if we were truly interested in helping out in Vietnam. I confessed to not knowing the rationale behind the PEPFAR pledge in Vietnam but suggested that as long as the funds were making their way down to the people and providing people the medical services and treatment they needed, it might not matter about why the funds were dispersed, only that they were. I did say that our country has great interest in helping to stop the spread of AIDS worldwide. President Bush’s recent pledge of additional PEPFAR funds brings the fund to 30 billion. No other country has matched that level of financial commitment. Of course, there are questions about how those monies are allocated and the types of programs they support, but it was encouraging to hear the First Lady’s recent comments about re-evaluating the portion of funds to be used for abstinence-only prevention (particularly in countries where the infection rate is already really high and prevention’s no longer an option for many living there). Then, there’s the question about why we’re giving so much abroad when funds are still desperately needed at home. In Vietnam, there is a big concern that the monies given are applied in the right way and that the people living with HIV/AIDS actually benefit from the grant. Like in so many countries, just giving the money is only the beginning. Though the socialist government of Vietnam provides healthcare and ARVs to all who need it, the country, still largely in development, needs what so many others do too: a healthcare system that works, qualified people to administer the healthcare system and to treat patients, including offering on-going counseling and support and monitoring patients in treatment, access to testing sites (both for diagnosis and for follow-up lab work), clear instructions/prescriptions to help people understand how to take the medicines, food and clean water to take with the medicines (I’ve heard a lot about how hard it is to take the meds on an empty, upset or only partially-full stomach. Adherence, and therefore, lack of resistance to drugs, is helped by adequate food supplies and clean water…), incentive to continue treatment (in the form of improving lab results) and support to combat the fear of stigma and discrimination.

One brave man stood and talked about living with HIV. He questioned how Americans got drugs. It’s amazing—so many people in Asia perceive that we have no issues with AIDS in America. They are shocked to hear that we have had 40,000 new infections for the last 5 years (of reported data) and amazed to know that people are dying of AIDS in the U.S. Another stat that blows them away is the rate of infection in the District of Columbia: 1 in 20.

After the talk, I met with more members of the local communist government and while I am aware that they are politicians first and foremost, I was encouraged by our work that morning. It felt good to be part of an effort to work with others—as different as they may be in their ideologies and political stances—on this problem that truly, as a global humanitarian crisis, deserves to be addressed regardless of the cultural and political barriers that may seem to stand in the way of a worldwide, unified attack on AIDS.

Later that afternoon, we traveled back to Ha Noi to meet with the UNAIDS technical working group at the Vietnam Women’s Museum and heard more about the local efforts to fight AIDS, and I felt the strong determination of the people to make a difference. I think there is significant political will in Vietnam and I think the officials understand the need to openly and vigorously battle AIDS. The country handled their outbreak of bird flu deftly; as a result, that epidemic was contained. When you have the government’s will, and the funding, even if the system is far from perfect or still in development, more can be done than if either or both of those things are missing.

That evening, the U.S. Ambassador to Vietnam, Michael Marine and his wife, Carmella, hosted a lovely reception for us at the embassy. Many of the people I’d met, as well as some I’d encounter the next day when I spoke at the La Thanh Hotel to about 75 members of advocacy groups in Hanoi (hosted by the Center for Study and Applied Sciences in Gender, Women, Family and Adolescents), attended and we had a chance to speak one-on-one about the work they are doing. I met three remarkable HIV-positive women who are working with the sex workers and educating them about condom use and how to negotiate asking for it with clients. The ambassador gave a fantastic speech and it was great to see his conviction in fighting HIV/AIDS in Vietnam.

Finally, the next day, we finished the Vietnam leg of our tour with the aforementioned talk in the morning and a web chat with readers of Tien Phong, Vietnam’s newspaper for youth (check it out at tienphong.com.vn). It’s amazing, though the language and cultures I am encountering are all so different, the questions about HIV/AIDS remain the same no matter where you are in the world.

Here are some pictures from the web chat. Note the statue of Ho Chi Minh in the background…

Some of the highlights are below (the wombat wasn't very camera-friendly so I've included a shot of his stuffed cousin so you can see his cute face as well as the rather less cute view he insisted on showing us).

We've had a lovely time exploring the city and rejuvenating ourselves for the conference and for the last leg of our state department trip. Sunday night's opening ceremony of the International AIDS Society conference commenced with a performance of native dance by local Aboriginal people. Even in the context of a modern, high-tech conference center, the primeval rhythms of the dance and music transported us to a time long before there were Europeans and Westerners here--long before AIDS had found its way into the world. As Tim has covered the content of the opening ceremony so well on our conference coverage page on POZ.com and AIDSmeds.com, I'll refrain from repeating it here...but I do want to say a few words about Maura Elaripe Mea, an HIV-positive woman who was the first person to come forward and reveal her status in her native land of Papua New Guinea. She gave a fantastic keynote speech. It was interesting to watch another woman tell her story. Though we are from lands tens of thousands of miles away - and have different jobs (she is a nurse) - we have experienced many of the same issues and feelings around being HIV positive and disclosing our status. She founded, along with 19 other positive people, a group called Igat Hope -- Papua New Guinea's version of The National Association of People with AIDS. She spoke eloquently and passionately about the need for people living with HIV/AIDS to come forward so that others may learn not to fear those living with the virus. My favorite suggestion she offered was that others "talk to us, not about us." It was so reassuring to know that others living with the disease around the world agree with me about the power of HIV positive people's unique ability to change the way the world perceives this disease. And she made an excellent point that when people fear those living with HIV/AIDS, it makes it hard for us to be able to take good care of ourselves. She used the example of how HIV positive people should be supported so that we can work to bring ourselves out of the poverty that HIV so often brings into our lives as we struggle to pay for medicines and treatment. I heard similar sentiments expressed in Vietnam - some of the people working at NGOs and ASOs there emphasized the need to help positive people keep jobs and perhaps find a job they could do closer to home (like raising water buffalo) so that they could keep productive and have income even if they could not work at a more physically taxing job, or were ousted from a job by others who were not comfortable working beside people who were HIV positive. I think it's so important for people to know how much their understanding and support can help people living with the disease be self-sufficient. Maura is a brave and wonderful woman...I'd say more about her here, but I was lucky enough to interview her so I'd rather send you to our page of conference coverage to hear her speak in her own words.

A couple of things struck me from all of the wise words shared at the opening ceremonies. One is how Australia has done a remarkable job combatting HIV from the very beginning. Since 1996, the country has succeeded in reducing its rate of infection by 17%. The phrase "testing to treat, not quarantine" was used to describe the philosophy behind their testing outreach and they are very progressive with harm reduction techniques such as dispensing clean needles. There are depository boxes for used needles in the restrooms...Australia's widespread openess about the issue has clealry helped control the spread of HIV among IDUs in particular. Another thing that I found interesting was how the overall health of the general populace (and lack of widespread HIV infection) is a necessary prerequisite for the growth of a developing nation - as opposed to widespread health (and a low HIV infection rate) being a side effect of that development. Having just come from Vietnam which seems to grow right before your eyes, we witnessed first hand the need for a healthy society...without it, who will build the roads, bridges, schools and hospitals? The third thing that I found fascinating was that the virological response to treatment was as good in developing nations (like South Africa) as it is in developed countries (like Switzerland). All over the world, given the chance, the right education and access to care, people can and will take their pills as recommended and get better. (A side note to this...in Vietnam, we heard that medications were sometimes distributed without prescriptions and people were confused about how to take their meds. This, combined with a shortage of health care workers, and testing sites that can give people the lab results they need to show them that their treatment is working thus providing positive incentive for good compliance which helps avoid drug resistance, can lead to less-than-ideal treatment results. But, when those things are addressed, it seems that people all over the world can have the same positive effect from properly administered treatment.) And, finally, Dr. Fauci referenced the words of Peter Piot, head of UNAIDS, who said that for every person put into treatment in 2005, there were six new infections, thus emphasizing that the pandemic can not be fought by treatment alone. Prevention and global access to treatment comprise the necessary one-two punch (combo therapy, if you will) to beat this sucker to the ground.

Having seen the effect of stories like mine and Maura's in terms of influencing behavior (when people hear our stories they are more likely to disclose, talk to their doctor about treatment options and get tested if they don't know their status), I strongly believe that people living with HIV can be one of the best prevention tools we have. Getting our stories out into the world so that others see and believe that HIV can happen to them is a powerful way to make people wake up. That's the thinking behind OurDignity.com (check it out and share your story!). Whether you're HIV positive, or just know someone who is, you can help support all the wonderful science we're hearing about here at IAS by making people aware, from a personal, real-life point of view, how HIV can happen to anyone. I am inspired by all the good scientific news I am hearing here in Sydney, by the innovative work of the many brilliant doctors and scientists seeking a solution to AIDS and especially by the likes of leaders like Maura. It feels good to know that we are not alone -- and the the world is a small one after all.

Sydney is an exquisite city. Though it's winter, the air is clear, the sky is blue and the sun is shining. As much as I loved Asia, it's a welcome relief to escape the heat and smog. No one is wearing a mask/scarf/t-shirt over their face to block the pollution. And I didn't realize how incessant the street noise and honking was until it was gone. We did have a little noise in the hotel the first night as the Asia Cup international soccer tournament is on and EVERYONE (except Americans) loves the game of soccer. We saw Japan beat Vietnam while we were in Vietnam; Saturday we saw Japan beat Australia shortly after we arrived in Australia. I fear we might be bad luck for the national team of the country we land in. Last night, we saw South Korea beat Iran, preventing a final between Iraq and Iran. Who knows who would have won if we had traveled to Iran. Now, it's South Korea versus Iraq. Hmmm. Hard to pick a team to root for in that match. I have to say, I am increasingly liking the game of soccer and have great admiration for the players who run for 90 minutes non-stop in the incredible heat. They get so soaked with perspiration they need to hike their shorts way up before taking a penalty kick just to have their legs free enough of the cloth to swing their leg. Many of the games we have watched have ended in a draw and they've had to result to a penalty kick-off to have a winner. I thought my job was stressful until I saw the faces of the goalies before the penalty kicks. Talk about grace under pressure!

Before I blog about beautiful Sydney and the start of the conference, I wanted to share a few more pictures from the remainder of the Taiwan trip. Below is a shot from the aforementioned Taipei Salon. And Sean and I in the news!

Sunday night before leaving Taiwan, Nick Papp had a wonderful dinner for us at his home in Taipei. Below are some fun shots of our new friends. We were so sad to say farewell!

The first shot is ICRT radio host Rick Monday (and Sean and me); next is Gabrielle, a beautiful and fascinating film producer/Fulbright scholar/professor from USC and Nick Papp; next is Nick, Nicole (of Harmony Home) and me; and finally Szu Lee (of AIT) and Nick).

Stay tuned for a blog on Vietnam...and on to highlights of Australia!

Okay...time to finish up chronicling the Taipei trip. After visiting the Garden of Mercy and Harmony House on Saturday morning, we headed to the Lung YingTai Cultural Foundation for the Taipei Salon hosted by Dr. Lung Ying Tai.

Dr. Lung hosts the Taipei Salon to discuss issues of cultural import. Also speaking with me on the panel was Nicole Yang, of Harmony House. Though I received much press in Taipei, it is people like Nicole, who stays up seven nights a week with the AIDS orphans and people living with HIV, and Hank, who is one of the first HIV positive people to come forward in Taiwan, whose stories must be told. I am grateful to Dr. Lung for providing a platform for all of our tales.

The subject of the Salon was "Global Issues and Me: Getting Involved in Taiwan" and Nick Papp from AIT gave a presentation about how fighting HIV/AIDS was one of the ways people in Taiwan could become better global citizens. Then, he showed a really tough-to-watch film about people around the world - in Uganda, Russia and Thailand - living with and some dying from HIV/AIDS. It's always so hard to watch films like these because I feel so sad for others who don't have access to medication or the support of their family. I feel guilt too, and fear, as there but for the grace of God go I. Still, it's important to show the reality of what it's like to live with HIV around the world. It seems so strange to me that when we have the treatment that people are still dying of AIDS in 2007. By the millions.

People in Taiwan and Vietnam found it really hard to believe that people are dying of HIV in America. They were shocked to hear that not all Americans have health insurance and that many can not, or struggle hard to, afford to pay for their AIDS meds. In Taiwan and Vietnam, healthcare and medicines are 100% covered by the government. I tried to explain that you can get covered if you are disabled, but they could not understand a system that only helps you when you are direly ill - so sick you can't work. I said we had Ryan White and ADAP to help cover some of what private insurance, Medicaid and Medicare did not cover; still, they were amazed that one of the richest countries in the world would let its citizens die of AIDS when treatment was readily available.

I explained that our federal government has been incredibly generous in their pledge of PEPFAR dollars internationally. Still, they could not imagine how America would help the world and not help its own citizens. Many of the questions were hard to answer; I want to be a good ambassador of sorts for the U.S. but I also need to tell the truth. I was asked repeatedly about the pricing of AIDS meds globally. I struggled to explain how if the drug companies reduce prices around the world they will not have the money to continue to search for new and improved treatment, but my response was met by quizzical looks and the comment: but we have what we need to save lives now.

It’s nearly as hard not to have the answers to questions like these as it is to watch the effect of lack of access to treatment and information around the world. And it’s especially hard to watch these stories right before you have to go speak. Somehow, I managed to pull myself together and wipe the tears from my eyes (and reposition my smudged eyeliner) before they turned the lights up and I had to go on stage. After all, I was the light relief. The symbol of hope. I had to smile and tell them it was going to be okay.

This is one of the hardest parts of speaking in such an upbeat manner about HIV. I do believe that we can have normal long lives and experience the acceptance of our friends, families, societies and governments. But I also know that so many people struggle to overcome fear to access medical care and ask for the support of people around them. I don’t want people to think it’s easy – I’ve been nearly broke struggling to pay for health insurance and meds and if it weren’t for my family I may very well have had to live in a place like Harmony Home myself. And, it took me ten years to come forward. That’s a decade of deliberating. And still, there are times when I’m afraid. But, there is such strength to be garnered from facing that fear and finding others living with HIV and having us band together and tell each other that we will find a way to survive and to help each other do so. After my talk, a young man and his female friend – a doe-eyed, fawn-like creature who exuded the strength of a mother lion – came forward. He told me he’d been an IV-drug user and that he had HIV. He was scared to go on treatment but from what he told me of his health and labs, it sounded like it might be time for him to consider it. He said it helped him to see me so healthy after 10 years and to hear that the side effects off the drugs could be tolerated. He said he would visit his doctor and asked if he could meet other HIV positive people his age in America. I told him about Mentors and the forums on POZ.com and AIDSmeds.com – and I shared with him OurDignity.com so he could eventually see lots of people living with HIV. Many more people than I imagined speak English and have access to the web in Asia – particularly the young people. We gave each other a hug and he said he’d let me know what his doctor said. When I struggle emotionally with this work, I think that even if one person like this young man feels or gets better because of this program, it is worth it all. The next time I feel wobbly before I speak, I will remember him - and I'll get up no matter what I feel like, and fight to change people's perceptions and misinformation - powered by the thought of people like him who need the world to change its collective mind. Each new person I meet reinforces my arsenal; each time it gets easier to get up there and talk.

After the salon, and a brief interview with the evening news (I have the clip and will post it soon), we walked out into the heat that hits you like a brick wall in the face. I exhaled deeply for what seemed like the first time in a week and Sean and I decided to spend the next day catching our breath before getting on the plane to Vietnam.

Sunday morning, we went to the National Palace Museum and saw some extraordinary pieces of Chinese art…then headed up a Mullholland-esque road in the mountains to an Alpine-like meadow in a park in the foothills outside of Taipei. All we needed was a little edelweiss to believe we were in Austria, on the set of “The Sound of Music.” However, the only music to be heard was the high-pitched whine of the cicadas as they puffed up their bellies and blew the air out of some part of their body (note to self: research how the cicada sings) and our own huffing and puffing (mine, more than Sean’s) as we walked up and down zillions of stone stairs en route to a waterfall.

The wind picked up and a stinging, prickly rain fell, masking the sweat that covers your body the minute you step outside in summer in Asia. I have felt so many deep emotions on this trip and often cannot let them out in the moment. I wanted to cry when holding the AIDS orphans, who are so hungry for love; when hearing Hank’s tale of how he has forsaken physical pleasure, getting his release from meditation instead; and hearing how fearful people are of taking medicine that can save their live because they have heard how it burns the stomach and they don’t have enough food to buffer their insides. But at those times, I must smile and tell people it’s going to get better – saying we’re going to fight discrimination and stigma so that HIV positive babies can find love and new homes, that people living with HIV can have rewarding sex lives and that we’ll find a way to get medicines and food to all who need it – someday.

Instead, I let my tears fall in the mountains, mixing with the rain and sweat sliding down my face, masked by the song of the cicadas and the water falling off the lip of the ridge. Up in the hills, only Sean and nature heard my cry.

Here are some pictures from our hike through the hills.

Saturday morning in Taipei, we visited two houses where they keep HIV positive children, and some HIV negative orphans of HIV positive parents. First stop was The Garden of Mercy, up a secret staircase where both the offices and the nursery are kept. The first three pictures are at The Garden of Mercy--the darling little boy pictured has been adopted by a couple in the U.S. and will soon be stateside. He tested HIV negative though his mom was positive. The woman seated on the floor with me is Susan, the lovely lady who runs The Garden of Mercy. The fourth picture is at Harmony Home, the aforementioned refuge for people living with HIV/AIDS that is being threatened because the neighbors are claiming that the presence of HIV positive people in the neighbborhood is emotionally disturbing. All I can say about that is that those people should go have a tea party with Nicole and the babies and then see if they feel "emotionally disturbed." We were overwhelmed by joy and love as they circled around us and hugged and kissed us. I have lots more to write about these incredible, tireless, brave women, both of whom are HIV negative, who have dedicated their lives to caring for those others have neglected. But, jet lag is catching up and I've written much, so I thought I'd just share the pictures. When I can figure out the technology, I'll post the video of Sean playing basketball with the toddlers. They are so in need of love!

(Left) Me and the host of Beautiful Life TV...

Well, it's Saturday afternoon and we've just arrived in Sydney after traveling all night via Singapore. But before I catch you up on the rest of of Vietnamese trip, I'll recap the rest of Taiwan...

Friday in Taiwan started out with the usual spread of incredible breakfast. The Grand Hyatt in Taipei is a magnificent hotel and it's hard to say whether our favorite part was the kicking penthouse pad they moved us to (who knows why but we weren't complaining with our nearly 360 degree views of Taipei from the 23rd floor, his and her bathrooms, a dining room, a lounge/TV area and a bathroom with whirlpool tub that sadly I never made it in to fearing that I might drown...given my fatigue level, slipping into a vat of hot bubbling water might have just melted me down) the outdoor swimming pool ringed with palms, the indoor fountain around some of the largest and most fragrant centerpieces or the breakfast. I'm beginning to wonder why I'm obsessing about food. I think it has a lot to do with the fact that in Asia, meals are a big part of the culture--experiences in and of themselves not simply a way to shovel fuel down the old gullet. Also, food is our primary form of diversion from the work and it's the one time during the day we get to sit down!

Breakfast at the Grand Hyatt is amazing. It's a buffet with many different stations--the first day I bravely tried the Taiwanese breakfast of rice and fish and greens. After that, it was back to bacon and yoghurt and breads galore. I have become addicted to watermelon juice and dragon fruit which is a hot pink and green fruit that looks like a cross between an artichocke and a hand grenade on the outside; inside it is bright white with with tiny black seeds. It tastes like a milder watermelon.

The service is attentive but invisible...you never have to ask for a thing. As soon as you finish, your plate is whisked away by a beautiful girl in a black dress and your tea is miraculously always full.

Our first stop was at ICRT to be interviewed by Rick Monday on Taiwan's largest English-speaking radio station. We were met by Nick Papp, the cultural affairs officer at the American Cultural Center (part of AIT), who briefed us on the ride over on Rick's show, and his direct interviewing style. Rick is a quick minded, big hearted man with a classic radio voice tempered by smoking and years of talking for hours every morning. He was tough and asked lots of direct and pointed questions but I liked his style as he asked what people really think. Things such as: I'm married, why should I care about AIDS? (Answer: being married is increasingly becoming a risk factor for contracting HIV in many countries as people aren't faithful and people in marriages often do not use condoms. And even if a woman suspects her husband is cheating, or vice versa, asking your partner to wear a condom in a supposedly monogamous relationship amounts to accusing them of being unfaithful. Let's get those microbicides approved!!!)

The next stop was at Beautiful Life TV, a Buddhist TV station that interviews people living "a beautiful life." The young host asked me a fabulous list of questions including my favorite: What is a beautiful life to you? Answer: Having faced my biggest fear (disclosing my HIV status to the world) and being able to live with integrity and without shame. I'm sure I babbled on much longer...but that's the main gist of what I said. Beautiful Life is a far cry from the likes of some of the American media I've been on. They were so sweet and as we discussed the questions pre-show, Buddhist monks wandered around bowing and smiling. What a different experience to feel that the media wants to celebrate you rather than flush out your flaws or ask questions intended to get at your darkest bits.

From the TV station, it was on to a courtesy call with AIT Director Stephen M. Young. As I mentioned before, Stephen is the equivalent of the ambassador to Taiwan. We entered his huge office and sat on a ring of couches to talk about what we'd seen of HIV/AIDS in Taiwan. He admitted that he'd had to be educated about the fact that mosquitoes don't carry HIV. I appreciated his honesty and it pointed out to me something I've always suspected: that many high level politicians, even those in the U.S. may not be clear on the facts of HIV/AIDS. (One of my goals upon my return is to build a political hub on POZ.com and reach out to all the presidential candidates' camps to see if we can play a role in educating them about the latest understanding of HIV/AIDS and the issues that are critical to the survival of those of us with the disease.)

Stephen was hosting a reception at the Hyatt that evening for all who would attend that afternoon's HIV/AIDS Summit ("The Human and Economic Impact of HIV/AIDS on Business in Taiwan") organized by the Taiwan AIDS Foundation.

The Summit was our next stop, back at the Hyatt. It was hosted by Dr. Anthony Pramualratana who is the Program Director of the Asia-Pacific Business Coalition on HIV/AIDS. The opening ceremonies were quite the thing--attended by Director Young, The Minister of Economic Affairs and the Taipei equivalents of the surgeon general and the head of the CDC. Cameras rolled and lights flashed as the press went crazy on the lineup of influential people who'd come in support of the event. But, as is often the case, they had to dash out after the welcoming remarks which allowed the tone of the summit to become much more casual and, I think, a huge success. Dr. Anthony, as we fondly call him because his last name is just too hard to pronouce, led the group of business men and women through a series of educational lectures and participatory exercises intended to illustrate how and why it is essential that business leaders teach themselves and their employees about HIV/AIDS. He also explained how it is in a business' best economic and humanitarian interest to care for workers who become HIV positive without discriminating against them. It's a fabulous presentation and he has visited with many of the world's great companies to inform them of the need to educate their executives and staff about HIV.

One exercise he conducts involves giving everyone a clear test tube filled with water and a clear straw. He asks you to put your finger on the end of the straw to draw up some water and then walk over and "exhange fluids" with another person, thereby simulating sex. The step is repeated several times until everyone has "exhanged fluids" with four people. (The room held about 75 people.) Then, he asked if anyone would like to be tested for HIV...several raised their hands and a man went around dropping a serum into the water...if it turned red, the person was HIV positive. At the beginning of the exercise, 4 of the original test tubes had been "laced" with a substance that, when these special "test" drops were added to it, would turn red. The first three people tested negative. They came to my tube, dropped in the test drops and WOULDN'T YOU KNOW IT? I was HIV positive. The room burst out laughing (as I'd already spoken and they knew my real HIV status). All told, from 4 original "cases of HIV" about 27 people were "infected." It was a very compelling exercise. Even some people who came in late and only "exchanged fluids" with one other person were positive. The point there was that even though this was their "first time" they were exposing themselves to others who'd been exposed to many people.

Dr. Anthony also inflated condoms and poked them with toothpicks to show how strong they are. Then, he covered an inflated condom with oil-based lube to show how the oil weakened the condom; it exploded in his hands as he was rubbing it (another round of laughter).

My favorite part was when we broke into groups and had to sort a list of scenarios printed on pieces of paper into two categories ("high risk", "no risk"). It was amazing that some people had no idea about the relative risk of certain activities. They were real life things like "sharing nail clippers with someone who has HIV," "putting your finger into an HIV positive woman's body" and "sharing a dildo." As team leader, I had to translate "dildo" to some of the Taiwanese business people. Who knows if they understood.

What I love about Dr. Anthony's presentation is that he shares medical expertise in an engaging and practical manner. No mind numbing powerpoint presentation here; instead, he offers simluated sex parties and exploding condoms. His audience is involved--and involved with others. One person remarked that the day changed the way she thought about sex. I reminded her that she (as she and I had "exchanged fluids") should get tested for HIV!

Afterwards, the group gathered in the "kitchen" of the Hyatt. It's a new concept in entertaining. You know how whenever you have a party everyone ends up in the kitchen? Well, the Hyatt built a beautiful huge one so that people can mill around in a gourmet cooking space, leaning over the shoulders of the chefs, tasting the food as it is cooked and standing around, cozied up to the center island laden with food. It was a great idea, and a generous gesture, for AIT to entertain the crew who'd spent the afternoon learning about HIV/AIDS. As I collapsed in bed (at 8:30!) I fell asleep with a smile on my face knowing that at least 100 of Taiwan's most influential opened their minds, and hearts, to HIV/AIDS.

Speaking of pig snouts, I met a cute one (see above) in the night market in Taipei. He licked my toes clean in a shoe store. I think he is a lucky one and is a pet, not a meal. Before I go forward in time, let me take you back to Thursday, day three of our Taipei trip. We flew down to the city of Kaohsiung, one of the largest ports in the world, to talk AIDS awareness, prevention and treatment tactics to students; people from ASOs and NGOs; government officials and the media. We’d been told that we might not have the same level of interest in the program down south and were so pleasantly surprised to see a packed house of people very eager and open to discuss how the epidemic could be avoided on the island of Taiwan and how they, as global citizens, could join in the worldwide fight against AIDS. Before the talk, Sean and I sat with Tracy, a lovely and brilliant woman who heads the AIT office in Kaohsiung. AIT plays an interesting role in Taiwan. As the U.S. government does not formally recognize Taiwan as a country, the United States cannot appoint ambassadors to the island. AIT was formed in 1979 as part an effort to establish good relations and open trade with Taiwan. The Americans are well liked in Taiwan and AIT does a great many things to develop good friendships between the people of Taiwan and those in the U.S. Tracy invited us to have tea with a local doctor who is an expert on infectious diseases—including Dengi Fever which can be as deadly as AIDS. (I find it amazing how insular America is; diseases that kill many around the world are hardly mentioned at home unless they affect us.) He spoke of the population of people living with HIV/AIDS in southern Taiwan and said that most would never admit to having the disease because they and their family would lose face if they did. Many people in Taiwan are infected through I.V. drug use and the root of AIDS stigma in Taiwan is strongly connected to people’s negative feelings about and fear of I.V. drug users. Yet, the doctor showed me charts chronicling the exact statistics and the story is, as is true in America, different from what the public perceives: an increasing number of heterosexual, non-I.V.-drug-using people are also contracting HIV in Taiwan.

I told my story again, to a new group of rapt and compassion filled faces. I have never met such a warm and lovely group of people as I have in Taiwan. Most Taiwanese are incredibly friendly; walking down the street, you’ll get a broad smile, a nod or a bow from almost everyone who passes. The culture is so polite. After I finished my speech, hands jutted in the air throughout the crowd, signaling a flow of intelligent, carefully considered and respectfully worded questions, many of which gave me pause as I had never heard them before. (I have to say, I am learning much about a topic I thought I had a pretty complete handle on – and it is refreshing to look at HIV/AIDS through a unique international perspective). There was simultaneous translation into Chinese and I had to keep putting headphones on and staring at the interpreter’s lips to understand. I’ve learned that almost everything can be explained across language barriers, but jokes and implications don’t always hold up…and, conversely, some things I didn’t think should be funny caused laughter. I just smile and keep talking no matter what.

One interesting thing that came up is that the current president of Taiwan plans to release a lot of prisoners; 400 of whom are HIV positive. The prisoners are scheduled to be reintroduced to society at the end of the month. The Taiwanese CDC is giving all who come out of prison in this huge wave of pardons a “societal re-entry kit” that will include a clean needle, a condom and methadone. It’s a controversial decision that prompts discussions reminiscent of our own nation’s battle with whether proven harm reduction tactics like clean needles and condoms (especially when they are distributed for free) help or hinder HIV prevention efforts. Interestingly, I have not heard the Taiwanese talk about the notion that giving needles or condoms encourages drug use or sex. The concern is more about whether the cost of such a program can be justified by the incidence of cases it may prevent.

After the talk, many people came up and asked if they could give me a hug. I can’t tell you how touching I find this…especially as I know how afraid people are of people living with HIV in this part of the world. One by one, they line up, offer me their “name cards” (everyone here has a business card and the polite custom is to offer the card immediately upon meeting someone) and ask if they can have a hug. Even without my typically high heels, I tower over most of the women. I always feel like such a moose when I embrace their bird-fine frames. One of the interpreters introduced me to her girlfriend who is a minister. Sharing the details of my life so openly often provokes people to share themselves with me and I feel honored to have earned their confidence. The two women said they are rarely are open about their relationship; I was glad they told me. The interpreting team, including their teacher who leads a famous school in Taiwan, offered to translate POZ and its information into Taiwanese and Mandarin. Other reporters in days to come would offer their freelance reporting skills. Heads of TV stations and media outlets have offered to air information and any footage we have about HIV/AIDS (a reminder: I need to ask the Cable Positive folks to send their wonderful documentary about women and HIV to Taiwan!). And the camera men offered their services too! It is clear to me that this is a nation that can be educated properly about HIV/AIDS and I have great hopes for their ability to avoid a massive epidemic. Even some in the government (from Legislator Wong who attended the first day’s presentation, to the mayor of Taipei who came to the third day’s presentation to the Minister of Health and the Minister of Economic Affairs, who came to day four’s AIDS summit) seem very open to learning about HIV/AIDS and discussing ways to contain it. I have to say, there is a real need for education. I have heard more than one high-ranking person ask whether HIV can be spread by mosquitoes (it can’t). The good news is that I see again and again how discomfort and fear turns to enlightenment and compassion with exposure to the facts.

Below are some shots from the night market—it’s much like a New York City street fair but more crowded, hotter and instead of giant pretzels and gyros, you can buy squid and various mysterious parts of animals I have never seen! Taipei is a motorcycle lovers paradise…everyone is on a scooter and one of my favorite shops was the one selling the cool helmets!

We awoke this morning (Tuesday) for our second day of the Vietnam leg of the trip to the sounds of incessant honking. Hanoi, like New York City, seems to never sleep, and neither do we. Thankfully, today we had a bit of a breather on our busy journey. After a brief press conference this morning at the American consulate with the press and cultural attaché Angela Aggeler and local Hanoi reporters we were on our way for a three hour tour through seemingly endless (and beautiful) rice paddies peppered with water buffalo and people in knee-high rubber boots (as protection against the leeches) tending to their precious chartreuse-green crops.

As we rolled along the new highway that leads from Hanoi to the coast, we discussed the local cuisine with Ngo Dinh Quynh, the cultural affairs specialist whose job it is to see we get everywhere safely. He asked if I had any dietary restrictions (as we were headed out to rural Vietnam for the day). I said no, though I did try to avoid intestines and pig snouts (two of the more interesting things I saw for sale along the streets of Hanoi’s French Quarter the day before). Now, I know he’s working for the embassy and is used to Americans many of whom don’t appreciate the wonders of boiled innards and noses, but Quynh’s diplomatic skills are unparalleled. Without insulting me in the slightest, he corrected my view that intestines and snouts are to be avoided, informing me that, to the contrary, they are delicacies to be savored. Quynh claims that the texture of the pig’s nose is what makes it so special. It is crunchy. He went on to tell us that pig’s ears and dog meat stuffed with dog intestines (first boiled, then grilled) is another great culinary wonder in Vietnam. Special spices are used when cooking dog and most families raise several dogs, keeping the wisest as a pet and guardian and either butchering or selling the others when they are grown. There is a piece of local folklore that (loosely translated) says that after a dog was butchered, he complained to the King of Hell about how he was butchered and the king said, “Stop! Your story is making my mouth water. If you continue I may have to eat you!” And, there is a saying: It is worth living on the earth if you have dog intestines to eat. I have learned that fresh food in this part of the world means that when you are hungry, you buy your meal alive and it arrives on your plate in short order dressed up with herbs and sauces. I have to admit, because the notion of eating dog is so foreign to me, it was hard to imagine—yet this is one reason why we travel the world: to realize that what is considered normal at home is only normal because it is familiar. Many of the things we Americans do are bizarre to those in other countries. As he talked, I wolfed down packets of peanuts cooked in coconut milk and crisps flavored with prawns I’d gotten from a roadside stand, washing them down with Diet Coke. No one drinks Diet Coke here and you usually have to go to a hotel to find it. And, apparently, only the children eat little bags of salty snacks and it is strange to see a grown woman stuffing her face with crisps. But I was starving, having eaten mostly fruit, rice and fish for more than a week. Sometimes, especially at certain times, a girl just have to have some carbohydrates and salt—maybe even a pig snout here and there.

We were headed to Ha Long bay, otherwise known as the Bay of the Descending Dragon. Quynh pointed out that before the country became more open to foreign investment five years ago, the same journey would have taken 5 hours instead of 3. And 10 years ago, it would likely have taken 8 hours. The Japanese (and other foreign investors) are pumping a lot of resources into Vietnam. Quynh joked that the Japanese’ desire to build roads and bridges might have something to do with their desire to sell more cars to the Vietnamese people. Where once there were barges that crossed back and forth shuttling people and supplies across the Red River (Hanoi’s largest; it is a milky raspberry color) now there are modern suspension bridges. Vietnam’s government is Communist but they have realized that offering economic growth and development to the nation is key to their maintaining stability. Interestingly, for a long time, everyone owned small plots of rice paddies and had to give their crops to a communal, government-run central supply post—they would get back for their family a small subset of what they had grown. Today, the Vietnamese people pay taxes and keep the crops they tend and harvest to themselves. Though they were reluctant at first to adopt a more self-sustaining model of farming, the Vietnamese seem to be evolving to accept a new sense of self-reliance. The influx of foreign cash also has factories booming and the construction business is on fire—as is the business of making building supplies for all the new construction. Boats so laden with coal (to power the electrical plants that power the factories) and sand (to make concrete) can barely stay afloat as they chug downstream to reach their destinations. Bricks are made by the thousands in row upon row of long chimney-topped buildings made from—what else?—bricks.

As we cruised along the new highway, water buffalo and cows lazed about in the mud and sun, sleepily chewing grass while farmers avoided the midday heat. We were headed, eventually to Hai Phong City, Vitenam’s third largest city—a giant port where the HIV/AIDS infection rate is very high—to meet with a support group of people living with HIV and those that support them. In Vietnam, there are an estimated 120,000 people living with HIV/AIDS. The U.S. has spent millions of dollars since 1999 helping Vietnam fight AIDS. In fact, Vietnam is a recipient of PEPFAR (President’s Emergency Plan for AIDS Relief) funds; there is the belief that the funds and man and woman power will be well-spent here as they have the potential to make a great impact in preventing AIDS from spreading. The Health Minister and Prime Minister are very supportive of fighting the disease and I have been told that Michael Marine, the U.S. Ambassador to Vietnam who is holding a reception for us tomorrow night, is very aware of HIV/AIDS and is a wonderful advocate for those living with the disease. My work in Vietnam will be a bit different I think than in Taiwan. Here, I will meet with more grassroots groups and people living with the disease. In addition to working with the support group I will work with the UNAIDS communication technical working group Wednesday afternoon and Thursday we’ll meet with various advocacy groups back in Hanoi.

I typically feel tireless when doing this work. Even though we have done much traveling and it can be stressful and exhausting to adjust constantly to new places, new people, new food and new languages, even though it’s hard to relax when you’re always “on”—concentrating and listening, learning and sharing what you know—most of the time I seem fueled by some invisible force. I love what I do and I love that all over the world there seems to be tremendous energy and determination to conquer AIDS. I have to say, I am far more encouraged than I thought I would be on this trip. The desire and resources to prevent infection are available and people in this part of the world do not have AIDS fatigue and they seem very eager (if sometimes uncomfortable at first) to discuss how to save their own lives and the lives of others.

Still, it is necessary to refuel and it was heavenly to relax in the air-conditioned van for three hours listening to the history of Vietnam and to see the countryside unfold. Quyhn is a very impressive man. He was raised on a farm. He said it was “above his imagination” as a child that he would have a different living than his father; he grew up tending water buffalo (he said they are very docile and you can ride them) and finding food in the forests. They were so poor he ate the root of banana trees as well as the fruit. But he did well in school, and excelled at the university where he studied to become a teacher. As a student, he saw that Vietnam was opening up and he wanted to work for an American company. When a job opening became available at the U.S. embassy, he applied and got the job. He seems so excited that the U.S. and Vietnam are exploring partnerships and friendships and with his excellent English, encyclopedic knowledge, optimism and astute insight, he embodies a new generation of Vietnamese people who will surely change this country considerably. I only hope that the development doesn’t spoil the natural beauty that is nothing short of breathtaking. Even today, when Quyhn sleeps deeply and peacefully, he dreams of the rustic beauty of days in his youth spent with the cows, fishing for his lunch.

We stopped for lunch at a roadside restaurant where the food was incredible (Sean had an entire chicken—feet and all) and shopped in a place full of handmade crafts and household goods. It was a big cavernous space filled with beautiful women in long red dresses who followed me around, turning on lights and fans as I inspected a particular section of goods. After rolling through miles of roadside fruit vendors selling pineapples and all sorts of cool tropical fruit I have never seen before, we reached the bay.

Ha Long is an expanse of light blue-green water with hundreds of dramatic rock formations jutting through the surface; erosion has eaten away the base of the rocks so they appear to be floating on the water. The harbor is filled with colorful wooden boats; the whole scene is very Pirates of the Caribbean. We rented a boat for four hours having no idea we’d have a private captain, endless cold beer and stops at a magical cave full of stalactites and stalagmites lit with glowing neon and an afternoon stop at a floating fish market where Sean picked out our lunch.

As we ate grilled shrimp pulled from the sea that day, cruising slowly through a landscape that looked straight out of a pirate movie, I felt a little guilty. But, reflecting on the last week’s work, and realizing we hadn’t had a day off in more than 10, I allowed myself to lay back in my wooden chair on the deck of the ship and day dreamed of black pearls (I later bought some of those famously harvested in Ha Long Bay) and fresh boiled pig snouts.

Below are some pictures from our journey around Ha Long Bay.

Hi from Hanoi! Sean (my boyfriend who is traveling with me) and I arrived in sultry, sweltering Vietnam today. Though it seems impossible, it is even hotter here than in Taipei. I am having a cup of tea and my malaria medicine. Quite a nightcap!

Hanoi is an incredible mix of historical and newly emerging influences. An iron bridge built by the French that resembles a crouching dragon hangs low slung over the Red River near new multi-storied homes with tromp l'oueil facades festooned with creeping vines. Business is booming in the newly opened country and where things are not covered in a fine dust from all the construction, they glow a deep emerald green. It is lush and mysterious and magical. We met with Angela Aggeler the cultural attache here in Hanoi this afternoon before exploring the French quarter near the Hilton (as in "Opera Hilton" not "Hanoi Hilton" as one famous prisoner of war camp was known here during the Vietnam war. The Vietnamese call it the American War.). The people here are very different from those in Taiwan. Many of them are young; about 70% of Vietnamese are under the age of 30. Those who survived the war are not, understandably, thrilled to see Americans. But, I have been assured by those who invited us here to speak about AIDS stigma that Vietnam is an open and progressive country when it comes to dealing with AIDS. Indeed, they are a recipient of a fairly substantial PEPFAR (President's Emergency Plan for AIDS Relief) grant as it is believed that money can actually help prevent a major epidemic in Vietnam.

As I have yet to start my program here, I'll just write briefly about the traffic. There are almost no traffic lights. No road signs. No right of way. No laws of the road. People on mopeds, motorcycles, bikes, foot, in cars, trucks, vans, and buses meet at intersections--sometimes six intersecting roads at once--and no one stops, or slows down. Like magic--everyone just slides past everyone else. Someone here likened it to flowing water: the traffic moves into any available space until it fills it and overflows into another empty space. What seems, at first, like a chaotic stream of honking, beeping, swerving vehicles and people is actually a beautifully orchestrated flow of humanity and motorized craft. It's like two rows of people waltzing coming face to face--at first, it looks like everyone's going to smash into each other and then suddenly, voila!, the rows have passed through one another and the dance goes on. Crossing the street is a leap of faith of philosophical proportions. You step off the curb and literally go with the flow. You can't stop or wildly accelerate or you'll throw off the rhythm of the entire thing and probably get run over.

I spent a lot of time at first standing on the curb waiting for the perfect moment to dash through the traffic. I learned to just take small regular steps and somehow, that gets me safely to the other side. Freneticism turns to a calming progression just by believing it is possible. I wonder if the artform that is crossing the street in Vietnam will relate to how this beautiful country handles its HIV population of approximately 120,000 people? Time will tell...

I have to leave very early for a press conference with reporters in Hanoi - so I'll sign off for now and tomorrow I will write a recap of my wonderful days in Taipei.

I'm just figuring out the new technology so I'm going to try to post this with a picture of me at the ICRT radio station in Taipei...hope it works!