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Position Statements
A current record of standing for ACT on issues impacting the health and well-being of people living with HIV and AIDS and those at increased risk of HIV.
ACT position statements
Below are ACT's position statements. These tackle a single issue and articulates ACT's viewpoint around it. Position papers exist around issues that impacts and/or is related to the agency's programs, services, strategic goals, mandate and/or mission.
Feedback or comments on where ACT stands? Get in touch with ACT's Communications Coordinator at email@example.com.
Friday, June 26, 2020
ACT continues to stand in solidarity with Black Lives Matter, and people in Toronto and around the world that are protesting anti-Black racism, systemic oppression, and racism towards Black, Indigenous and People of Colour (BIPOC).
It's important for us, not only as individuals, but as an organization, to strongly reject and dismantle racism and discrimination in all its forms. The relationship between police and LGBTQ2+ people and BIPOC has been one-sided, with these marginalized communities often facing violence and even death at the hands of the police.
Out of respect for these important issues and planned demonstrations scheduled for Pride this Sunday, June 28th, ACT has decided to cancel its Virtual Pride and AIDS Walk Kick-Off previously scheduled for Sunday at 1 pm. A rescheduled AIDS Walk Virtual Kick-Off date will be forthcoming.
We invite you to remain with Pride Toronto to enjoy the Virtual Pride Parade at its new time of 12 - 1:30 pm. Please visit https://www.pridetoronto.com/virtualpride/virtual-pride-parade/ for more information.
ACT encourages members of our community to join us at the sit-in rally planned for Nathan Phillips Square Sunday from 2 – 6 pm and for the Rally on Abolishing the Police. Please remain safe and adhere to physical distancing guidelines due to COVID-19.
ACT implores LGBTQ2+ people worldwide to join the fight for racial and economic justice and fight against oppression. Let us not forget that Pride began as a protest against police brutality and injustices LGBTQ2+ people faced and was led by Black and Brown trans women. They demanded fundamental rights and freedoms to live proudly without fear and violence. The fight against systemic oppression and anti-Black racism is also our fight - as is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination.
Tuesday, June 2, 2020
In Solidarity with Black Lives Matter
ACT stands in solidarity with Black Lives Matter and protesters demanding justice, including the prompt arrest and fair trial of law enforcement personnel. We also call for wide-ranging, progressive reform to policing as well as to the racist and broken criminal justice system and other systemic barriers that disproportionately affect Black communities.
As we head into this Pride month, ACT implores LGBTQ2S people worldwide to join the fight for racial and economic justice and against oppression in all its forms. For over 50 years, Pride has commemorated the Stonewall riots in New York, which were led by Black and Brown trans women protesting police brutality. They demanded fundamental rights and the freedom to live without fear and violence. Now, a half a century later, and in the face of the COVID-19 pandemic, we must continue that fight in the spirit of solidarity. Let us not forget that Pride began as a protest against police brutality and the injustices LGBTQ2S people faced. The fight against systematic oppression and anti-Black racism is also our fight. As is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination.
These systems and structures have been broken for generations, and it can feel impossible to address as an individual. Through collective action, these systems can begin to be addressed and dismantled. It is important for us to amplify Black voices and for allies to listen, support and advocate, and to unlearn problematic biases and behaviours and be critical of our actions. On an individual level, here are some ways that you can take action and make a difference:
March 16, 2020
Dear ACT Community,
Today the ACT Management team met again to discuss ways in which we can strategize and plan to minimize exposure and help contain the spread of the COVID-19 virus. These measures are about prevention, not to increase panic or fear related to COVID-19.
Based on local trends and communications from public health, and the message from the Prime Minister, ACT is shifting to have all ACT staff working from home starting Tuesday, March 17th. We will be closing today (Monday) at 6 pm.
ACT's offices will be closed to the public until further notice; however, you can still connect with staff via phone or email. Staff will be regularly checking their voicemail and their email remotely and will respond to service users in a timely manner.
We will continue to monitor the situation and updates will be posted to the ACT website (www.actoronto.org) as well as on our social media feeds on Facebook (www.facebook.com/ACToronto/), Twitter (www.twitter.com/ACToronto) and Instagram (www.instagram.com/aidscommitteetoronto).
We understand that these are unprecedented times and that this can be confusing and stressful: but nothing is more important to ACT than the health of our service users, community members, staff, and volunteers.
John Maxwell
Executive Director
March 13, 2020
Dear ACT Community:
With the World Health Organization (WHO) declaring COVID-19 a pandemic, ACT is committed to taking proactive steps to respond to this growing community health concern. While Toronto Public Health has not declared community spread with COVID-19, ACT is working to play its part for the safety of service users, staff, volunteers and community.
Like other agencies in the community, ACT has moved to Stage 2 of its Preparedness Plan. We will be stepping up the frequency of cleaning and disinfecting of spaces within ACT including:
- Disinfecting surfaces within the Public Access Centre every hour
- Disinfecting of public computers and telephone after every use
- Service users are being asked to use hand sanitizer upon entering and exiting the ACT offices.
The following programs will be impacted beginning Monday, March 16th:
- Bathhouse counselling services will be postponed until further notice
- All group programming will be postponed until further notice
- All lunch programs (out of Dixon Hall) will be postponed until further notice
- Sexual health and harm reduction outreach in bathhouses and at bars/clubs/events will be postponed until further notice.
The following programs will proceed as normal, including:
- Intakes for new service users
- Counselling services at Church-Wellesley and Maple Leaf Medical Clinics
- Counselling services at ACT
- Income Tax Clinic
- Employment Services
We will be implementing a screening procedure for all visitors to the 4th floor of 543 Yonge Street.
Should you feel unwell and/or experience symptoms such as fever, sore throat, coughing or body aches, you are discouraged from coming into ACT for programming or support. You're asked to communicate with your ACT staff contact to make alternative arrangements for your care and support, which could include support over the phone.
It is recommended that the ACT community continue to follow appropriate health activities:
- Wash hands regularly with soap and warm water for at least 20 seconds.
- Do not touch your face, and cough and sneeze into your sleeve if you do not have a tissue.
- Have extra food on hand at home should you be required to self-isolate.
- Ensure that you have an adequate supply of all medications (including HIV medications and PrEP).
The following are some additional resources related to COVID-19:
Please let us know if you have any questions, comments, or concerns.
Thank you,
John Maxwell
Executive Director
Queering Sexual Health Services in Toronto
Excerpt from Sex, Stigma, and Healthcare Systems: Community consultation series – Final report (2019)
Mike Smith I ACT
April 2019
From June 2018 to November 2018, 45 community consultation informants described barriers to healthcare impacting their ability to access services in Toronto. Some informants' perceptions of healthcare services are positive, yet the majority of informants have had negative experiences and perceive elements of health services as problematic, especially sexual health services. With sexually transmitted and bloodborne infection (STBBI) transmission rates continuing to rise among cis and trans gay, bisexual, and queer (GBQ) guys[1], there is an urgency to adapt Toronto sexual health services to address population needs.
In our interviews, informants faced difficulty and distress when accessing sexual health services. Efforts to access adequate care often results in experiences of anxiety, shame, and discomfort. Informants expressed a perceived need for designated queer spaces and specialized services to address GBQ culture, experiences, and unique healthcare needs. As stated by Levesque, "health services should respond to the population's characteristics to ensure the people's capacity to use the services when facing need for care."[2] This suggests that healthcare systems and services should be adapted to address specific healthcare barriers among diverse populations; and that services designed to serve members of the general population may be inherently less effective in serving the needs of cis and trans gay, bisexual, and queer guys.
The 6 Cs for improved healthcare access:
Informants offered many suggestions on how to improve access to services. These priorities can be summarized into the 6 Cs for improved healthcare access. This approach outlines informants' perceived needs for improved experiences when interacting with healthcare services (see Figure 1):
Convenience – Make services easier to access
Increase service hours, schedule service hours during evenings and weekends, and open new spaces outside of the downtown core. Reduce wait times by introducing self-administered intake and risk assessment forms. Provide more drop-in services rather than exclusively appointment-based services. Allow service users to wait in spaces other than crowded waiting rooms if long wait times persist.
Comfort – Make services more enjoyable to access
Balance efficient operations with exceptional customer service to reduce service users' feelings of anxiety, fear, and shame. Use patient-centred communication strategies that demonstrate compassion and empathy. Create a warm and inviting atmosphere with soothing imagery, open space, natural lighting, and calming sounds. Eliminate shame-inducing health education and counselling approaches.
Cultural connection – Make services more relevant
Design services to align with the values of diverse service users. Design services that respond to the distress preventing folks from accessing services. Ensure the imagery and staffing reflect this diversity. Invoke a sense of belonging and safety in clinical spaces for underserved populations such as racialized and gender-diverse folks. Demonstrate high levels of knowledge (or demonstrate an intention to learn) to increase perceptions of service suitability. Prepare staff to communicate using trans-inclusive language.
Choice – Make services more empowering
Empower service users to have an increased element of self-determination when accessing services. Offer multiple types of tests, types of counselling and education methods, types of support services made available, types of treatment plans, and so on. Considering that some service users may not feel comfortable reporting certain behaviours during screening or risk assessments, increase flexibility when determining eligibility for services.
Confidentiality – Make services more private
Make every effort to create discreet and private services. Provide anonymous services when possible and protect service users' identities for non-anonymous services. Design clinical spaces to address service users' privacy concerns; for example, consider having multiple wait rooms or private spaces for intake meetings.
Communication – Make services more well known
Produce promotional materials that engage specific sub-populations. Create multi-media health education campaigns for underserved populations, including folks who use substances, sex workers, and Two-Spirit folks. Measure the reach of these campaigns to indicate strengths and areas of improvement for communication strategies. Provide detailed information about testing and treatment protocols, clinical processes, how personal information will be stored, and so on.
For a thorough description of these findings, please refer to Sex, Stigma, and Healthcare Systems: Community consultation series – Final Report (2019), available soon at www.actoronto.org.
Toronto healthcare service agencies (and agencies throughout Canada) are encouraged to apply these findings and discover new opportunities to improve healthcare access for existing and prospective service users.
[1] Toronto Public Health (2017). Sexually Transmitted and Bloodborne Infections. Communicable Diseases in Toronto.
[2] Levesque, J., Harris, M., Russel G. (2013). Patient-centred access to health care: conceptualizing access at the interface
of health systems and populations. International Journal for Equity in Health, 12(18).
Tuesday, November 20, 2018
Trans Rights Are Human Rights.
Today is Trans Day of Remembrance and we want to let our trans community know that their gender identity matters, and we have your back. While Premier Doug Ford has stated publicly that he has no intention of moving forward on the Ontario PC Party resolution, which was passed at the party convention this past weekend (which stated that gender identity was a "Liberal ideology" and that references to gender identity should be removed from the Ontario sexual health education), it's disturbing to know that in 2018, such views are held by a major political party. We've already seen this government roll back the update to Ontario's sexual health education curriculum. This will have damaging effects on students as they will no longer be supplied with the knowledge they need about consent, online sexual harassment, bullying and sexual health education inclusive of those in same gender relationships. To suggest that gender identity is "not real" is deeply rooted in transphobia.
Trans people continue to face violence, and not recognizing their gender identity is a form of violence. The passing of this resolution is a fundamental attack on the rights of queer and trans people and their rights. Because trans rights are human rights.
We at ACT want to let our trans family know that we see you. Your gender identity matters and we will continue to fight with you for your right to self-identify.
We kindly ask our community to continue speaking up and standing up against transphobia, homophobia and other oppressive behaviours.
There is no pride in policing.
The police should not be allowed at the Pride parade. At least not yet.
Pride started as a protest against the police and their raids on Toronto bathhouses in the early 1980s. ACT was formed 35 years ago by a group of activists and allies from the LGBTQ community to fight for our lives and the lives of people living with HIV and AIDS. Pride became a platform where we expressed our resistance and our collective rage towards institutions that continued to discriminate against us, as men in our community were dying.
We remember our history and our roots. We haven't forgotten about the violence queer people – especially queer, trans, disabled, Black, Indigenous and other people of colour - have experienced and continue to experience today, including from the police. This is why ACT needs to express our disappointment with Pride Toronto. We believe that the decision to allow uniformed members of the Toronto Police Services to apply to march in the 2019 Pride Parade has been made prematurely and without meaningful consultation with the community.
What improvements have the Toronto Police Services made over the past two years to establish a better relationship with the LGBTQ community? Let us not forget the bathhouse raids in 1981, the Pussy Palace raid in 2000 and Project Marie in 2016, when the police focused resources to arrest men in a Toronto park at the same time they were "expressing regret" for the bathhouse raids and dedicating a mural in the Church Street Village. Remember the missing and murdered members of our community including Sumaya Dalmar and Alloura Wells, Tess Richey, Selim Esen, Abdulbasir Faiza, Majeed Kayhan, Kirushna Kanagaratnam, Andrew Kinsman, Dean Lisowick, Soroush Mahmud and Skandaraj Navaratnam, whereby the police failed to respond to the community's concerns.
Let's also remember the HIV-phobic comment that was made by the police in 2017 when they tasered a man who was already restrained, while telling bystanders that "he's going to spit in your face and you're going to get AIDS."
The fight against systematic oppression and anti-black racism is also our fight. As is our fight against homophobia, transphobia, heterosexism and HIV-related stigma and discrimination.
Our work in preventing new HIV infections and supporting those living with HIV involves working with diverse, marginalized communities including diverse groups of women, non-binary folks, and cis and trans gay, bisexual, and queer guys.
We call for both meaningful engagement with our diverse communities, and concrete actions to build trust between the community and the Toronto Police Services before allowing uniformed members of the service to march in the Pride parade.
Introduction to issue:
People who inject drugs are more vulnerable to acquiring hepatitis C and HIV. In Toronto, people who inject drugs have also been dying from overdoses at an increasing rate. Harm reduction distribution and establishing integrated supervised injection services are effective public health tools for reducing the spread of HIV and hepatitis C, and preventing unnecessary deaths from overdoses. For these reasons, ACT fully supports Toronto establishing comprehensive harm reduction services that protect people who inject drugs and affirms their right to healthcare services.
Background + context:
In 1989, and in the face of ardent opposition from the police, Toronto Public Health began offering unused injection drug gear as part of a new needle distribution program called the Works. The program was initially set up in direct response to high rates of HIV and AIDS among people who inject drugs.
Toronto Public Health's Harm Reduction Distribution Program has since expanded to cover many areas of the city and has been highly effective at preventing HIV from spreading. It has been found that the prevalence of HIV among people who inject drugs is approximately 3%, one of the lowest among major North American cities. However, upwards of 70% of people who inject drugs in Toronto were living with hepatitis C.1
In 2012, St. Michael's Hospital and the University of Toronto published the results of a feasibility study into supervised consumption sites in Toronto. The authors recommended that Toronto "would benefit from implementation of supervised injection facilities" and that "the optimal model" for such sites was a "fixed facility that is integrated within an existing organization."2 In 2017, the City of Toronto Public Health Department approved three supervised injection sites to be located at Public Health (The Works), Queen West-Central Toronto Community Health Centre, and South Riverdale Community Health Centre. These agencies are three of the busiest needle distribution programs in Toronto and together they distribute almost 75% of sterile needles in Toronto. 3
Between 2004 and 2015 (the most recent figures available), deaths resulting from overdoses increased by 73%, from 146 to 253. When looking specifically at deaths from accidental overdose, the numbers have jumped by more than 149%, going from 82 in 2004 to 204 fatalities in 2015. The reason for such a rise is understood to be an increase in the prevalence of narcotics such as fentanyl and heroin. 4
Toronto's Overdose Action Plan (2017) outlines 10 recommendations, two of which are related to the work of ACT; Recommendation #2: Overdose Protocols and Naloxone, and Recommendation #9: Social Factors. ACT is committed to meeting these recommendations through its policies and procedures, resources, and by training its staff.
ACT supports equitable access to life-saving health services for all people living with and affected by HIV and AIDS, including people who inject drugs. We acknowledge that some people who inject substances may not be ready, willing, or able to begin treatment to reduce their use. For this, we encourage all proposed and future supervised injection sites to offer a range of supports to help care for people who use drugs who struggle with addiction, HIV and AIDS, hepatitis C, mental health challenges, and other physical sickness.
ACT believes in the benefit of comprehensive harm reduction strategies for all groups living at increased risk for HIV and hepatitis C, including safer sex tools, harm reduction distribution, safe injection sites and procedures for responding to an overdose.
1. http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 11.
2. http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 14.
3. https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=f998163207663510VgnVCM10000071d60f89RCRD
4. Toronto Public Health, Toronto Overdose Action Plan: Prevention and Response (March 2017) page 4.
A growing body of evidence demonstrates that people living with HIV who are able to attain and maintain an undetectable viral load will not pass the virus on during sex, regardless of whether condoms were used. Given this breakthrough, ACT is confident in the use of effective HIV treatment as a reliable form of HIV prevention.
ACT's position rests upon evidence from two scientifically and statistically sound, large-scale research studies. Together, they have demonstrated the effectiveness of HIV treatment and undetectable viral loads at preventing HIV transmission.
The HPTN 052 study first reported interim results in 2011 and final results in 2015.1HPTN 052 compared the rates of HIV transmission between serodiscordant (mixed HIV status) couples. In one group, the HIV-positive partner waited to start HIV treatment after being diagnosed. In the other group, the HIV-positive partner began HIV treatment upon learning of their diagnosis.
Takeaways from HPTN 052:
- beginning HIV treatment upon learning of a diagnosis reduced the risk of onwards transmission by 96% compared to people who were HIV-positive but not on treatment
- the study was interested in the effects of antiretroviral treatment more broadly on HIV transmission risk, not just people who attained an undetectable viral load
- the study looked only at heterosexual transmission risk; it did not investigate HIV transmission risk through anal sex among serodiscordant (mixed HIV status) MSM couples (men who have sex with men)
The PARTNER study reported interim results in 2014 and published final results in 2016.2 PARTNER looked at the risk of HIV transmission when a person's viral load had been rendered undetectable. The criteria used to qualify as undetectable was a viral load below 200 copies/ml of blood.3 Participants included serodiscordant heterosexual and MSM couples having condomless anal and vaginal sex. With a combined but approximate 58,000 sex acts reported, there was no linked HIV transmission between couples.
Takeaways from PARTNER:
- effective HIV treatment lowers the viral load in many people living with HIV to undetectable levels, and an undetectable viral load renders the risk of transmitting HIV to effectively zero
- some participants were removed from the study because their viral load ceased to be undetectable and did not return to being undetectable
- some participants' viral load briefly rose but then returned to undetectable levels. They were kept in the study and did not transmit HIV despite a temporary rise in their viral load4
- the presence of an STI did not impact the risk of transmission for a person living with HIV when accompanied by an undetectable viral load5
What These Results Mean:
The results of these studies attest to the truth and power of treatment as prevention. A Canadian-born strategy, it improves the health of people living with HIV, reduces the stigma surrounding HIV, and dramatically reduces the risk of HIV transmission.6 This new research should be embraced and celebrated. It should also serve as further motivation to ensure all people living with HIV in Canada and around the world have access to HIV treatment and the supports to remain adherent.
The results of these studies are definitive but that does not mean there are not considerations. The authors of the PARTNER study report a 95% confidence limit to its data and explain that "with eligible couple-years accrued so far, appreciable levels of risk cannot be excluded, particularly for anal sex and when considered from the perspective of a cumulative risk over several years."7 If concerned about STIs or pregnancy, an undetectable viral load is not applicable and other safer sex methods should be used.
ACT also recognizes that for some people living with HIV, attaining and maintaining an undetectable viral load may not be possible. Reasons for this are complex and relate to both treatment access, treatment effectiveness and personal health challenges. As a result, we understand the benefits of an undetectable viral load to be absolute but further work is required to extend the benefits to as many people living with HIV as possible. While HIV treatment will not always yield an undetectable viral load, it can consistently lower viral loads and generate a host of benefits to the overall health and well-being of people living with HIV.
ACT is dedicated to strengthening the health and well-being of the communities it works with, and recognizes its role in communicating the benefits and limitations of emerging HIV treatment and prevention technologies. We will continue our tradition of challenging HIV-related stigma and commit to achieving our vision of a Toronto with zero AIDS-related deaths and zero new HIV infections. Treatment as prevention and undetectable viral loads are crucial to securing this optimistic future.
1. Cohen MS; Chen YQ; McCauley M; et al. (August 2011). "Prevention of HIV-1 infection with early antiretroviral therapy". N. Engl. J. Med. 365 (6): 493–505.
2. Rodger AJ, Cambiano V, Bruun T, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316(2):171-181.
3. This is a significantly higher threshold than in Canada, which defined undetectable as a viral load below 50 copies/ml of blood.
4. Rodger, Cambiano, Bruun et al, "Sexual Activity Without Condoms," 177.
5. Rodger, Cambiano, Bruun et al, "Sexual Activity Without Condoms," 179.
6. Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, Harrigan PR. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006 Aug 5; 368(9534):531-6.
7. Rodger, Cambiano, Bruun et al, "Sexual Activity Without Condoms," 179.
This paper was originally published in October, 2012. To ensure its accuracy, updates have been made as new data surrounding the efficacy of and access to PrEP emerge.
The AIDS Committee of Toronto (ACT) supports the introduction of innovative strategies that help to reduce the transmission of HIV, including Pre-Exposure Prophylaxis (PrEP).
ACT believes that PrEP should be a part of a comprehensive approach to HIV prevention that includes access to condoms and lubricants, risk reduction counselling, information provision, the scale-up of social and behavioural interventions, access to regular and voluntary HIV and STI testing, community development activities, as well as the development of other biomedical interventions such as mircobicides.
While PrEP is not licensed for use in Canada as an HIV prevention method, it is being prescribed "off label" for these purposes. ACT encourages the implementation of PrEP in Canada and welcomes further research to inform individuals, communities and health care providers regarding its use as an HIV prevention technique. ACT is concerned about the costs associated with accessing PrEP off-label in Canada and encourages its coverage under both private and public drug plans.
In July 2012, the US Food and Drug Administration (FDA) approved the licensing of the anti-HIV medication Truvada for PrEP, and have developed guidelines for PrEP eligibility and implementation1. Truvada's safety and efficacy for PrEP were demonstrated in two large, randomized, double-blind, placebo-controlled clinical trials: The iPrEx trial evaluated Truvada in 2,499 HIV-negative gay men or transgender women who have sex with men with evidence of high risk behaviour for HIV infection, such as inconsistent or no condom use during sex with a partner of positive or unknown HIV status, a high number of sex partners, and exchange of sex for commodities. Results showed Truvada was effective in reducing the risk of HIV infection by 44 percent compared with placebo in this population. Efficacy was strongly correlated with drug adherence in this trial: in a sub-study that measured Truvada drug levels in participants, comparing those with drug measured in their blood (i.e. those that were adherent with their medications) to those with no drug measured in their blood (i.e. those that were non-adherent), the effectiveness of reducing the risk of HIV infection rose to 92 percent.
The Partners PrEP trial was conducted in 4,758 heterosexual couples where one partner was living with HIV and the other was not (serodiscordant couples). The trial evaluated the efficacy and safety of Truvada and Tenofovir versus placebo in preventing HIV infection in the uninfected male or female partner. Results showed Truvada reduced the risk of becoming infected by 75 percent compared with placebo.
As these large-scale trials continue to develop, the efficacy of PrEP, when taken daily, is being shown to reduce the transmission of HIV by over 90% and as high as 99%.
PrEP was also endorsed by the World Health Organization (WHO) for use among men who have sex with men that may be at higher risk for HIV infection in July 2014 2.
According to the FDA, "Truvada for PrEP is meant to be used as part of a comprehensive HIV prevention plan that includes the following:
- HIV risk reduction counselling
- consistent and correct use of condoms
- regular HIV testing (at least every three months)
- screening and treatment for sexually transmitted infections (STIs)."
Truvada will not prevent the transmission of other STIs including syphilis, gonorrhea and chlamydia. Some STIs increase the likelihood of HIV infection. Regular STI testing and treatment is therefore integral to the use of PrEP.
When used as PrEP, Truvada should be taken every day in people who are confirmed to be HIV negative. The FDA warns that when used as PrEP, Truvada must not be prescribed to patients whose HIV status is 'unknown' (ie. they have not been tested for HIV) or who are HIV-positive (as this could lead to the development of drug resistance as Truvada is always prescribed in combination with other anti-HIV medications for those who are HIV-positive). The FDA encourages physicians to test their patients who use PrEP for HIV at least every three months.
Truvada is not approved in Canada or other countries for use as PrEP; it is however, approved for HIV treatment and is therefore available with a prescription. Truvada manufacturer Gilead Sciences has yet to seek approval for Truvada as PrEP in Canada, Western Europe and Australia. In Canada, a month's supply of Truvada (for HIV treatment) costs between $800 - $1,100 per month.
Concerns exists as to whether public and private drug plans in the US will cover the costs associated with Truvada as PrEP, thus reducing access to PrEP for those who might benefit the most from it.
ACT is dedicated to strengthening the health and well-being of the communities it serves and recognizes its role in communicating the benefits and limitations of emerging HIV prevention technologies. ACT is optimistic about the implementation of PrEP in Canada, but is concerned about the costs associated with accessing PrEP off-label in Canada. To that end, we encourage its coverage under both private and public drug plans, and support efforts to achieve such access.
1 Interim Guidance: Preexposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men:
2. WHO: People most at risk of HIV are not getting the health services they need
Post-exposure prophylaxis (PEP) is a four-week daily dose of anti-HIV medications in pill form that can possibly stop HIV infection if taken within 72 hours of potential exposure. (ii, iii, iv, v, vi)
In Ontario, access to PEP is subject to a healthcare provider's discretion. It can be argued that people who are exposed in the workplace to body fluids that may contain HIV (e.g. a healthcare worker who accidentally suffers a needle-stick injury) or in emergency circumstances, such as a sexual assault, elicits one response, while those people whose exposure to HIV is through unprotected sex, a condom break during sex or shared needles elicits another. ACT believes that PEP be prescribed to individuals regardless of method of exposure.
Barriers to accessing PEP include incorrect assessments, the cost of PEP medication and a lack of information regarding prioritization or awareness of PEP among health care providers. These barriers can reduce the timeliness in which people receive treatment or the prescription of anti-HIV medications with difficult side effects.
It is estimated that 646 people were infected with HIV in Toronto in 2012. Each HIV infection prevented in Canada is estimated to save our health care system between $242,686 and $376,785.(vii)
While PEP is offered free of charge in a sexual assault situation and in many occupational exposure situations, the cost of a month's supply of PEP for an individual in Ontario can cost between $900 - $1300 depending on the medications prescribed and requires private health insurance to cover it.(viii)
ACT believes money should not be a barrier for an individual's access to PEP and that a provincial standard of care for non-occupational PEP is long overdue.
This disparity between Ontario and other provinces and jurisdictions' standards leaves Ontarians at a greater risk of a potentially preventable disease.
It is imperative that the government of Ontario extend treatment coverage of PEP to all Ontarians and establish provincial standards of care for all types of HIV exposures; and to ensure that all health care providers are informed and equipped to provide service to people who have been potentially exposed to HIV in a timely and respectful manner.
After potential exposure to HIV in the workplace and in sexual assault circumstances the cost of PEP is covered through Ontario's health care system. ACT believes that other circumstances of exposure such as consensual sex or drug use also merits the same, consistent coverage.
Affordability, stigma and a lack of access should not be a detriment to an individual accessing medication. ACT believes that prevention is a more sustainable and considerate allocation of resources than a lifetime of treatment.
ACT believes that all Ontarians deserve access to PEP if they have been exposed to HIV, regardless of method of exposure. People who are at risk in community settings (i.e. human bites, accidental contact through discarded needles, or those that result from consensual sex or sharing of injection equipment) should be eligible for coverage. The current two-tier approach adopted by the Ministry of Health and Long-Term Care discriminates against those who have had sexual exposure. Moral judgements about people who engage in sex have no place dictating public health policy.
There is currently no standard of care for non-occupational exposure in Ontario. The decision to provide PEP lies with the healthcare provider and is made on a case-by-case basis. Many healthcare providers in Ontario are unaware of non-occupational PEP, are not trained to provide PEP, or may be unwilling to prescribe it. This means that people may be assessed differently, kept waiting longer, or prescribed older anti-HIV drugs with more severe side effects that impact people's ability to adhere to the treatment.
PEP for non-occupational exposures is an accepted clinical practice in many jurisdictions. In Canada, Alberta, Quebec, Manitoba, Saskatchewan, Prince Edward Island and British Columbia have standard of care protocols in place. Internationally, the US, UK, Australia, Netherlands, France, Switzerland, Spain and Denmark, among others have protocols.
The present funding position of the Ministry of Health and Long-Term Care represents a contradiction. The science and efficacy of PEP treatment is not in question. We know that it works and the government recognizes this by providing access and coverage for occupational and sexual assault exposure. ACT believes coverage of PEP should be provided as part of a comprehensive HIV prevention strategy.
i. CDC. 2005. Antiretroviral Post-Exposure Prophylaxis After Sexual, Injection-Drug Use, or Other Non-occupational Exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. MMWR. 54(RR-2): 1-20
ii. Tsai CC, Emau P, Follis KE, Beck TW, Benveniste RE, Bischofeberger N, Lifson JD, Morton WR. 1998. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. Journal of Virology. 72: 4265–73.
iii. Otten RA, Smith DK, Adams DR, Pullium JK, Jackson E, Kim CN, Jaffe H, Janssen R, Butera S, Folks TM. 2000. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). Journal of Virology. 74: 9771–5.
iv. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, Heptonstall J, Ippolito G, Lot F, McKibben PS, Bell DM. 1997. A casecontrol study of HIV seroconversion in health care workers after percutaneous exposure. New England Journal of Medicine. 337(21): 1485-90.
v. Tsai CC, Emau P, Follis KE, Beck TW, Benveniste RE, Bischofeberger N, Lifson JD, Morton WR. 1998. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. Journal of Virology. 72: 4265–73.
vi. Otten RA, Smith DK, Adams DR, Pullium JK, Jackson E, Kim CN, Jaffe H, Janssen R, Butera S, Folks TM. 2000. Efficacy of post-exposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). Journal of Virology. 74: 9771–5.
vii. Toronto Public Health. 2012. Sexually Transmitted and Bloodborne Infections: Communicable Diseases in Toronto 2012.
viii. Shoppers Drug Mart via Toronto Public Health, September 16, 2013.
On October 24, 2012, the Commission for the Review of Social Assistance in Ontario released its final report and recommendations.
In the past year since the release of the report, several of its recommendations made have been implemented, including:
- Creating a $200 monthly earning exemption for people who receive benefits from Ontario Works (OW) and Ontario Disability Support Program (ODSP).
- Improving financial independence for OW clients by increasing the amount of assets they are able to keep before they can get help, such as a car they may need for employment.
- Encouraging businesses to improve job opportunities for people with disabilities by establishing a Partnership Council on Employment Opportunities for People with Disabilities.1
ACT supports and commends the Government of Ontario for these positive changes to social assistance and welcomes the implementation of any recommendations that will improve the lives of people on social assistance and improve models of service delivery.
How will proposed and recent changes to social assistance affect people living with HIV/AIDS?
Many of ACT's service users rely on ODSP or other forms of social assistance to meet their basic needs including housing, food, transportation and health care. A number of the reviews recommendations directly impact people Living with HIV/AIDS. ACT also receives funding for its employment services program (Employment ACTion) from the Ministry of Community and Social Services through ODSP, and any changes to the funding model will affect program and service delivery.
Of the 108 proposals made regarding social assistance in the review, ACT is taking a position on the following recommendations from the implementation priorities laid out in year one of the proposed provincial strategy.2 These are recommendations that may have a direct or indirect impact on ACT programs and services, and the well-being of ACT service users and members of the community.
Early Priorities identified in Brighter Prospects: Transforming Social Assistance in Ontario:
- Moving forward on employment for people with disabilities
We strongly encourage the Ministry to modify the eligibility requirements for ODSP Employment Supports, so that once an individual is deemed eligible for ODSP Income Support they become automatically eligible for employment supports. This will eliminate the need for employment service agencies to get additional approvals prior to assisting these individuals to find employment.
ACT also supports the Ontario Disability Education Network (ODEN) position to streamline the approval process for people who have a disability who are not in receipt of ODSP Income Supports. At the same time, people with disabilities who are not able to work should not be forced to look for work.
In addition, the government should eliminate the punitive approach to people who make mistakes in income reporting and/or other documents required by ODSP.
- Transfer ODSP delivery to municipalities
ACT does not support the downloading of social assistance, including affiliated employment service delivery, to the municipal level. There is a concern that if services are downloaded, individual municipalities may not prioritize ODSP recipients in the same way and may not dedicate the appropriate level of resources to service delivery, thereby increasing the vulnerability of this already vulnerable population. The current provincial delivery of ODSP Income and Employment Supports ensures a level playing field for delivery of services because those services are managed and delivered through one provincial body as opposed to many different municipal bodies. As the Government of Ontario is a champion of the Accessibility for Ontarians with Disabilities Act (AODA), by maintaining ODSP supports at the provincial level, the government can demonstrate its commitment to action as well as legislation.
People with disabilities (including people living with HIV/AIDS) must be viewed as a distinct group for employment services and such services must take into account the specific disability. The stigma of HIV/AIDS remains pervasive in the workplace. People living with HIV/AIDS need to have continued access to specialized employment services and supports which they need to help achieve successful employment outcomes. This requires contracting out the delivery of direct services to third party delivery agents who are specialized in providing employment services for specific disabilities.
- Implement new performance-based funding arrangements with third-party service deliverers
The current ODSP funding model for third-party service deliverers needs to include funding for service providers for intake/assessment, skills upgrading, preparing for job readiness, job placement and retention supports follow-up while recognizing the unique needs for people living with disabilities. We understand this model is currently in place for Employment Ontario and under review with ODSP.
ACT's Employment ACTion program experiences many clients who need a second, third or more replacement jobs due to a labour market that increasingly relies on contract work or part-time work. Helping service users to find work after their initial contracts expire requires additional employment supports which are not covered under current ODSP funding model.
- Earnings exemption of $200/month
We applaud the government for taking this first step in increasing the earnings exemption, but feel it does not go far enough. We advocate for an exemption of up to $500 a month in earnings and/or to reduce the claw back on earnings from the current 50% to 25%.
People with disabilities should be provided with an incentive to find and keep work. As well, housing-geared-to-income should be taken into account when considering earning exemptions, as the majority of people on disability are also in subsidized housing.
- Examine the impact of benefit withdrawal rates on the financial incentive to work to provide a better basis on which to establish the rate of withdrawal of social assistance benefits.
In today's labour market which relies on contract or part-time work, often without benefits, people living with HIV/AIDS engaged in employment often need continuance of these benefits if they are not provided for by the employer.
- Accelerate the implementation of the adult phase of the comprehensive mental health and addictions strategy with a focus on employment as a key outcome.
In addition to health status, some people living with HIV/AIDS often experience mental health and substance use challenges as barriers to employment and personal well being. This population needs increased supports to access high-quality services including early identification and intervention.
- Partner with corporate leaders to champion the hiring of people with disabilities
We encourage the government to support and encourage the corporate sector to hire more people with disabilities. There are many small and large businesses who have been proactive and successful in hiring and integrating people with disabilities into the workforce. These models should be explored using a business-to-business educational approach and emphasizing the AODA. Service providers, particularly service providers with an expertise in episodic disabilities, should also be consulted and included in this process.
1. News Release: "Ontario Government Helping People Find Jobs, Improve Their Financial Security", Ministry of Community and Social Services May 22, 2013
2. Lankin, Frances and Munir Sheik, Commissioners. Brighter Prospects: Transforming Social Assistance in Ontario. A Report to the Minister of Community and Social Services, 2012. Toronto, Ontario. P124-125.
ACT believes that criminal law is an ineffective and inappropriate tool with which to address HIV non-disclosure. HIV/AIDS is an individual and public health issue first and foremost, and should be addressed as such.
ACT opposes mandatory minimum sentencing for drug crimes.
For several years, Canada's Parliament has debated bills on mandatory minimum sentencing, with the latest focus on drug crimes. The latest omnibus crime bill proposed by the federal government would remove judicial discretion and force courts to implement minimum sentence lengths for drug-related crimes.
Research and expertise in other jurisdictions has shown that this punitive approach is ineffective at curbing drug use or crime, is harmful to public health, hampers efforts to prevent HIV transmission, and will be unnecessarily expensive.
- Jurisdictions that have implemented mandatory minimum sentencing for drug crimes have not shown success at reducing drug use or crime. Many of these jurisdictions are now moving away from this failed approach.
- There is an HIV epidemic in Canada's prisons, and the federal government is failing to address it. Putting more drug users in prisons – already a vulnerable group for HIV – will result in more HIV infections. The direct cost of every HIV infection in Canada is more than $370,000 over a lifetime 1.
- Forcing courts to lengthen sentences, even when unwarranted, will require a massive expansion of prisons. Canada's Parliamentary Budget Officer has estimated that the federal government's new crime legislation will add 4,000 prisoners to the federal system, costing the correctional system an additional $1 billion every year.
ACT opposes the excessive use of the criminal law to address public health issues, and believes that everyone – including drug users – deserves access to health care and harm reduction information and programs.
Mandatory minimum sentences restrict the ability of courts to address drug crimes properly by applying a one-size-fits-all approach to all drug use and all drug users. We encourage the federal government and Members of Parliament to join other jurisdictions in abandoning this failed approach.
1. Lima, Hogg, and Montaner, 2010. Expanding HAART Treatment to All Currently Eligible Individuals Under the 2008 IAS-USA Guidelines in British Columbia, Canada.
ACT supports expanding access to the HPV vaccine, regardless of sex or gender, to reduce transmission of the cancer-causing virus and to save long-term health care costs. Allowing males to access the vaccine for free would allow men and women to take equal responsibility for preventing HPV, and also provide protection for gay men.
This could be implemented through a combination of the following strategies:
- Expanding Ontario's school-based HPV vaccination program to allow all students to participate, regardless of sex or gender.
- Providing the HPV vaccine for free to males, females and trans people up to the age of 26, via public health units, sexual health clinics, HIV clinics and primary care physicians.
In July 2006, Health Canada approved a new vaccine to provide protection against four types of human papillomavirus (HPV), which can cause cancer and genital warts. Due to the limited research studies available at the time, Health Canada only licensed the vaccine for use in females aged 9 to 26 years. In 2007, the Government of Ontario rolled out a free province-wide school-based vaccination program for female students.
After studies demonstrated the effectiveness of the vaccine in preventing pre-cancerous anal lesions and genital warts in men, Health Canada approved its use on males aged 9 to 26 years in February 2010. However, Ontario's school-based HPV vaccination program has not yet been extended to male students.
HPV is of particular concern to gay, bisexual, and other men who have sex with men, who are 17 times more likely to develop anal cancer than heterosexual men. Among HIV-positive gay men, the likelihood is even higher. The HPV vaccine prevents 77.5% of pre-cursor lesions to anal cancer in gay and bisexual men. Yet gay men do not benefit from the current vaccination program, and they must pay for the vaccine out of pocket, costing each individual hundreds of dollars.
Limiting the HPV vaccine to females also limits the effectiveness of the program in a heterosexual context, by reducing the number of eligible participants. Providing the vaccine for free to all eligible males would allow everyone – regardless of their sex or gender – to share responsibility for preventing HPV.
HPV vaccination not only benefits the health of the individual and our communities, but also reduces long-term costs in the health care system by preventing illnesses. In one modeling study by the Harvard School of Public Health (The Lancet Infectious Diseases. 10(12):845-52, 2010 Dec.), vaccination of gay, bisexual and other men who have sex with men would provide a cost effectiveness ratio of up to $15,290. The study found that vaccination was cost effective for this population even up to the age of 26, pointing to the benefit of expanding free access beyond school-based programs.
The health and economic benefits of HPV vaccination demonstrate the need to eliminate barriers by expanding coverage beyond the existing school-based vaccination program.
Recent research has resulted in confusion about whether lubricants increase, reduce or have no effect on the risk of infection from HIV and other sexually transmitted infections (STIs) during anal sex.
The AIDS Committee of Toronto (ACT) continues to recommend the use of water-based or silicone-based lubricant with condoms for anal sex, and calls for more research into the effects of lube on rectal tissue.
Lubricant that is compatible for use with condoms (water-based or silicone-based) has been proven to decrease the risk of condoms breaking or slipping off. When condoms are used correctly and consistently, they provide the most effective protection against HIV and other STIs during anal sex.
Some studies have tested the effects of lubricants on rectal tissue – some in the laboratory and one on humans – and have concluded that certain types of lubricant can cause damage to rectal tissue. The reasons are not yet clear. Damage to the rectal tissue could increase vulnerability to STIs (including HIV) if a condom is not used.
The AIDS Committee of Toronto (ACT) believes that HIV testing and treatment should be offered to all people living with HIV, but no one should be forced to undergo either. No response to HIV can work without the engagement and voluntary participation of people living with and at increased risk of HIV.
ACT supports universal access to anti-retroviral (anti-HIV) drug therapy and other treatments for HIV/AIDS, in Canada and around the world. ACT believes that access to HIV treatment is a right of all people living with HIV/AIDS.
Recently, discussion has emerged regarding the potential of anti-retroviral treatment to be used as an HIV prevention tool. Some researchers have projected that universal application of anti-retroviral treatment could stop the global HIV epidemic in its tracks, by reducing viral load and infectiousness among those living with HIV.1
ACT supports a comprehensive approach to HIV prevention and treatment. Universal access to HIV treatment is a part of the HIV prevention response. However, any response must respect the health and human rights of people living with and at risk of HIV, and be delivered in combination with other HIV prevention methods, including:
- access to condoms (male and female/receptive) and other barriers;
- the development of microbicides (for both vaginal and anal use);
- pre- and post-exposure prophylaxis;
- voluntary, confidential and anonymous testing for HIV and other sexually transmitted infections; and,
- needle exchanges and other harm reduction initiatives.
While ACT supports the laudable goal of increasing access to HIV treatment, and the concurrent role it can play in HIV prevention, we remain concerned about:
- Treatment in settings without adequate viral load testing to identify cases of treatment failure, which could result in undetected viral rebound;2
- Treatment in settings without access to second-line (ie newere) anti-HIV drug regimens which could result in increased transmission of drug-resistant HIV;2
- The application of drug treatments that lower infectiousness, but are not medically necessary, which may have negative health impacts on those living with HIV/AIDS;3 and,
- Universal application of treatment which violates the human rights of people with HIV/AIDS by removing the choice of when to begin anti-retroviral therapy.
1. Montaner JSG et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. The Lancet 368: 531-536, 2006.
2. Alcorn, Keith. Treatment as prevention tool: enough evidence to say it works, says IAS president.<http://www.aidsmap.com/en/news/30D49BD7-41FC-4E0D-AEBD-A210794D0533.asp>
3. O'Neal, Reilly. Is HIV treatment HIV prevention? <http://www.thebody.com/content/art54536.html>
In order to create universal access to HIV/AIDS treatment, the AIDS Committee of Toronto (ACT) supports:
- The creation of a federal program to provide catastrophic drug coverage1 in Canada, as advocated by the Canadian Treatment Action Council and the Best Medicines Coalition.2
- Legislative amendments to Canada's Access to Medicines Regime, as proposed by the Canadian HIV/AIDS Legal Network,3 to reduce red tape and encourage its use by Canadian generic drug manufacturers, non-governmental organisations and developing countries.
Since the introduction of highly active antiretroviral therapy (HAART) to treat HIV/AIDS, access to treatment has been unequal and often impossible, based on income and geography.
People living with HIV/AIDS in Canada face unequal access to treatment through the lack of a federal government program to cover the high cost of treatment for chronic or life-threatening diseases and conditions for Canadians who are working but have limited or no private insurance. Today, Canada remains one of the few industrialised countries without a nationally supported catastrophic program to assist with the out-of-pocket costs of prescription drugs.
While some Canadians are reimbursed for the cost of prescription drugs through an inconsistent patchwork of private and public drug plans depending on the province or territory where they live, many Canadians have no prescription drug coverage at all.
For people living with HIV/AIDS in the Global South, unequal access to treatment stems from the fact that developing and least developed countries have no capacity to produce pharmaceuticals, and the cost of importing patented drugs from industrialised countries is prohibitive.
Canada's Access to Medicines Regime (CAMR), established in 2004, created a legislative framework to allow Canadian manufacturers to produce generic pharmaceutical products for export to developing countries.
However, unnecessary red tape and bureaucratic hurdles within the Regime have prevented both Canadian generic manufacturers and importing countries from using the program. As of October 2008, only one shipment of generic drugs has been made under CAMR to a developing country.
The AIDS Committee of Toronto believes that a world without AIDS can only be achieved when all barriers to treatment are eliminated, regardless of an individual's income or geography.
1 According to the Canadian Treatment Action Council (CTAC), a catastrophic drug plan is "a publicly-mandated and funded health insurance plan which covers prescription drug costs for chronic, life-threatening diseases and conditions for individuals who do not have private health insurance or whose private insurance is insufficient to cover their prescription drug costs."
2 Best Medicines Coalition, "National Pharmaceuticals Strategy: An Urgent, Emerging Issue", Canadian Treatment Action Council Newsletter. Summer 2006.
3 Canadian HIV/AIDS Legal Network, Review of Canada's Access to Medicines Regime - Legal Network Submission to the Government of Canada. January 24, 2007.
In late March 2007, UNAIDS and the World Health Organization endorsed circumcision as a way of reducing heterosexual men's vulnerability to HIV infection. Their endorsement was based in part on the findings of three recent studies which indicate that circumcised men are up to 60 per cent less likely to contract HIV from vaginal intercourse than uncircumcised men.
The studies looked at the vulnerability of heterosexual men in three high-prevalence, or HIV-endemic, countries: South Africa, Kenya, and Uganda.
The AIDS Committee of Toronto (ACT) recognizes the significance of these studies. Given, however, that the studies took place in social and epidemiological contexts different from those here in Toronto, ACT would like to clarify what the studies do and do not tell us.
What the current research tell us:
- Uncircumcised men are more vulnerable to acquiring HIV during vaginal sex than circumcised men are. The foreskin is susceptible to nicks and tears during intercourse, which can act as entry points for the HIV virus. Compounding this vulnerability is the fact that the foreskin is rich in Langerhans cells, a target for the HIV virus.
- While circumcision can reduce men's vulnerability to getting HIV, it does not eliminate it.
What the current research does not tell us:
- It is not clear whether uncircumcised men are more likely to pass on the HIV virus than circumcised men.
- It is not clear whether circumcision significantly reduces the risk of HIV transmission to the insertive male partner (the 'top') during anal sex. It is possible to infer that the same factors that make uncircumcised men vulnerable to acquiring HIV during vaginal sex would make them vulnerable to HIV transmission during anal sex. However, the studies themselves did not look at this.
ACT would like to stress that while circumcision may reduce some men's risk of HIV infection, it does not eliminate that risk.
Condoms are the most effective way to protect yourself and your partner from HIV transmission during sexual intercourse, whether you're circumcised or uncircumcised, straight, gay, or bisexual.
Circumcision is a personal decision that may be made on religious, cultural or other grounds. As preventative measure against HIV, however, ACT cannot endorse circumcision based on the current research.


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Well my plan for advancing the build over the holidays was probably a bit optimistic on my part. So I did manage to finish the underframe and get it primed. I did get started on adding details to the car sides.
I use the San Juan Car Company AB brake set on nearly all of my cars. The prototype added small brackets to the crossbearer and crossmember. the reservoir is supspended on the brackets. The piping goes through the centersill between the reservoir and the control valve. I made a brass bracket to support the control valve. I anchored one end of the bracket to the floor on the outside. It was attached the sidesill on the prototype.
The picture below was taken by Rick Leach that shows the bracket and plumbing.
I used clevis that were made by San Juan Car Company with levers that came from Chooch Enterprises. The piping and brake rodding was done with .020″ brass wire.
I NP used an unusual arrangement to their brake rigging. A spring was attached to an intermediate lever that pivoted off the centersill. I used some .010″ brass strip to tie the chain to the clevis.
Notice the color of the underframe parts. It is likely the road sprayed black car cement on the underframe at one time. Lots of dirt deposited on the centersill.
The primed underframe is shown above. I used Vallejo acrylic urethane paint as the base. I will Model Masters acrylic dark gray as the final color.
Next time I will work on detailing the sides and ends.
Happy New Year

subset: commoncrawl


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Many women find the process of trying to conceive very frustrating because they thought it would just happen. Pregnancy doesn't happen for every woman the first month, and to believe with every fiber of your being that it'll be that quick and easily usually just sets you up for disappointment. Although people accidentally become pregnant all the time, getting pregnant actually requires that everything is just right. So, go in assuming that it won't happen right away and you'll probably be able to hang in there a lot longer without getting frustrated.
Most couples will experience conception within the first 12 months of trying, although for some it may take up to 18 months. Most practitioners will not intervene in the conception process unless it has been more than 12 months since the couple actively began trying to conceive. In some cases, a practitioner will intervene sooner if there is a history of serious fertility issues in which the couple will not be able to become pregnant on their own. So, for most people you will be on your own for those first 12 months of trying. Because a year can be a long time, it's a good idea for a couple to go into the conception process thinking that it will take a full 12 months of trying to get pregnant, so that when they become pregnant after just four or six months it'll be a wonderful surprise!
Pregnancy Statistics
You might find the following statistics comforting or just very informative:
· Just 25% of couples actively trying to conceive become pregnant the first cycle.
· 60% become pregnant in the first six months of trying to conceive.
· 75% of couples become pregnant within nine months.
· 90% of couples experience pregnancy within 18 months.
While pregnancy is something that you'd probably like to happen sooner rather than later, when you look at these statistics you should feel some comfort. 90% of couples actively trying to get pregnant will experience that joy within the next year and a half. That sounds like a long time, but a planned pregnancy is something worth waiting for, whether it's one month or eighteen.
The key to getting pregnant is to know your body and understand your fertility cycle. Knowing the signs and signals your body gives you every month as to your fertility will help guide you on your way to conception. If you are in doubt as to whether you are proceeding in a successful fashion, you can always talk with your doctor. Just remember that they are not likely to intervene until 12 or 18 months have passed.
There is a lot of great literature out there, both in the bookstore and on the Internet, that will help you with positions to try, herbs you can take, and methods you might employ to speed up the conception process. How much faith you put in these tactics is up to you, just remember that this should be a fun experience!


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Here are the essential things you should know before start collecting vinyl records.
Why You Should Buy Vinyl at the First Place
First thing's first. Have a clear objective of having vinyl record player collection. There are two ways to explain this question:
- You're a die-hard music lover and you can do anything for vinyl records
- Perhaps, you got attracted by the aesthetics of vinyl or the turntable mechanism. You may not have that much interest in music but you adore the construction and wanted to collect as many records as possible.
Or you may have both the attributes, although physical features of vinyl are more appealing. And why not, because vinyl looks more attractive than ordinary CD players. When you purchase them, you're showing the world, "It's not an ordinary office supply or a software, it's serious music!"
Your love for albums and your sentiments are better reflected with vinyl records:
- The quality and feel of the records
- Unlike pressing a button in your iPod, you take out the record from its sleeves and place it carefully on the turntable.
- May be for a little while, the whole act gets your 100% attention.
The entire experience is different and much better than what you get from MP3 players.
Is it Wise to Buy Vinyl Record?
Well, there are plenty of reasons why vinyl are better investments, compared to CDs or MP3s
Vinyl material can be cleaned and maintained. If it is well-maintained, it can last for decades. The records come in a proper casing that has its own value. Imagine you own a limited edition of a great album people would die for. On the contrary, CDs and MP3 songs don't have that much value.
CDs don't give the same impression and inspiration as vinyl records. The reason is, they're so common people wouldn't even care if you have a limited edition of something really great.
You Can Sell Them
Can you resell your MP3 songs? Not practically! Can you resell your Vinyl records? Off course!
That's the best advantage vinyl has over that intangible music; it gives a return on investment. How much? It totally depends upon the life, quality of sound, popularity of the album and your own enthusiasm to sell. But you can't sell just any vinyl record. Make sure that the copy remains in good condition. In fact, titles, design and construction also have their worth.
It's not recommended that you build a collection just to grab some money, yet it's always good to know that you can raise some funds when you had to.
What does the term "Analog" refer to?
The world has gone digital many years ago, yet there are some analog mechanisms connecting us to our past, and vinyl is one of them. Analog refers to the phenomenon of continuous signal with varying parts. These varying parts represent another time-varying quantity.
Talking about sound recording, sound waves apply pressure on the signal's instantaneous voltage due to which there is a continuous variations in it. Vinyl also has this feature and that's why it's analog.
Why Vinyl is Analog?
Vinyl records have grooves. These grooves are like a sketch of soundwaves. It's a single unbroken line with uncountable variations in it, running in a continuous circle from the end to the middle of the record. The purpose of turntable is to read those lines and decode them into the sound which you finally listen.
How Vinyl is Not Digital?
Digital signals are entirely different from analog signals. They're discrete, not continuous. It means, there is a precise interval in between sound batches (or samples) sent to the sound source.
As mentioned earlier, sound is continuous. So, a digital system breaks it into smallest possible piece of information we know as "Bits". Remember the binary code? Everything breaks into either 1 or 2 directives (0 or 1). So, by means of 0 and 1, you can break or decode anything into just two elements.
It's hard to imagine, but if you know how to plot points on the graph, you'd have some kind of idea. However, the end result of both, digital or analog is same. When the sound from digital or analog source is amplified and comes out of the speakers, it's hard to differentiate which form it is, because the sound waves will remain continuous for your ears.
In fact, there's no way to determine the source, because you are not listening to analog fluctuations or binary codes. Vinyl produces voltage fluctuations and these variations travel continuously, without breaking.
Is it True that Analog or Vinyl Sound Better than Digital?
It's a debatable topic and it does get heated up when music lovers with different taste talk over it. However, there are so many factors to consider, just to explain which of the two may be better for you. Some major factors include:
- Turntable quality
- Quality of the amplifier
- Quality of the speakers
Then, you also need to consider the quality of vinyl record, a digital file or CDs. By listening each of them on a home stereo system, you cannot determine which one's generating better sound unless they have scratches, defects or dust.
Studies have revealed that an ordinary human ear cannot differentiate between the two sources. So, if someone prefers vinyl over digital albums, he's doing it because of his own experiences.
Why People Listen to Vinyl and Find it Better?
There are some noteworthy aspects of analog recording and the records beyond familiar sounds of pops and crackles produced by vinyl. "Warmth" will be the first word you'll listen when analog enthusiast explains analog sound.
In reality, this sound is an indication of analog's limitation compared to digital recording system. It tends to produce certain noises at the low end of the records while capturing sound. Here, "low end" means those points on the record where there is much less detail, at times, gaps in data. These small gaps result in abstraction which seems pleasing to ears.
On the other hand, digital recording is far more precise and accurate, and has a broader dynamic range as compared to analog system. This consistency and accuracy tends to give cold, clinical and inhuman impression to human ears. This is the basic reason why audiophiles tend to favor analog recordings.
Which Type of Turntable Should You Choose?
It depends whether you're an audiophile or someone who just love to have vinyl records. It's obvious, you'll be willing to spend a lot just to listen to quality music. Or, if you want to buy an inexpensive yet good-looking turntable, you can have one cheap, but the sound quality may not be as good.
Should You Go For Vintage Turntables or Should You Choose the New Ones?
It's recommended that you should find a new turntable instead of the vintage version. Old tools will definitely have wears and tears. They may need expensive fixing, which can be avoided with new turntables.
You can save some more money if you buy a turntable with built-in pre-amp. In this way, you don't have to buy or build a stereo system.
Some Good Options of Turntables for You
Here are some options for you, depending upon your preferences:
You can have a portable turntable, such as Crossley, or any similar product. These turntables are easy-to-handle, occupy less space, have built-in speakers, and you can carry and play them anywhere. You may want to compromise on sound quality though.
Crossley turntables are well acclaimed by immature or irregular listeners. They have sophisticated suitcase-like design that makes them more attractive. More importantly, they're cheap, available in the range of $70 – $100.
Or perhaps you're more concerned about something really solid in a limited budget. You can go for durable turntables from Audio Technica. The brand is known for its basic turntables that can be connected to the home stereo systems. Some models also offer built-in amplifier, as well as USB connectivity.
They're slightly expensive compared to Crossley models, but they offer superior sound quality. Price range for Audio Technica models range between $90 and $300.
For serious music enthusiasts who don't want to compromise over sound-quality, there are some great turntables available in the market. For example, this Linn Sondek LP12 model is a combination of style and finance when it comes to sound reproduction.
The wooden deck, high torque motor, moving coil cartridge, and everything other component makes it one great sound producing machine. You can have these models at over $2000.
Why are There Direct Drive Turntables and Belt-Driven Turntables?
In fact there are three kinds of turntables; idler-wheel drive is another mechanism that has a wheel attached to the motor. The record is placed and rotated on the wheel.
In belt-driven turntables, the turntable is separated from the motor. The motor drives the platter by means of rubber belt.
In direct-drive mechanism, instead of rotating, the platter spins with the power of motor integrated to it. DJ's prefer direct drive turntables, because they can manually turn the records according to their liking.
Which Turntable is the Best for Listening Vinyl Records?
Audiophiles and sophisticated listeners prefer belt-driven turntables (although the mechanism is older than direct drive version). The reason is, belt-driven turntables are considered to produce less vibration and outside noise.
Should You Choose a Fancy Stereo System along With Speakers?
Yes! If you care so much about sound. Speakers make a remarkable difference in sound quality. Built-in speakers are not that capable, because of the size and other mechanisms attached with the turntable. Good speakers can enhance sound while bad speakers can even make good recordings bad.
If you're an audiophile, there's no limit of choice for speakers. Stereo speakers start from as low as $150 and go in excess of thousands of dollars. Have a look at these book-shelf speakers from Mordaunt-Short. They are quite inexpensive, available at under $100.
Is it Important to Get "Pre-Amp"?
It depends whether your turntable has a built-in pre-amp, or you need a separate device. They convert the output from the turntable into line level signals, which when used by speakers, turn into sound waves. You can identify a pre-amp in your turntable if it has an input slot marked as "phono". Or if your turntable has USB connectivity, it'll definitely have built-in pre-amp.
For external pre-amp you also need to buy RCA cables in order to connect your turntable to the receiver.
Is Stereo Receiver Really Necessary?
For standalone turntable, stereo receiver or amplifier is really important. A stereo receiver processes the signals coming from the turntable or pre-amp and transfer them to the speakers. It gives you volume and audio control option as well.
You can find good receivers from online stores, such as Amazon, or other auction sites.
How to Setup a Stereo?
If there's a built-in pre-amp in your turntable, setting up stereo will be much easier. Simply connect everything using stereo wires and appropriate RCA cables.
If your turntable doesn't have a built-in pre-amp, the connection will be complicated. You have to ground the system to make sure electric signals flow properly; otherwise, there you have to bear the constant low-pitched humming noise. Refer to this simple guide to ground your stereo receiver.
Is Tone Arm Necessary for All Turntables?
Off course, tonearm is the part that's responsible for holding the needle and transfer the vibrations through the wires inside it, into the magnetic cartridge. The tone arm also controls the movement of the needle and directs it to extract vibrations from the grooves of the vinyl record.
It is important to control the pressure on the needle, because it affects sound quality. Inappropriate pressure on the needle can damage both, the needle and the record. Tonearm quality depends upon the overall construction of the turntable. The more expensive they are, the better will be the tonearm.
Important Things to Remember About Cartridges and Needle.
Needle or stylus and cartridge are important elements of any turntable. Needle collects vibrations off the grooves while cartridge collects these vibrations and turn them into electric signals, followed by sending them to the amplification unit.
Modern-day turntables have both, the needle and cartridge installed. Needle hangs at the moving end of the tone arm while the cartridge rests at the fixed end of it. Needle wears out with time and needs replacement. Make sure to replace regularly (after 10,000 rotations approximately) or it'll damage your vinyl records.
Should You Care About RPM?
RPM means revolutions per minute. It indicates towards the spins per minute of the platter. Vinyl records usually have one of three standard speeds; 45 rpm, 33-1/3 rpm and 78 rpm.
78 rpm records hare almost obsolete, so it's unlikely you'll deal with them unless you find a record from 50s or 60s. Here's more about the speed:
- Full-size records come with 12-inch size and mostly offer 33-1/3 speed.
- Maxi-singles and EPs also have 12-inch size, but they have a speed of 45 rpm.
- 7-inch singles and some 10-inch singles usually offer the speed of 45 rpm
In order to run the records at the right speed, you need to switch and adjust the speed of your turntable.
Why Are There So Many Sizes and RPMs?
Size and rpm depends upon the amount of music contained in vinyl record. A 7-inch record contains less music compared to full-size record, and it's cheaper too.
There's still a limit to store music on vinyl; otherwise, the sound quality will be deteriorated. The more music on the vinyl, the narrower the grooves will be. If the grooves become too narrow, it will be difficult to extract vibrations off the surface, and record will produce more crackles and skips.
This is the reason why a full-length album that can be stored in a CD, takes up to two vinyl records 12-inch. A 12-inch record can store up to 22 minutes of quality sound, and 7-inch singles contain songs with extended length beyond 5 minutes.
It is a limitation, but it's also an advantage of vinyl. You can put less music for greater quality.
What's the Best Place to buy Vinyl?
You can buy vinyl records from any record store. Then there's a better place called Amazon where you can find a wide variety of vinyl records at fairly reasonable prices. Your intended record will be shipped and delivered at your door step.
Other options for vinyl stores include Insound, GEMM, Amoeba and Turntable Lab etc. Then you can buy old records from used bins available in some record stores. Buying records cheap from garage sales is another way to build vinyl collection quickly.
Should You Really Care About the Color of Vinyl Record?
These days, colored vinyl have been used to press albums and singles, although many music-lovers don't like this idea. A combination of carbon black and plastic is used to press black vinyl, making them more durable. However, there's no difference of sound quality between black or colored vinyl.
But if you really look forward to decorate your music library, colored versions are more suitable. As they're produced in limited quantity, colored vinyl will make your library look more appealing for music lovers.
Does Thickness Matters?
Thickens does count, considering it makes vinyl record heavier and makes it more durable. Many new albums, especially the ones from independent labels, are durable and have better sound. You can run the records on mediocre stereo system, still they'll deliver better sound.
You must have seen records with stickers saying "180 grams". Well, it's not the standard, but it's good to have those heavy pieces. The reason for thickness is, vinyl degrades a little bit with every play-time. So, thicker vinyl will take more time to degrade.
Are New Vinyl Versions of Old Records Better?
Be careful about new copies of old vinyl albums. Most of the time, the master is created from recent CDs, as original analog master offers no access to the record label. So, you will not experience the same warmth of the old version as the copy was made from a lower quality CD. If you're not so sure about the source of vinyl, you can search it online.
Things to Keep In Mind While Buying Old Records?
First thing you should consider is, old albums you're looking for might not be released in the same format, or they might have been released in a limited quantity. Second proposition holds more weight, because in the last decade of previous century saw less vinyl records and more CDs.
It's quite difficult to find vinyl pressing of popular albums from the 90s. If you get lucky, you may have to buy them on higher price.
How to Store Vinyl Collection?
- Store your albums in a dry, cool place.
- The vinyl records should be placed vertically, because stacking them horizontally over one another will warp the records.
- Once warped, vinyl records cannot be fixed.
Do You Know about Warped Record?
Warped record means bent or melted record. If you play a mild warped record, it'll sound weird. But if it's badly warped, you cannot play it again. Warping may occur on the record if it is exposed to sunlight for a long time.
How to Clean the Vinyl Record and Why?
There are quite a few record cleaning techniques and none of them can be termed as "standard". The easiest way to clean vinyl record is by means of record brush. You can also buy record-cleaning kit from a nearby record store. Use the liquid (cleaning solution) carefully and use brush gently on vinyl surface.
The reason for cleaning is, grooves of vinyl attract dust and dirt while playing. As dirt and debris settle inside the groove, the more time it takes the harder it becomes to remove. Dirt and dust cause slips and skips and affect the sound quality.
How to Clean the Record Player and Why?
You can use the same record-cleaning kit to clean your record player or turntable. Pay attention to the platter and the needle. Don't press or push the needle too hard to bend it.
Record players can catch dust and dirt while playing the record. It's due to the vibration and the magnetic field that catches dirt and dust from the surrounding. This is why it is recommended to clean the record players before and after playing vinyl record.


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