After 10 years of AIDS, safe-sex message still controversial

RRESTR

(temazepam) Hypnotic

Indications: Temazepam is a hypnotic agent useful in the shortterm management of insomnia. It has no effect, however, in shortening the time taken by patients to fall asleep. Efficacy has not been established in children under 18 years of age. As with other hypnotics, temazepam is not indicated for prolonged administration. Contraindications: Hypersensitivity to benzodiazepines and in myasthenia gravis.

Cameron Johnston

and people with multiple sexual partners are not the only ones who should be concerned about safe sex, a professor at the University of Western Ontario, London, maintains. James Miller says the issue should concern everyone, including heterosexuals in monogamous relationships. Miller, who teaches an undergraduate course entitled AIDS and the Arts, does not mind flouting convention by putting his perG

ay men

Cameron Johnston is a freelance writer

living in London, Ont.

sonal collection of "safer-sex" posters on display. (The term safer sex indicates that even if precautions are taken, a sexual encounter can pose a health-related risk.) Miller, who has "well over" 1000 posters from 60 countries, contends that safer sex and AIDS are not only medical issues, but also cultural and anthropological ones. Unfortunately, he adds, the same people who would quarantine HIV carriers also want to "quarantine the information about safer sex." They want the message bowdlerized to avoid offending the general public. "General public," explains

Warnings: Occupational hazards: driving, operating dangerous machinery or engaging in any activity requiring mental alertness and physical coordination after taking temazepam. Physical and psychological dependence: Temazepam should not be administered to individuals prone to drug abuse, or that may have potential for psychological dependence. Withdrawal symptoms are similar to those manifested by patients with excessive anxiety and may appear to justify continuation of drug use. Potentiation of drug effects: Temazepam may potentiate the effects of other CNS depressant drugs: e.g. alcohol, barbiturates, nonbarbiturate hypnotics, antihistamines, narcotics, antipsychotic and antidepressant drugs, and anticonvulsants. Different benzodiazepinesshould usuallynot be used simultaneouslyand careful consideration should be given if other CNS depressants are administered in combination with temazepam. Patients should be advised against the simultaneous use of other CNS depressant drugs including alcohol. Pregnancy: Temazepam should not be used during pregnancy. If the drug is prescribed to a woman of child-bearing potential, she should be warned to consult her physician regarding discontinuation of the drug if she intends to become or suspects that she is pregnant. Lactation: Temazepam should not be given to nursing mothers.

Precautions: Patients with emotional disorders: use temazepam with caution in patients with symptoms of depression, latent depression, or suicidal tendencies. Elderly and debilitated patients or those with organic brain syndrome: are prone to CNS depression after even low doses of benzodiazepine and may experience paradoxical reactions to these drugs. Use temazepam only in the lowest possible dose and adjust when necessary under careful observation. General: Temazepam is metabolized in the liver and is primarily excreted by the kidney. Caution should be exercised in administration of temazepam to patients who might have impaired hepatic and/or renal function. Adverse Effects: Most common adverse reactions reported: dizziness, lethargy and drowsiness, confusion, euphoria, staggering ataxia and falling. Paradoxical reactions such as excitement, stimulation, hyperactivity and hallucinations are observed

infrequently. Other adverse reactions are weakness, anorexia, horizontal nystagmus, vertigo, tremor, lack of concentration, loss of equilibrium, dry mouth, blurred vision, palpitations, faintness, hypotension, depression, shortness of breath, nausea, diarrhea, abdominal discomfort, genitourinary complaints, pruritus, skin rash, urticaria, and anterograde amnesia. Abnormal liver function tests have been reported occasionally.

Dosage: An appropriate hypnotic dose should produce the desired effect while avoiding oversedation and impairment of performance the next day. Adults: 30 mg before retiring. Elderly and debilitated patients: initial dose should not exceed 15 mg before retiring (see Precautions). Temazepam is not indicated in children below 18 years of age. Temazepam is intended only for short-term use. Prescribe in quantities not exceeding those required for that cycle of administration. Prescriptions should not be renewed without further assessment of the patient's needs.

Supplied: Each maroon and blue capsule, imprinted Restoril 30 and SANDOZ contains: temazepam 30 mg. Also contains lactose. Each maroon and flesh colored capsule, imprinted Restoril 15 and SANDOZ contains: temazepam 15 mg. Also contains lactose. Bottles of 100.

Protect from moisture and excessive heat. Full Product Monograph available to physicians and pharmacists upon request. 'Registered trademark 1. Roth T. In: Clinical management of sleep disorders: Our aging population (Symposium). Sandoz Pharmaceuticals, 1987, pp. 4-7. 2. Kales A, Kales JD. Evaluation and Treatment of Insomnia. New York, Oxford Uniwrsity Press, 1984, p. 11. 3. Restoril Product Monograph. 4. Fillingim JM. Clin Ther 1982:4:369-380. 5. Jochemsen R, Breimer D. Acta Psych Scand 1986;(S332):74:20-1. A. Greenhlatt OJ et al. J Pharm Sci 1QR4;73:399-401. 7. Sussman N. Hosp Formulary 1985;20:298-305.

Dr. Iain Mackie (left) and Miller with one of the controversial posters: Eroticism needed? FEBRUARY 1, 1992

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CAN MED ASSOC J 1992; 146 (3)

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Miller, is a code word that means white, heterosexual males. "The concept of 'general public' is used by people, including the medical profession, to enforce their doctrines on other people. They say that something is appropriate for private viewing, but not for the public - that the public must be shielded. "If, to address safer sex, you must talk about eroticism, and if you can only do this while talking behind closed doors, then how can safer sex really become a public issue?" Indeed, many people would probably want Miller's posters kept behind closed doors. One, from Denmark, shows two men engaged in oral sex in a washroom. Miller says it was meant to illustrate that no matter what one thinks of washroom sex, it is not going to go away and the public might as well be educated about it.

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CAN MED ASSOC J 1992; 146 (3)

A poster designed by the AIDS Committee of Toronto shows one man trying to remove the underwear of another man. "Take it off," part of the caption reads. Underneath is a picture of a condom and this caption: "Put it on." At the other extreme, the only AIDS-related poster approved for distribution in Roman Catholic schools in suburban Toronto did not even mention condoms. "AIDS is forever," that poster states. "It only takes once." "That's the message of damnation," Miller comments. Miller is no stranger to controversy. In 1989 he was criticized when two of his students posed nude in intimate positions while making their own safer-sex posters. In 1990, after he displayed his posters in a library on the Western campus, London police threatened to charge him with distributing obscene material.

One of more than 1000 posters in Miller's collection

His most recent exhibit, which was restricted to people over age 18, drew a mixed response on opening day. "They've got to educate people somehow," said Michael Kalchman, a fourthyear genetics student. Still, he was offended by a poster that showed a man with an erection wearing a condom. "Dress for the Occasion," the caption read. Karen Millard, a second-year law student, said she did not find the display shocking but acknowledged that she did feel uncomfortable while viewing it. David Scott, also in secondyear law, was "initially shocked" but he argued that shock was part of the exhibition's intent. "It's plain to see that this is targeted almost entirely toward gay men," he said. However, Miller says the display was not solely about safer gay sex. He maintains that the exhibition was designed to show the variations and the strategies for safer sex, from political confrontation to explicit eroticism. Pictures of group sex, solo sex and lesbian sex all carried the same message, he says: sex can still be fun even if it is being made safer.m LE I er FEVRIER 1992

After 10 years of AIDS, safe-sex message still controversial.

After 10 years of AIDS, safe-sex message still controversial RRESTR (temazepam) Hypnotic Indications: Temazepam is a hypnotic agent useful in the s...
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