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December 21, 2010: Hobbling Around and Taking a Closer Look

January 22, 2011 | Author khoward

I’ve been less active, overall, since recovering from total hip replacement surgery on my right hip on December 6 (the left one was done in April, 2008, so I kind of know the drill). As I hobble around, walking with the aid of a cane for about the next two months while I undergo physical therapy, I was frustrated with not being able to really “run the rat race” at my usual speed. Everything takes longer, especially my morning routine, and for a gay man, that’s a loooong time!

But it’s also allowed me to have one of the best holiday seasons in a long time, because when everything is slowed down, you really see every detail of your life. It’s like HD TV. And while, just like HD TV, it can show things that are unpleasant in detail (like noticing dust on things you don’t normally notice), for the most part, it brings vivid detail to life. The practice of “stop and smell the roses” is something a hip replacement will definitely inspire. I’m not smelling that many roses in December, but I am slowing down enough to savor things that we usually take for granted. Even walking. I’m so grateful that my inability to walk normally is temporary, a recovery from a surgery where muscles are strained, but not permanently damaged. It gives me a new gratitude for just the basic function of walking, and a renewed sensitivity and admiration for those who can’t. This recovery is not the most fun thing in the world, but I feel like I mustn’t complain, when I think of those who won’t walk with physical therapy, or at all — or those, like soldiers at Walter Reed Hospital in Washington, who, because of Bush’s blood-for-oil wars, don’t have legs anymore. I will never forgive that awful — AWFUL — man for what he has done to our world, and to so many people. I will hold the legacy of George W. Bush in enmity for the rest of my life, as I do with the uber-evil Ronald Wilson Reagan (666). Because the policies of men like that lead to the needless suffering of men who struggle to complete the most basic of life tasks. Cane or not, one has to “stand” for something, and I try to “stand” for justice — particularly for the under-dog — whenever I can.

Having a physical challenge to overcome, then, sure does prompt philosophical thinking and perspective. And a certain “mindfulness”, which is a popular buzzword today in psychotherapy, however fleeting that model might be. Facing these temporary challenges as best I can, with the best attitude I can toward growth, gratitude, determination, persistence, and appreciation, is important because it helps me “walk my talk” with my clients. They see me in my office during therapy with my cane at my side, and there is a certain “If I can do THIS, you can do THAT” — whether it’s facing their own health challenges, or other kinds of life challenges that we work on in therapy.

Like everything, I try to take a lesson from this period of physical recovery and learn something from it. And the lessons are profound — appreciating every moment of life, especially at the holiday season, for we’ll all be walking right past the holidays, into the new year, cane-free, soon enough, walking full-pace back in the rat-race. I just hope I remember to still stop and smell the roses.

Posted in Blog: Musings on Current Events, Health/Illness Management, HIV: Living Successfully, Life Skills | Tags: , , , , , , , | No Comments »

December 16, 2010: The HIV 'Cure' and Never Say Never

January 22, 2011 | Author khoward

With the news this week that a man has been declared officially “cured” of HIV by way of stem cell therapy (http://www.huffingtonpost.com/2010/12/14/hiv-cure-berlin-patient_n_796521.html), I was heartened, to say the least. Immediately, my mind went to two things: one was about what this means for the immediate future of HIV eradication research, and how soon could something like that one, unique man’s experience be extrapolated to the entire HIV-positive population, and two, a more emotional side — How many people that we lost, or that I lost personally, would have loved to have seen this day? This is the day that many said could never arrive, the day that we declare the “c-word” — no, not that one — CURE in HIV.

I wondered what my friends Keith Markin, or Fernando Baell, or Charlie Wills would say about this day. Knowing them, I think it would be a chorus of “it’s about fucking time!” And they would be right. This day does seem a little long-time coming, 30 years into the HIV/AIDS epidemic. And the full day of known “cure” for all still eludes us. But this day does give hope that this very easily could be “the beginning of the end” of HIV as we know it. And, as I sit and recover from my second hip replacement surgery (December 6) due to HIV-related Avascular Necrosis, a bone disease, boy do I “know it” all too well!

But beyond what this news means for the medical, and more specifically HIV medical community, I think about the existential and philosophical aspects of this news. I think about how this defies nay-sayers that cure is “impossible”, just like the nay-sayers circa 1955 or so who said that we would never put a man on the moon. To say it reminds me of, “Never Say Never” might be a little cliche’, but I often think in cliches (as anyone who reads my writing knows).

I think of this news in the context of the time period that it comes to us — the holiday season. More specifically, the Christmas season. I don’t identify as being particularly religious, and I’m the first one to defiantly, humorously, subversively, and just a little bit ragefully challenge the prevailing notion of the implied “superiority” of so-called “Christians” and the general passive or active homophobia, heterosexism, and just plain hate of far too many of them. But if we take the Christian idea, or dare we say “myth” (don’t shoot; it’s just a blog!), that Christmas is representative of the birth of Hope, of Peace, and of a Sun (“son”), what better time of year for news that something as antithetical to Hope and Peace such as HIV could be “cured”, at least once?

The implications of this news extend beyond the medical fascination of it all. It is a parable, a Life Lesson, a historical reminder that things DO change. That the diffculties that seem “un-curable” today may indeed be “curable” tomorrow. Or a thousand tomorrows after that.

It needs to be said that this man’s experience is extraordinary, and the measures used were something that would not be feasible to apply to everyone living with HIV.  It’s really still considered a “fluke”.  But, that said, I still think HIV’s days are numbered. Polio’s certainly were. The Bubonic Plague’s were. Smallpox’s were. Diseases are just as superficially vulnerable as fashion; they “go out”. HIV has been an unwelcome guest at the World Party for far too long, and you know, it’s just getting to be that time. You don’t have to go home, but you can’t stay here.

Whatever your nay-saying is, stop for a minute and challenge the “permanence” of that thinking. Never say never. Let there be a Birth of Hope for you this holiday season. Happy Holidays!

Posted in Blog: Musings on Current Events, Health/Illness Management, HIV: Living Successfully, Life Changes, Life Skills, Stress Management | Tags: , , , , , , , | No Comments »

November 3, 2010: On Twenty Years of Living with HIV

January 22, 2011 | Author khoward

It was 20 years ago today, November 3rd, 1990, that  I was diagnosed with HIV.  Knowing this “anniversary” was coming up, I was thinking about how to write about it.  I had things in mind, like a bullet-pointed “highlights” of the challenges and even perhaps “rewarding” or at least “poignant” experiences since that time.  And then, I received an email late last night — and I knew that I had what I wanted to share, which is the email exchange, below, of that note to me, and below it, my response:

Hello Ken,

My partner and I need counseling and have a couple questions for you. Neither one of us are HIV-positive and have strong moral beliefs. How can you counsel us when your indiscretions and carelessness are not compatible with our HIV-negative lifestyle? Also, why is your website and Facebook picture over 20 years old? Are you using it as a dating site for yourself? Please let me know. Thank you.

Sincerely,

[Initials Redacted]

Dear [name redacted],
 
I read your note carefully, and while I could dismiss it handily, which would be understandable, given your hostile and insulting tone, and your insincere “request” for counseling, it is nevertheless my policy to help those in need, and I believe, from your note, that you are very much in need. 
 
I’m curious about what the issues that you and your partner face.  Could it be that you are in conflict related to something about your apparent aggression and hostility?  Certainly you have demonstrated that to me, so it’s an easy hypothesis.  But in the theory behind anger, usually there is great pain — fear, sadness, loss, frustration, regret, etc. And while it is easy to get angry at those who act out their anger with us, such as your note to me, I believe it is also important to try to understand the pain that is behind the anger.  If I were to work with you and your partner, that is something I would want to explore, as well as how your anger affects your relationship.  My hunch is that it’s probably driving your partner away in some way.  To be on the receiving end of anger hurts us, but it also disgusts us and makes most of us want to pull away, unless you’re like me, as a therapist, when it makes me wonder why you are so angry, so that maybe we can address it, and reduce its harmful effects. 
 
To answer your questions, as you may know from my website, I specialize, as I have for the past 19 years, in working with gay men — either individuals or couples — as well as those living with HIV.  I was the co-chair, for 9 years, of the Los Angeles County HIV Mental Health Task Force, helping other mental health professionals to effectively work with, empower, and advocate for their clients.  I helped co-write the Standards of Care document for LA County HIV mental health services for all non-profit agencies receiving funding under the Ryan White CARE Act, a federal funding program to help people with HIV/AIDS to get free case management, counseling, treatment education, peer support, and home health care, named for Ryan White, a young 8-year-old boy who died of AIDS in the late 80′s, after winning a well-publicized right to attend school, after ignorant classmates, parents, and school officials cruelly tried to force him out. His mother, Jeanne, still speaks at schools, churches, and conferences all over the world, about her experience losing her son to AIDS and trying to explain to him why people were so hostile to him.  I also co-chaired the annual “Coping with Hope” HIV Mental Health conference for 9 years, and spoke at many of them, on issues such as how to help people who are both living with HIV and coping with psychiatric disorders like Major Depression or Bipolar Disorder, or addictions.  These conferences were to help those who were ignorant about HIV issues to become educated, so that they could be sensitized and less judgmental.  I’ve also spoken several times at NSWAN, the National Social Work AIDS Network.  And for two years, I was a monthly mental health columnist for A&U, America’s AIDS Magazine.  You get the idea. 
 
So, how can I counsel you and your partner when you are HIV-negative?  Because I understand and work with a wide variety of gay men, including those who have differences from me — whether it’s HIV status, ethnicity, age, country of origin, religion, relationship status (I am legally married to an HIV-negative guy, and we’ve been together for 8 years), socioeconomic status, zodiac sign, political affiliation, and so on.  The differences between client and therapist have been studied extensively, and the main conclusion of these studies has been that it is the relationship between client and therapist that has the most impact on positive therapeutic outcomes, regardless of differences, or even the theoretical orientation the therapist uses. 
 
That’s great you have strong moral beliefs.  I do, too — so that wouldn’t be a difference for us, per se, but perhaps the actual content of our moral beliefs might differ.  I believe, generally, in approaching people with a spirit of generosity and goodwill.  From the tone of your note, we might differ on that.  People who are HIV-positive do not lack “moral beliefs”; that’s a cruel stereotype and accusation that has been used to discriminate against people with HIV/AIDS since the beginning of the epidemic.  That’s also something I have spent great effort – many hours, many days, many articles, many conversations — trying to fight.  People living with HIV have morals such as fortitude, courage, compassion, resilience, stamina, gratitude for life, the ability to overcome fears, and the determination to fight hard against the harmful effects of ignorance, intolerance, and stigma wherever they encounter it.   
 How can I counsel you with “indiscretions” and “carelessness”?  I’m not perfect.  Therapists are not perfect, and it is folly for them to present themselves to be.  The difference, perhaps, is how we cope with our imperfections, with realism, bravery, humility, courage, creativity, and determination.  I am middle-aged, and so of course I have things in my past that I regret that have hurt others.  I don’t see the circumstances of my HIV transmission as being “careless”; I was very young, and I was perhaps ignorant at the time of how extensive the epidemic had become to us “young guys” at the time.  The reason I got tested was because a friend who was my age at the time (26) tested positive, who was my best friend growing up in Fairfax, Virginia, who was my first love in high school (though we never had sex).  And, I figured, that if someone as young as him could be infected, I could be, too, and not know it.  So, I tested, and indeed I was positive, but his “T-cell” count was much lower than mine, and eventually he passed away at age 34 in 1998.  I still miss him, even though he, like you, could be very hurtful when he got angry, and he got the most angry when his great love, Fernando, a beautiful Latin guy from Uruguay, died of AIDS at age 34 in 1996, after their many happy years together. 
 
How can I counsel you, then?  Because a therapist must keep many “discretions” — all that we discuss in my office is confidential, as are the records I keep, according to strict guidelines.  On Wednesday, November 3rd, it will be exactly 20 years since I first tested positive.  I remember the day very well.  I was upset that day, of course, and I went to my friend’s place and we watched “Tales from the Crypt” on VHS video.  Most people with HIV remember well the day they were diagnosed.  It’s not something you forget easily. 
 
I’m confused when you mention you and your partner’s “HIV-negative lifestyle”.  What is, exactly, an “HIV-negative lifestyle”?  Do you eat?  Pee?  Poop?  Work?  Do chores? Have sex?  Vote?  Watch TV?  Have dreams, goals, hopes, and dreams?  Fears, frustrations, annoyances, and worries?  How would any of these differ from whatever an “HIV-positive lifestyle” is?  
 
You asked why my “website and Facebook picture are over 20 years old”.  How would you know?  Do you somehow see me often in person?  Your name isn’t familiar.  This doesn’t make sense; are you sure you’re not coping with a delusional psychosis as well as anger?  My website is changed almost daily, including today, as a dynamic and ever-changing professional website presence.  So, of course, it is not “20 years old”.  The same with my Facebook picture, which, if you’re referring to the one on my fan page on Facebook or on my website home page, was taken a little more than two years ago (that’s not 20; that’s off by ten-fold), and my current personal profile picture was taken at a gathering of friends just last Friday night.  You asked to let you know, so I have.
 
I’m not a young man anymore, and I don’t look like one.  I don’t look as attractive as perhaps I might have been 20 years ago.  Years of HIV-related lipoatrophy, expensive reconstructive treatments, physical hardships, and late nights working on articles and advocacy projects have made their presence known on my face.  My guess is that you are quite young, and while I could explain more, Time itself will have its own way of explaining it all to you in its own good, well, “time”, when you will understand exactly.  Trust me on that. 
 
I do appreciate that your signed your letter “sincerely”.  I am responding sincerely.  I am sorry that whatever is bothering you, and perhaps you with your partner, has motivated you to write what you wrote, and indeed, how you wrote it.  I’m not sure if you intended it to be insulting and hostile; my guess is that you did, and it somehow makes you “feel” more empowered, and a little less scared, to take that approach.  So I respond with perhaps a bit of the same, frustrated as I am with over 20 years of witnessing ignorance, hate, intolerance, and fear from others, with their stigmatic fear of HIV.  It’s all been cruel.  It’s been deadly.  And it’s all been infuriatingly unnecessary.  But I’ve also seen in these decades of HIV/AIDS epidemic grace, sacrifice, tireless work, commitment, patience, and profound – even divine – love — as evidenced by things like the 30,000 walkers in this year’s AIDS Walk LA, raising over three million dollars, benefiting AIDS Project Los Angeles, where I was a “phone buddy” volunteer in 1990 when I decided to go to graduate school and become a therapist, and help those in need.  I didn’t have a choice; I felt I was compelled to help my brothers in their hour of need.
 
That’s why, at 12:59 a.m., when I am tired from a long day of seeing clients, and worrying over election results about people who might bring hate, fear, and hostility in abundance to our national and local governments – that I write this to you, and to answer your questions.  Because as tired as I am (fatigue is my most common HIV-related symptom) I believe you are in need, and you are in as much fear now as the men I counseled on the phone as a volunteer for AIDS Project Los Angeles in 1990.  They needed my compassion, and my help, as best as I could give.  That’s what I do. 
 
In answer to your questions, that’s how I help couples like you and your partner, even as a “careless” HIV-positive person.
 
Good luck.
Posted in Blog: Musings on Current Events, HIV: Living Successfully, Life Changes | Tags: , , , , , , | No Comments »

Inspiration from Music: Dolly Parton's "Better Get to Livin'"

September 22, 2008 | Author khoward

In my work as a psychotherapist and life coach, I am always grateful for the many and varied sources of inspiration that come my way.  The latest uplifting piece of material I’ve come across is in music, in a relatively new song by country/pop star Dolly Parton, well-known by her fans and her colleagues for being so cheerful that she refers to herself as the “Dolly Lama” for being asked for her advice on how she keeps her perennially-positive attitude.  Summarized in a song, “Better Get to Livin’”, (from her new CD, “Backwoods Barbie”) and featured in her new Broadway-bound musical version of “9 to 5”, opening soon in Los Angeles, Dolly describes her philosophy, available at iTunes.com or at http://www.dollyon-line.com/archives/lyrics/better_get_to_livin.shtml.  The lyrics go like this:
: 
“You better to get to livin’, givin’, Be willin’ and forgivin; ‘cause all healin’ has to start with you.  You better stop whinin’, pinin’, Get your dreams in line, and then just shine, design, refine til they come true —  and you better get to livin’.”

As simple as these words are, they reveal a similar philosophy about self-empowerment that I often teach my clients as I encourage them to identify, call forth, strengthen, and implement the skills of coping they need to face life’s challenges head-on.  One of the best strategies for any challenge is to adopt as relentlessly positive an attitude as you possibly can, even if that’s hard to do.  Earlier this year, when I was facing Total Hip Replacement surgery of my left femur bone joint in my left leg due to HIV-related Avascular Necrosis (crumbling bone), I took this attitude to prepare for my surgery.  I worked out extra-hard the week before the surgery so that I would be in peak shape for my subsequent recovery and physical therapy.  I was grateful for the not-so-bad hospital food, for the cute physical therapist, for the silly word games my fiancé played with me to pass the time, and for the nurses who took good care of me, I believe, in part due to the relentlessly polite and positive approach I gave them (I wanted them to be happy to answer my buzzer!).  Later,  I undertook my physical therapy not as a chore, but as a joy that the exercises would restore me to full athletic physical functioning — which they did, after only 12 weeks of consistent and diligent work.  I don’t think it would have gone as fast or as well if I hadn’t been practicing Dolly’s advice — and this was before I learned about her song! 
In daily practice with clients, I will often quote an inspirational song, story, script, or poem that I think might help them, or ask them to see if they can draw inspiration from a piece of music or literature that inspires them.  Getting inspiration from the materials we are exposed to, and applying that material to challenging situations, is one aspect of emotional coping with the challenges that life inevitably tosses into our path. 

Dolly’s song goes on to suggest that if “your life’s a wreck, your house is a mess, and your wardrobe’s way outdated, all your plans just keep on fallin’ through; overweight, underpaid, under-appreciated — I’m no guru, but I’ll tell you, this I know is true:  You better to get to livin’, givin’, a little more thought about bein’ a little more willin’, to make a better way — Better start carin’, sharin’, tryin’, smilin’ — the day we’re born, we start to die, don’t waste a minute of this life — get to livin’.”  All of these “in” verbs are a motivating list of how we need to jump-start our self-empowered attitudes.  If something isn’t right, reach deep down into yourself and ask, “What do I need to evoke in myself to make things better?”  Or, “What do I need to ask of others to make things better?”  Knowing the internal resources we need (motivation, assertiveness, stamina, self-respect, effort, belief, inspiration, compassion) and the resources from others (information, elbow-grease, wisdom, time, compassion, faith, trust, courage, patience) helps us to assemble the tools we need to make change.  Applying our resources — plus those we borrow from others — is  what makes change in our lives.

Dolly’s more religious side suggests, “If it gets too rough, fall on your knees and pray — and do this every day.”  For non-religious but perhaps more spiritual people, maybe it’s about meditating, concentrating, releasing, and believing.  For people in AA, it’s about “giving it up” to a God of their understanding, or to their Higher Power.  Sometimes, when it gets real rough, our spirituality has to augment all the resources that are within us and those near us.  The anniversary of 9/11/01 comes to mind, or when things happen that seem to take all that we can give — and then some.  When we really stretch at those times, we grow. 
Lots of song lyrics can inspire us, and other materials that I can explain in therapy or coaching.  What songs inspire you?  Get to listenin’ — and get to livin’ — so that you, too, can Have The Life You Want!

Posted in Health/Illness Management, HIV: Living Successfully, Life Changes, Life in West Hollywood/LA, Life Skills, Motivation, Stress Management | Tags: , , , , , , | No Comments »

Worried Mom

March 24, 2008 | Author khoward

Dear Ken,My son is 26 years old, and I’m his mother. I live in a suburb of a major American city. My son just told me he is HIV-positive. How do I respond to this? I love my son, and I want him to be happy and healthy, but I’m just now sure “how” to react. Any advice?Signed, Worried Mom

Dear Worried Mom, Read the rest of this entry »

Posted in Family Conflict, HIV: Living Successfully | No Comments »

From the Los Angeles Times – Letters to the Editor:

September 17, 2005 | Author khoward

Dear Editor:

Regarding the LA Gay & Lesbian Center’s new “HIV is a Gay Disease – Own It, End It; social marketing and advertising campaign (“HIV Ads Embrace, and Stun, Audience” (Sharon Bernstein, September 30): As a gay man living with HIV since 1990, and since that time working in HIV mental health and social services in various community agencies (including the LA Gay & Lesbian Center), and as currently a psychotherapist in private practice specializing in serving gay men, including many living with HIV, I am deeply offended by this campaign. I find this campaign heinous as much for what it isn’t as for what it is. It is a throwback to the early days of the AIDS crisis when anti-gay forces in this country used AIDS as “justification” to hate and discriminate against the entire gay community, without realizing that AIDS is a disease caused by a virus that can strike anyone – Read the rest of this entry »

Posted in Gay Political Advocacy, HIV: Living Successfully | No Comments »

How to Have a ‘Magnetic’ Relationship: You’re Neg, He’s Poz – Now What? (Part 2 of 2)

April 9, 2005 | Author khoward

In part I of this article, I described some of the very practical HIV transmission risk management issues involved in sex between HIV negative and positive guys. Other issues that often confront “magnetic” or “serodiscordant” couples include not fully understanding the burden that HIV is to your partner, and being only partially able to sympathize and “relate” with his various fears, frustrations, and symptoms. Read the rest of this entry »

Posted in Dating Successfully, Gay Relationships, HIV: Living Successfully | No Comments »

How to Have a ‘Magnetic’ Relationship: You’re Neg, He’s Poz – Now What? (Part 1 of 2)

April 5, 2005 | Author khoward

You’re on your third date with someone who very well could be Mr. Right. You’re impressed that you got him to go to your favorite restaurant when you weren’t sure he would like it. You’re staring across the candle-lit table at those beautiful green eyes of his. He pauses and then takes a deep breath, a little sigh, and says, “So… I guess I should tell you that I’m HIV-positive.” Read the rest of this entry »

Posted in Dating Successfully, Gay Relationships, HIV: Living Successfully | 1 Comment »

Educated… UB2

March 15, 2005 | Author khoward

Recently I was browsing through online personal ads in various online services for gay men. I was surprised at how often the term “UB2” came up. This is an appreviation for, “You be, too!”, in reference to a negative HIV status. It seems to say, in those succinct three characters, Read the rest of this entry »

Posted in Gay Political Advocacy, Gay Relationships, HIV: Living Successfully, Life in West Hollywood/LA | 1 Comment »

Tsk, Tsk: People with HIV are being disempowered in ways they don’t even know

February 11, 2005 | Author khoward

After recently shifting my focus after 10 years of working with non-profit HIV and mental health social service organizations, I’ve been reflecting on both the positive – and negative – things that I witnessed. With the re-election of President Bush and a Republican majority in Congress, social services and other “liberal” institutions are certainly out of favor and have come under fire as a low priority for the American public and taxpayers. Read the rest of this entry »

Posted in Gay Political Advocacy, HIV: Living Successfully | No Comments »
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