World AIDS Day Speech 2014

Anthony asked me to speak on this year’s World AIDS Day theme, 
'Focus, Partner, Achieve: An AIDS-free Generation.'
I will be looking closely at these words in this speech.  I challenge you to look closely at your own definitions and ask yourself, Where do I fit into this theme?

Focus is the first word, so when I sat down to write this speech I translated the word focus into mindful. I sat down and took some time to be Mindful, many people think it’s an overused word, what do you think? I like the word, I also like the phrase “to take Notice”. So specifically to Maui here is what I noticed.
In order to achieve an AIDS-free Gen
What must we notice here on Maui?:
We must acknowledge that this is a small island, positive or negative there is little anonymity, the coconut wireless is faster than the internet.
In small communities (especially in some ethnic communities) there is still a great fear surrounding HIV
Fear of being found out - because it is still considered shameful to be infected with HIV.
This fear stops people from coming in to be tested.
This fear stops people who are HIV+ from linking to the medical help they need.

What role do you play in addressing this fear?
Because it is only when this fear is addressed can we hope to achieve an AIDS-free generation.  We have all had some sort of our own fear surrounding HIV,
take time to be mindful, to remember what those fears were like and what helped you overcome them.  Your remembering may change a person’s life.


Let’s be mindful that when someone who is HIV+ is linked to medical care – they not only help themselves – they help the community.
An HIV+ person who has an undetectable viral load and a healthy CD4 count, they have a 96% less chance of passing the virus on to another person. This is a fantastic statistic!
Being on medication is an integral part of achieving an AIDS-free generation.

So who do we partner with in order to achieve this goal?
We (meaning professionals, families and friends – all of us) All of us have to create a safe space, a confidential place that fosters deep listening and respect.
Now how do we acknowledge the fears, validate an individual’s reality and build a relationship of trust before diving in with medication agendas and CDC guidelines?  Most every worker in the field, every partner of an HIV+ individual, every parent of and HIV+ individual knows that if someone is not ready to take their medication – they will not adhere and without adherence, a person is at risk for resistance.

We must listen deeply to see: what is at the root of their fear?
Is it Misinformation? a misunderstanding of what living with this virus means (and I do mean living – versus what they might believe is dying), Is it judgment? – self judgment as well as judgment from others,

Do their fears revolve around Proprietary needs?  - a homeless individual is not going to make meds a priority – they are going to make shelter a priority. (If we think developmentally – as in Maslow’s Hierarchy – survival needs come first, we must meet individuals at their particular need– partner with those who can assist, from a friend’s sofa, to a homeless shelter, to a housing program or in cases of domestic violence Women Helping Women.



Another survival issues is Hunger, someone who is searching to keep themselves and their family fed
are they thinking about spending money on medication? – even if it’s just a copay? No of course not. 
We must partner together . . . with the Food Bank, donations to keep our food pantry going, cooking a meal for someone in need, connecting individuals to government assistance.

What about the homeless and hungry HIV- individual?  Do you think they are putting themselves at risk in order to obtain shelter for the night or even just a meal? What is their focus?
It is also survival.
To achieve an AIDS-free generation it will take a village to address these needs (even if some of us look like the Village People – for those of you old enough to remember them)
It will take family, friends, volunteers, organizations and the government.

Another area to be mindful of are mental health issues
– someone who is unable to address their anxiety or depression either through medication, counseling or both – how likely are they to stay on their HIV medication?
Let alone that the individual may see their mental health diagnosis as yet another stigma.

It is imperative that we partner, partner with mental health professionals and partner with the individual who attempting to cope.
We must listen to our friends, our clients, to see if their therapist is a good fit, to see if the meds they are taking are making a difference for the better, not increasing mental health issues. Remember, there is no absolute science to prescribing meds, it is often a trial of a few meds before the right medication and dosage is achieved.
– we as a community need to be there helping, through direct observation and kind feedback – along with a listening heart.
If want an AIDS-free generation we must be willing to address mental health issues.

An individual who is looking for their next high -  whether it’s addiction or just substance use,
Do you think this gets in the way of making HIV adherence a priority? Of course it does.  Do you think substances interfere with an individual’s judgment? Of course they do. Poz or Neg individuals.
Often times while high, risk of transmitting the virus increases because negotiating safer practices is not a priority with dulled senses. To achieve an AIDS free generation we need the courage – all of us, not just the professionals, to address these concerns with those we care about and to address them with a nonjudgmental and compassionate heart – truthfully. 
We also need to partner with substance abuse programs to find the fit which will allow the person in need to achieve sobriety.  Whether outpatient like AA or NA or programs like Aloha House of Malama Recovery.
If we want an AIDS free generation then we are all going to need to step it up

Now imagine if your friend had a combination of these factors – this is not a task left to one of us.  It is a task for all of us. To stand together and support.

We need to embrace what is working . . . and acknowledge what isn’t!
Why is it that in young MSM in the US between the ages of 13 and 24 there has been a 300% increase in HIV? I hope this statistic shocks and saddens you as much as it does me. And that it will move us into action.
Why is it that 70% of Asian Americans have never tested? How do we reach this population?
2/3 of Native Hawaiian Pacific Islanders have never tested.  How do we change that?
We need to ask ourselves – “What role do “I” play in changing these statistics in order to achieve an AIDS free generation?
Again – what does it take to clear preconceived judgments and notice the needs of the community. We must be culturally aware. An AIDS-free generation will not be achieved if we expect a culture different from ours to accept what we have to offer
if we do not honor and accept what they have to offer.  This takes deep listening.  This takes noticing. It takes respect.
It means working with youth – listening to youth. Listening to the needs of the various ethnic communities on Maui.  It means Partnering with other organizations like Hui No Ke Ola Pono and grantors like Maui County

As for Prevention and Education – we have to meet the individual where they are.  What are they interested in?
Abstinence only?
Condoms?
Med adherence?
PrEP?
A combo of these?
When we talk to individuals, do we have our foot in one of these camps and not another? We need to take a look at this before we address prevention needs with an individual.  We need to notice our own fears and biases.
Remember, in prevention, The goal is to be heard, (I repeat) not vilify or judge.  In order to achieve an AIDS free generation we must meet individuals openly and honestly about the choices available and allow these individuals to choose the best risk-reduction that fits their worldview. And in order to do that, we may need to push our comfort edge, suspend judgment and increase our knowledge base.

Why are we still using stigmatizing language? You hear it from stranger, from friends – you may even have used it yourself.
“I’m clean you be too” – this phrase, this word “clean” implies an HIV+ person is somehow dirty.
This kind of language inhibits trust, reduces conversation between HIV+ and negative individuals, increases stigma and decreases disclosure.  In order to achieve an AIDS free generation we must “notice, pay attention” to our words and the words our friends use and push our boundaries and confront this language head on! Let’s not inhibit conversation, let’s encourage it.

The newest roadblock I’ve seen comes from the very community that has fought judgment, stigma and shame for generations. The Gay Male. What is being judged?  Of all things risk reduction.  People in the community who choose PrEP as a means of lowering risk!  They are not “Truvada Whores” – what a vulgar expression for someone who is taking responsibility for their sexual health.  If we want an AIDS free generation we must be mindful of our language and our judgments. Especially since taking PrEP as prescribed decreases HIV transmission 99+% And this study was done with magnetic partners where the HIV+ partners were not on meds and had high viral loads! The HIV- partner who took PrEP and did not contract HIV! Why would we judge this? We need to stop – especially in light of the 300% increase in HIV cases in young MSM. And in light of the fact that 47% of gay men report they do not use condoms consistently. We need to notice this judgment in our language and have the courage to confront it.
 
We need doctors.  How does one achieve an AIDS free community without doctors?  This has been a changing landscape on Maui. Yet by paying attention we can do everything in our power to advocate and plan for HIV docs t be here on Maui. Supporting our partners like Malama I Ke Ola, Mango Medical, Kaiser Permanente and Spencer Clinic.
Ideal? No. But a work in progress These partners are crucial in achieving an AIDS free generation.
The national average is that only about 25% of HIV+ individuals are linked to and in care.  Maui is double this and I am proud of our community.  But this still leaves 50% out of care. To achieve an AIDS free generation we must focus on these individuals and (what is often) their non HIV needs.

Finally, while not specific to Maui, we need to be invested.  Where would we be without financial investment from individuals and corporation? Not only locally but world wide. 
The all important funding that goes to research?
Meds have greatly improved over the years, studies continue to be conducted for a vaccine
and more and more researchers and scientist are actually hopeful for a cure.
An AIDS-free generation relies on these researchers, scientists and we rely on their partnership as well.

Finally I hope you take with you that this year’s WAD theme
'Focus, Partner, Achieve: An AIDS-free Generation. Has meaning for you. 
It is my hope you will take this phrase with you and contemplate your role in it. Be mindful of its meaning.
We owe that to every individual who has passed on, gone before us in this fight.

Mahalo for all you are.
John

My Understanding Of Karma Was Just Blown Out Of The Water!

I love when someone comes along and expands my view of the world!

I've been reading a series of articles by Ken Mcleod (a Tibetan Buddhist teacher with Taoist influences); it is his thoughts on Karma that make up the gist of this blog. To read the articles for yourself go to http://www.unfetteredmind.org/karma-genesis-conditions

I am not a Buddhist, not in the religious sense anyway. What attracts me to Buddhism are its many psychological and philosophical principles, particularly it's teachings on compassion, kindness, awareness, ego and mindfulness.

Karma is another principle that captures my attention.  In particular I have found  Gary Zukav's chapter on Karma in his book "The Seat Of The Soul", well thought through and I have often returned to that chapter many times over the last 20 years. Ken Mcleod's writings have now gifted me with a deeper understanding - another layer. So I wanted to share some of the highlights.

I often see "cause and effect" references to Karma posted on Facebook, Instagram, Twitter and other social media. It's a very black and white, mechanical view. It's a westernized view that is almost scientific in nature - a law, like the law of gravity. It's viewed as punishment. Ken immediately progresses from this western concept by giving the Tibetan translation of the word "Karma":

The full term for karma in Tibetan is las.rgyu.abras which in translation yields Action-Seed-Result. 

What a different implication! Action-Seed-Result.
The idea of Karma is removed from a linear view of cause and effect and becomes multidimensional. If you're familiar with my writings you know I love developmental or evolutionary world views, so this definition easily makes sense to me. Karma can now be viewed as how our actions grow from a seed into a result. There are a chain of events from each decision we make. He postures that these chain of events are similar to an acorn becoming an oak tree. Ken writes:

"Compare this chain of cause and effect to the growth of a tree. An oak tree starts with an acorn. An acorn is not a tree. The acorn, under the right conditions (we’ll come back to this point in future articles) starts to sprout. After a short time, the acorn is gone and a shoot with growing roots and a growing stem has formed. Bark, branches, and leaves form. Totally new features emerge at different stages. An oak tree consists of many different kinds of structures, all of which have grown from the original acorn. Karma describes growth, not causation. An acorn doesn't cause an oak tree. It grows into an oak tree. Actions don’t cause our world of experience. They grow into our world of experience."

So rather than just a result from an action, there is this growing myriad of results from our actions - for us personally, for others whom our lives touch and for the relationship/interaction of us with others.

For example, our actions/choices can either reinforce a negative or positive behavior which will continue to grow; they can influence how we view the world and everything and everyone in it (are people to be used or do we treat everyone we meet - and don't meet - as sacred). Our actions will also influence how others view us (are we acting as someone who can be trusted and continuing to grow in our relationships or are we losing credibility and growing in our own self deception). Karma has internal as well as external results. There is always growth. It's a matter of what we are seeding to grow. For me there has never been a greater argument for Mindfulness or Contemplative Practices. If every action shapes our personality and our experience of the world and also takes part in the shaping of others, it is essential to develop a practice of paying attention. Mindfulness, Meditation and Contemplative Practices allow us to see what's behind certain patterns and they offer us the opportunity to let it go.

Ken elaborates on this view of Karma by writing:

To see what you've done, look at what you are.
To see what you’ll be, look at your actions.

In other words look at the person you are today. How did you become this person? Look at the actions, the decisions you've made along your past - that's how you got here. Now if you want to know what kind of person you'll be in the future, take a close look at your current actions and decisions. You don't have to be psychic to see your future.
(Before we continue, I need to pause and elaborate. While some of my language has been dualistic - positive versus negative actions - it is important to remember there is an implied hierarchy when we look at growing, at evolving. This is not an issue of good versus bad. At one level we are all one, on equal footing - this the ground of being, where we humbly and lovingly acknowledge there is no difference between us. In another sense we are in the process of becoming. Becoming implies growth. Now in order to grow, it is imperative to look at our choices through the eyes of Compassion and Loving-kindness. Looking with critical self-hatred will not yield the kind of growth that benefits us or those around us. So one of the first steps in looking at the difficult places within us is to cultivate a sense compassion and gentleness towards ourselves)

This goes way beyond a set of rules regarding our behavior.  It exceeds simplistic notions that treat Karma as a "sin", where we believe in Instant Karma as punishment. In this sense Karma means paying attention in the moment to proceed with the right choice.

Each moment brings to the forefront something that will grow out of the decisions we make in those moments.

And let's face it, paying attention, being ever mindful isn't the most natural way of proceeding. We have to cultivate this practice. It means showing up for ourselves. It means showing up for the others in our lives. When we do this Karma is a beautiful thing.

Here's to the end of suffering,
John