Highlights of the International AIDS Society Conference in Brisbane 2023

The Indigenous HIV and HCV Health Equity pre-conference day one was INCREDIBLE. Clear-eyed assessment of the harms caused by colonisation and continued by — that deceptively benign word — ‘settlers.’ The linkage of this history with contemporary HIV incidence and outcomes was also made clear. It was powerful hearing from First Nations advocates from Australia, Canada, Hawai’i and New Zealand, and the parallels and differences in their experiences. We heard about many innovative and exciting projects led by Indigenous HIV advocates and program staff in epidemiology, social research, prevention, HIV care and support. I loved the PrEP Pono campaign from Hawai’i.

A presentation by Prof Kane Race to the U=U Global Forum on Day Two. Snarky as FUCK in Kane’s own inimitable style, it raised a whole range of vital questions for the movement — questions, it should be noted, the movement is already grappling with. And probably the most hilarious slide fail I’ve ever seen, prematurely unveiling an image of Kairon Liu’s spectacular sculpture for HIV Art as Science, a giant penis in clear plastic filled with unused HIV medications.

A different artwork by Andrew Chan for the HIV Science as Art exhibition.

Next, a self-care fail: transiting from one event to another left no time to have lunch, and low blood sugar led to a migraine without headache — just aura and puking for hours — so I missed out on the interactive bits of the ACT NOW Forum on Global HIV Migration as well as the Unity Vibes community art festival and dance party.

Day three involved a bunch of satellite sessions and doing some IAS training for rapporteurs. I was a rapporteur for Track E, health economics and implementation science, on a team led by Omar Galarraga from Brown. The IAS computer systems are a little terrifying but the rapporteur liaison Justyna Gaczorek was a calm and clarifying presence. I’m running on about three hours sleep and I skip the HIV Science as Art exhibition launch for an early night — devastated to miss the launch but I’m calling this a self-care win.



Day four was the first day of the conference proper. Memory gets a bit blurry. I wake up at 6AM and start my conference day at 7:30am delivering a training session to volunteers in the Positive Lounge. The ‘Poz Lounge’ was organised by Queensland Positive People and looks absolutely stunning; an oasis of calm and creativity amid the rigours of the conference.

I attend a session on social science in the fifth decade of HIV and maybe I’m just tired and emotional but it makes me rather cross. In part it’s just the setup of the session but it makes it seem like HIV social scientists spend as much time defending their turf as they do presenting actual social science.

I rapporteur the Track E Late Breaker Session and it’s incredible to hear what LoveYourself are doing in the Philippines. They have developed an all-virtual de-medicalised PrEP service called E-PrEPPY and to get around logistics challenges in one of the world’s densest cities they developed their own motorcycle courier service, with riders receiving SOGIESC sensitivity training.

Day five (Tuesday) sees me rapporteuring another session on community-led models of care, which includes a fantastic presentation by Prof James Ward, introducing the Aboriginal Community Controlled Health Service model to the HIV world. I rapp another session on achieving the 95-95-95 cascade goals.

Day six, Wednesday, and the finishing line is in sight! I’m rapporteuring a session facilitated by my lovely colleague Beau, featuring another presentation from LoveYourself Philippines as well as one by Laura Nyblade on stigma reduction. Nyblade’s study claims to be responding to and measuring intersectional stigmas but it operationalises stigma entirely in terms of individual negative attitudes. It reports a statistically significant and sustained reduction in stigma, but it’s about 0.3 points on a 5-point scale.

I’m typing away in the rapporteur’s lounge — yes, it is INCREDIBLE having somewhere quiet to retreat to at an international conference — when suddenly… is that SINGING? It’s a protest led by the U=U movement and its organisers the Prevention Access Coalition — demanding the international HIV/AIDS community #sayzero. In other words, don’t say effective HIV treatment ‘reduces’ risk or comes with ‘negligible’ risk — suppressed viral load means zero risk for HIV transmission during sex.

It is lovely attending the final reportback session and hearing the chief rapporteurs giving the highlights of the conference. Track E chief Omar Galarraga is extremely consultative (slash pragmatic about workload) and invites his three rapporteurs to nominate three findings we’d like him to highlight in his reportback. I choose the E-PrEPPY project, as well as Prof James Ward’s remarks about making peer work sustainable, and projects offering non-HIV care (e.g. gender affirming care) as entry points into HIV care. I get to see my name up in lights and my colleagues capture the moment for me…

Some other highlights in no particular order:

  • Seeing the incredible work of my NAPWHA colleagues on the Deliberate Discussions series paying off in a series of well-attended, thought-provoking short conversations on stage in the exhibition space.
  • Volunteers helping out everywhere and having fun attending the conference and spending time in each other’s company. 😉
  • I finally got to meet Bernard Gardiner in person and he gave me a copy of a new report ‘Living Positive in Queensland: 2013-2020.’ Its key themes include a generational lens, place and locality, ageing and older PLHIV, stigma, social isolation and support, and the new pandemic, Covid-19. It will be an essential resource for the work NAPWHA is leading on quality of life for PLHIV.
  • Flying Jetstar on their A320s that are wider than 737s and don’t require me to hunch up into a little ball of back pain to avoid crushing my seatmates.

Roast your damn vegies

[Vegans, heads up, there’s a picture of roast meat about halfway down.]

This is my true ideology — I evangelise roasting your damn vegies. It is not without peril: as a clumsy person, running my oven full blast is a recipe for first-degree burns, and the PM 2.5s are not to be sneezed at (except I do). But the risk to deliciousness ratio makes it a winner.

Roasting in general makes food more appetising. It dehydrates food, concentrating flavours, and it adds texture by generating an exterior crust with a tender interior. Maillard reactions also generate lovely caramel flavours.

I personally find caramel a bit boring; it’s the reason dishes cooked in a slow cooker often end up tasting the same. My rule of thumb is cook until cooked and where vegies are concerned, cooked to me often means burnt around the edges — that lovely char adds bitterness, complexity and additional texture.

Roast vegie salad

When I worked at a weird little offshoot of Latrobe University in Melbourne CBD, I used to walk with my friend and colleague Nat to a nearby resto that served salads for lunch made from vegies roasted in their wood-fired oven, and I’ve been a salad person ever since.

You want a mix of hard and soft vegies, like carrots and zucchini, to create a pleasing textural contrast. That means roasting the hard vegies for 20-30 mins before adding the soft ones, and you can also chop the soft vegies in larger chunks, because they will shrink as they dehydrate in the oven/on the barbie.

Here’s a roast veg salad I made for a recent dinner with friends in Tassie. Too simple — just carrot, parsnip, zucchini, and red onion, served over a thick schmear of tahini mixed with Greek yoghurt and microplaned garlic, lemon juice, and finely chopped carrot fronds for a pleasing bitter note.

Transforming a roast

For the same meal, I added baby truss tomatoes, still on the vine, to the roasting pan about an hour before the lamb was cooked. They burst in the fierce heat and let go their liquid, turning a dry roast into more of a daube — my favourite way to roast lamb. In the last ten minutes, I added pearl cous-cous to the pan to soak up all the lamb-y, tomatoey pan juices.

Roast your brassica!

If you’ve ever eaten pan-seared or oven-roasted brussel sprouts, you already know that brassica — the mustard plant whose variants include broccoli, kale, cabbage, cauliflower and brussel sprouts — loves to be roasted.

I am a huge fan of Deb Perel from Smitten Kitchen and also Justine Doiron and their genius came together in this recipe for a roast cauliflower and cabbage salad. Now hold up a second, I hear you thinking, those are not charismatic vegetables. They go soggy and unpleasant at the drop of a hat!

This is where roasting comes in — it dries them out and gives them those delicious charred edges. Deb reassures her readers it will taste good rather than burnt. This is the ‘trust me’ aspect of roasting your damn vegies.

I’m extending the salad by adding oven-roasted chickpeas that I have roasted with a coating of harissa paste rather than serving the harissa on the side.

This is how the key ingredients look before I roast them. Pallid all round.

The after pics show how far you can push them without any unpleasant burnt flavours:

As you can see they shrink down a lot. I’m cat-sitting at a friend’s place right now, but at home, I own a bunch of cheap baking sheets, so I can roast three trays of vegies at a time. Just lay down baking paper on each tray to make clean-up easier and keep in mind the top-most tray will cook faster.

Give it a go

Fold up some teatowels or bust out your oven mitts, dial up your oven as hot as it will go, and your tastebuds will thank me.

Roast your damn tomatoes

For years I’ve been an irascible presence on social media telling my friends to roast your damn vegies. This post is specifically about roasting your tomatoes. I don’t mean slow-roasting them, confit-ing them in olive oil. I mean blasting them with the hottest temperature your oven can muster.

Nothing tastes better than the charred sweetness of a properly roasted vegetable and tomatoes, so full of sugar, are perfect for this treatment.

There are two options: plain, and fancy.

Pre-heat your oven, with your baking tray inside it, to the maximum temperature it will go, for at least 30 mins.

Plain roasted tomatoes

Fresh truss tomatoes should be cut in half through their equator — don’t let me see you cutting them top to bottom!

Baby truss tomatoes after they have been carefully turned in the pan.

Carefully remove the roasting tray from the pre-heated inferno (first-degree burns are probably inevitable but use a double-folded teatowel, or oven mitts) and place a sheet of baking paper on the bottom.

Then put the tomatoes cut side up in the roasting tray, sprinkle them liberally with flaky salt (the only kind, in my book) and drench them with olive oil (not extra virgin; the ordinary stuff).

Roast them for 45 minutes to an hour thirty. This is another cook until cooked scenario — the time depends on how hot your oven gets. You can turn them over midway through or just leave them the fuck alone.

When cooked they should be completely collapsed, releasing their juices into the pan, and charred around the edges.

Take those roasted tomatoes and mash them into a pan with some well-crisped batons of streaky bacon, some softened diced shallot, some sliced garlic, add some white wine, add two tbsp of sour cream, add some parmesan, add some finely chopped chives, spoon that over pasta and promptly die of happiness.

Fancy roast tomatoes

My gorgeous ex once took me to see Yotam Ottolenghi interviewed by my fave Aussie cooking writer Karen Martini. He is a generous talker and careful thinker but I almost never cook his food — because the fucker just has no idea how many ingredients is enough. But this recipe is an exception.

https://ottolenghi.co.uk/recipes/hot-charred-cherry-tomatoes-with-cold-yoghurt

Don’t worry about the Urfa chilli flakes. Whatever flaked chilli you’ve got is fine. Pul biber is great if you can find it. Sweet or smoked paprika is also fine.

Crushed garlic, thyme, sage, fresh oregano, lemon peel, baby truss tomatoes cut through their equator, a metric fucktonne of good olive oil, then roast those little bastards like they insulted your mother.

Pull them out when the oil is spitting and the herbs are crispy and the pan is scorching your oven mitts. Pour the whole mess over yoghurt that has been sitting in your freezer for a couple of hours.

Look at that. Charred, collapsing, sweet, caramelised, herby deliciousness. It’s the perfect dish to accompany roast chicken or roast lamb.

Roast your damn chicken

For dinner tonight I roasted maryland portions of ethically raised chicken in a marinade suggested by Sabrina Ghayour: rose harissa, lemon zest and juice, sheep’s milk yoghurt, and I add a whack of flaky sea salt for my own reasons. I served it on buttered rice.

I’m here to tell you to roast your damn chicken. Don’t listen to those awful American and Aussie food writers who tell you the most important thing is keeping the chicken breast moist. They’ll tell you to cook it to an internal temperature where the nasty bugs are killed and no further, in case the meat dries out.

I’m here to tell you to cook the chook until cooked. There are worse things than chicken breast that requires cutting and chewing to eat it. Those worse things are perfectly moist but chalky, flavourless chicken. I would much prefer you cook the bird like they do in a supermarket rotisserie — until the drumsticks are kinda tough and a little chewy but the whole thing tastes like heaven.

And I’m here to tell you to marinade it beforehand in something intensely strong tasting — because chicken itself tastes like nothing — and let it sit in the marinade on your benchtop til it comes up to room temperature and start cooking it from there. It’ll take about 2 hours. Stop hyperventilating, you’ll be fine.

Recipe

  • 2 chicken maryland pieces
  • 2 tbsp of Herbies dried rose harissa spice mix
  • Juice of one lemon
  • Zest of half a lemon
  • 1 tsp flaky sea salt
  • 2 tbsp yoghurt of your choice

Combine the marinade ingredients, mix well, spoon over the maryland pieces.

Let marinade for 2 hours on your benchtop or on top of your fridge.

Roast in a pre-heated 180C oven for 45-50 mins until the chicken is deeply caramelised outside and the flesh is starting to come away from the bone. Don’t be afraid to pick it up with gloves and give the joint a gentle yank to see if the muscle is still tight or starting to relax (this is when it’s becoming edible).

Above all, cook until cooked. Don’t be temping that thing. It’s only going to taste better — chewier, more Maillard goodness — if it overcooks a little.

I’ll do a separate post about roasting your damn vegies.

Trauma and the therapeutic possibilities of public narrative

In the past couple of weeks I’ve had a couple of publications that centre on the same theme: the possibilities of public narrative for healing individual and collective traumas.

Public narrative is an extremely broad term and captures a wide range of practices from autobiographical writing and public speaking through to the creation of cultural products including books, TV and film.

The concept of trauma is similarly broad (and increasingly contested). It includes experiences that meet the criteria for PTSD (DSM-V and ICD-11) and complex PTSD (ICD-11 only).

I recognise and have some time for the criticism of recent popular cultural tendencies to describe every negative experience as ‘trauma’ and every strong emotion as ‘being triggered.’

But I would also note we’re still only just beginning to grasp the full extent and diversity of experiences that can cause and constitute traumatic disorders. It wasn’t that long ago (two editions of the DSM) that we excluded events like sexual assault and domestic violence as potential causes of PTSD. The DSM-V authors still don’t agree that prolonged exposure to those two things in childhood can constitute a separate and more severe form of the disorder.

Acknowledging these debates, I use the notion of traumatic experience to describe and talk about sub-clinical trauma — experiences that meet some but not all of the criteria for PTSD or complex PTSD. These experiences can still be powerfully distressing and debilitating and fundamentally call into question our ability to survive and the linear temporal structure of our adult lives.

The Last of Their Number

This piece poses the problem of feeling isolated because your life story cannot be told and cannot be heard; it explores public narrative, particularly autobiographical writing and public speaking, as a possible solution, while cautioning that we need to build public listening skills and practices as well.

Pandemic déjà vu

This piece acknowledges that collective traumatic experiences of pandemics can produce paroxysmal public rage — and explores the possibilities of cultural production (books, film, TV) for telling stories of mass traumatising events.

For trans people with HIV, visibility means better data

Today is the international Transgender Day of Visibility and I wanted to quickly share a statement I wrote for work to mark the occasion. I also had fun designing a graphic visualising the concept of ‘trans data’! Of course, it goes without saying this post is inspired and enabled by the work of Teddy Cook, a powerful advocate for better representation of trans experience in research.


Recently Australia has witnessed an organised campaign of hate towards trans folks, seeking to deny the simple reality that trans women exist. This campaign seeks to constrain the ability of trans people to participate in public life, to use the bathroom, to take part in sport, and to be heard in public debate. On this Transgender Day of Visibility, NAPWHA says: we see you, we believe you, and we are here with you.

There is little research into the HIV-related needs of trans and gender diverse (TGD) people in Australia. A landmark study in 2018 found ‘TGD people have been erased and excluded from HIV and sexual health surveillance systems in Australia. This has contributed to a lack of evidence about our sexual health, which has meant TGD people have been excluded from strategies, services, programs and campaigns. Despite this, we have continued to organise, strategise and mobilise for action.’ Today, NAPWHA calls for enhanced and ongoing efforts to ensure that TGD folks are made visible in the data sources that are a precondition for funding HIV programs and services in Australia.

Artwork: Daniel Reeders (2023). Please do not use without citation.

In that study, 2.6% of trans women participants reported living with HIV (Callander et al, 2018). Yet, in some Australian states, systems that capture clinical data force trans women (and nonbinary persons assigned male at birth) to be ‘recoded’ as men who have sex with men. It means we do not have an accurate picture of the trans positive community — its size, age, gender breakdown, years living with HIV, transmission routes, and most importantly for NAPWHA, the unmet health needs arising for this group.

On behalf of NAPWHA and our members, if you are a trans person living with HIV, here is an open invitation — make yourself known to us; let us get to know you and help us better understand how we can serve you. Join our call for better data and sharing of stories that give us a clearer picture of the positive trans community in all its diversity. Together we can challenge the invisibility and erasure that surround trans people with HIV.

Announcing The Firehose

I made a linkblog. I know, right? It’s like time travelling back to 2006.

The Firehose is a collection of spicy takes and thoughtful features, updated frequently. I’m a voracious reader and it’s a way of capturing and sharing what I’m reading. For a long time I shared these links on social media but I recently ditched twitter and the Facebook algorithm has become particularly unfriendly.

A picture of a red fire hydrant with brutalist stencil text in red saying 'The Firehose.'
Photo by Aleksey Shkitenkov at Unsplash

At the moment I am trying out Flipboard Magazines as a way of sharing links, because nobody needs another e-mail newsletter in their inbox!

(Unless it’s by Ann Deslandes, Erin Cook, Anne Helen Petersen, or Jess Ho.)


As you can see, the format is a lot like Pinterest, with tiles for each story:


Flipboard has a great app for browsing content but you can access The Firehose on the web — for free — without having to install the app.

Not feeling Pride

Sydney WorldPride 2023 begins this weekend and I am not feeling it.

Late last year I was conscious of surfing right on the edge of burnout. We’d plunged straight back to work after two years of pandemic disruption without any real pause to stop and interrogate what it was we lived through. We tried to maintain the same level of productivity without acknowledging there was something a bit manic about the level of output we delivered during the pandemic. Everyone I know was battling burnout to some degree or another. We went through this mass-traumatising event and there’s been no collective reckoning with what that means and what it did to us.

And Pride comes with a degree of compulsory affect that is difficult to maintain when you’re on the verge of burning out. Pride is upbeat. If I had to assign Pride a texture, it would be shiny. Pride is inescapable, judging from the corporate ad campaigns emanating from Uber and Telstra and American Express across all the apps and websites and social media and public spaces I frequent. Pride is feature-length articles in broadsheet news media negotiated by PR companies promoting first-person narrative campaigns on tiktok. Pride celebrates human rights and a sense of inevitable social progress. Pride is fucking exhausting.

Sydney Opera House laser-lit in Progress Pride colours (SBS)

Forgive me, I’m a queer about to turn forty-two and I’m just not feeling it.

Style editor at Fairfax, Damien Woolnough, had a catastrophically bad go at articulating his own not-feeling-it. He lacked the range. I would express it differently. It’s not that there’s too many drag queens in the promotional materials. (I don’t even understand the concept ‘too many drag queens.’) But WorldPride isn’t queer enough.

And I realise this is a cliché — queer people are always going around saying what or whomst isn’t queer enough. And there’s often a lack of specificity about what they mean by ‘queer.’

I describe queer as a coalitional politics among sex and gender undesirables born of the recognition that we are all getting fucked by the Right. It is not an essentialised identity but a practice of community across differences in sexuality, gender identity, disability, embodiment, sex work, drug use, etc.

My problem with Pride is the way it strips out all the politics we are fighting, as queers, to bring into public conversation. It papers over them with its faith in the discourse and legal process of human rights, and its confident expectation that social acceptance of sex and gender diversity is inevitable in the end. It is liberal centrism in a nutshell and it frowns on the queer critique of the Right. Pride turned up after the really ugly battles had been fought and won and declared itself the victor, thanking liberal centrists and respectability politics.

I pored over the WorldPride calendar looking for events that had a queer vibe. I went to the Queer Sydney Reading Group at The PARTY exhibition at UNSW Galleries and — as always — it was great. I’m booked in for Blessed Union at the Belvoir and I am looking forward to seeing the Dyke Bar exhibition at the National Art School. I’ve registered to watch the Mardi Gras parade for the first time in my life, something made possible by a partnership between Club Cindy and People with Disability Australia. I’m attending Fair Day tomorrow in a gorgeous dress. I’m walking across the Harbour Bridge with two lesbian friends. So don’t get me wrong — I am making the most of WorldPride, and my journey through the WorldPride calendar is a celebration of queer coalition.

But amidst all the rainbows and corporate advertising, I fear an opportunity has been missed. First, I wish for something like the two-day Queer Thinking festival that Maeve Marsden and Nikki Stevens organised in 2018 and 2019. Not a conference with a ten minute slot for every visiting LGBT luminary working in the UN human rights system. Rather, a celebration of queer critique that provokes its participants to consider how we can live and protest in community with each other, celebrating our differences, in effective opposition to the Right.

Second, and this would have to be part of such an event, we need to be talking about how we protect trans communities from attack. It feels bizarre to me to be celebrating Pride, which sees progress on LGBT rights as inevitable, at a time when events in Australia, the United States and United Kingdom tell us that every single thing we’ve achieved can be undone in a matter of years, and simply because our putative liberal allies — the Guardian, the New York Times — can’t get their heads around the idea that trans people are just trying to live our lives. In the space of five years we’ve gone back to the Right calling gays ‘groomers’ — and the liberals are saying ‘but they’re giving hormones to kids.’

These are battles we thought we’d won and done with — Section 28, anyone? And they’ve come back around because the people whose support we thought we had in our pockets were easily swayed by liberal transphobia. We are discovering that court victories and legislative reforms are easily reversed if we don’t also win and keep winning the cultural battles. These are the battles that queer politics draw to our attention and demand we address — together.