Michael Petrelis chronicles the impact of long term retroviral therapy on the faces of those who have survived HIV a long time -  by boldly posting his own above. I am lucky not to have been too affected by this, but some loss of fat in the face and accumulation of fat on my back or deep in my gut - the "elephant hump" and "protease paunch" - is something I've learned to live with (and counter with the only drug that seems to work, the prohibitively expensive serostim).

Michael notes how some of this happens to all of us: old faces always lose fat. Plenty of older men have paunches. But there is a distinctive look of pozzy survival. Michael deploys the same tactic toward it that many of us learned to adopt as a survival mechanism with the virus itself: own the condition, be public with it - and, if necessary, tackle it head-on. Of course, I see nothing wrong with a little infusion of fake fat to prevent a gaunt look - but there is something characteristically stark about Petrelis's bravado.

I wonder sometimes if this long-term fight with what was once a terminal, terrifying disease has shaped me in ways I do not fully appreciate. The knowledge that my virus, with the HIV ban in force for almost all my HIV life-span, could literally expel me at any moment from the country I love and the husband who supports me and the friends who keep me going must have instilled in me a deep and constant sense of insecurity, of guardedness, of fear. The illness itself compressed my sense of mortality in ways that started young. In grappling with this bit by bit, year by year, I have shifted back and forth from a kind of prudent defensive crouch (I have seen far, far less of my family than I would have without the travel ban) to a brazen, angry candor.

Perhaps the instinct to say things outright, to vent all and any questions on my mind, to hide little, to cast aside politesse, to vent to the whole world every day what's on my mind, is related to this. Once you leave the gay closet and the HIV closet, all closets, all silences, all evasions seem threatening. As Michael still has it on his little button, Silence = Death.

It literally meant death for so long. But it can also mean a silent death of the spirit and soul, a deadening of the eyes, a surrender to shame or social expectations imposed from the outside against the human life-instinct within. Through the death of others, and the the fear of my own, I guess I have come to see the defense of that life-instinct as a core part of self-preservation - and find nature (especially the sublime beauty of Cape Cod) the only true salve. And blogging, the rawest, roughest, most candid form of writing came naturally to me perhaps as part of this survival mechanism, as a way to keep opening doors and windows, to ensure that the light coming in could overwhelm the darkness I always felt, and still, feel advancing behind my back. Something must have kept pushing me forward every day for ten years now.

Perhaps I still speak for fear I will otherwise die - somewhere, somehow within.

How many still live in fear and shame? How many still die inside long before their body gives up? And how can our honesty - sometimes to the point of masochism - help them? Or bring them back from the dead?