A&U March 2016 (Mariela Castro) by A&U: America's AIDS Magazine

MARCH 2016 • ISSUE 257 • AMERICA’S AIDS MAGAZINE

VIVA CUBA

Black AIDS Institute in Havana • Belkis Fonseca Medina • Jesús Manuel Rodrigues Valle • VIVA: Find Your Voice

plus • David Hilliard • MSMGF • LGBT Survival Guide

mariela

CASTRO

CENESEX’s Director Helps Lead the Fight for HIV & Sexual Health Awareness in Cuba

New Genvoya is now available 速

Actual Size

Onepill pill contains One contains elvitegravir, cobicistat, emtricitabine, elvitegravir, cobicistat, emtricitabine, and tenofovir (TAF). and tenofoviralafenamide alafenamide (TAF). Ask your healthcare provider Ask your healthcare provider if GENVOYA is right for you.

if GENVOYA is right for you. To learn more visit GENVOYA.com To learn more visit

GENVOYA.com

Please see Brief Summary of Patient Information with important warnings on the following pages.

Brief Summary of Patient Information about GENVOYA GENVOYA (jen-VOY-uh) (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide) tablets Important: Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA. There may be new information about GENVOYA. This information is only a summary and does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is the most important information I should know about GENVOYA? GENVOYA can cause serious side effects, including: • Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis may happen in some people who take GENVOYA. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms, which could be signs of lactic acidosis: • • • • • • •

feel very weak or tired have unusual (not normal) muscle pain have trouble breathing have stomach pain with nausea or vomiting feel cold, especially in your arms and legs feel dizzy or lightheaded have a fast or irregular heartbeat

• Severe liver problems. Severe liver problems may happen in people who take GENVOYA. In some cases, these liver problems can lead to death. Your liver may become large and you may develop fat in your liver. Call your healthcare provider right away if you get any of the following symptoms of liver problems: • your skin or the white part of your eyes turns yellow (jaundice) • dark “tea-colored” urine • light-colored bowel movements (stools) • loss of appetite for several days or longer • nausea • stomach pain • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking GENVOYA for a long time. • Worsening of Hepatitis B infection. GENVOYA is not for use to treat chronic hepatitis B virus (HBV). If you have HBV infection and take GENVOYA, your HBV may get worse (flare-up) if you stop taking GENVOYA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. • Do not run out of GENVOYA. Refill your prescription or talk to your healthcare provider before your GENVOYA is all gone. • Do not stop taking GENVOYA without first talking to your healthcare provider. • If you stop taking GENVOYA, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking GENVOYA.

What is GENVOYA? GENVOYA is a prescription medicine that is used without other HIV-1 medicines to treat HIV-1 in people 12 years of age and older: • who have not received HIV-1 medicines in the past or • to replace their current HIV-1 medicines in people who have been on the same HIV-1 medicines for at least 6 months, have an amount of HIV-1 in their blood (“viral load”) that is less than 50 copies/mL, and have never failed past HIV-1 treatment HIV-1 is the virus that causes AIDS. GENVOYA contains the prescription medicines elvitegravir (VITEKTA®), cobicistat (TYBOST®), emtricitabine (EMTRIVA®) and tenofovir alafenamide. It is not known if GENVOYA is safe and effective in children under 12 years of age. When used to treat HIV-1 infection, GENVOYA may: • Reduce the amount of HIV-1 in your blood. This is called “viral load”. • Increase the number of CD4+ (T) cells in your blood that help fight off other infections. Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your blood may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak (opportunistic infections). GENVOYA does not cure HIV-1 infection or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. Avoid doing things that can spread HIV-1 infection to others: • Do not share or re-use needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. • Do not have any kind of sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your healthcare provider if you have any questions about how to prevent passing HIV-1 to other people.

Who should not take GENVOYA? Do not take GENVOYA if you also take a medicine that contains: • alfuzosin hydrochloride (Uroxatral®) • carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) • cisapride (Propulsid®, Propulsid Quicksolv®) • ergot-containing medicines, including: dihydroergotamine mesylate (D.H.E. 45®, Migranal®), ergotamine tartrate (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), and methylergonovine maleate (Ergotrate®, Methergine®) • lovastatin (Advicor®, Altoprev®, Mevacor®) • midazolam, when taken by mouth • phenobarbital (Luminal®) • phenytoin (Dilantin®, Phenytek®) • pimozide (Orap®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • sildenafil (Revatio®), when used for treating lung problems • simvastatin (Simcor®, Vytorin®, Zocor®) • triazolam (Halcion®) • the herb St. John’s wort or a product that contains St. John’s wort

What should I tell my healthcare provider before taking GENVOYA? Before taking GENVOYA, tell your healthcare provider if you: • have liver problems including hepatitis B infection • have kidney or bone problems • have any other medical conditions • are pregnant or plan to become pregnant. It is not known if GENVOYA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking GENVOYA. Pregnancy registry: there is a pregnancy registry for women who take HIV-1 medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry. • are breastfeeding or plan to breastfeed. Do not breastfeed if you take GENVOYA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. – At least one of the medicines in GENVOYA can pass to your baby in your breast milk. It is not known if the other medicines in GENVOYA can pass into your breast milk. – Talk with your healthcare provider about the best way to feed your baby. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how GENVOYA works. Some medicines may interact with GENVOYA. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. • You can ask your healthcare provider or pharmacist for a list of medicines that interact with GENVOYA. • Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take GENVOYA with other medicines.

How should I take GENVOYA?

• Take GENVOYA exactly as your healthcare provider tells • • • • • • •

you to take it. GENVOYA is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection. GENVOYA is usually taken 1 time each day. Take GENVOYA with food. If you need to take a medicine for indigestion (antacid) that contains aluminum and magnesium hydroxide or calcium carbonate during treatment with GENVOYA, take it at least 2 hours before or after you take GENVOYA. Do not change your dose or stop taking GENVOYA without first talking with your healthcare provider. Stay under a healthcare provider’s care when taking GENVOYA. Do not miss a dose of GENVOYA. If you take too much GENVOYA, call your healthcare provider or go to the nearest hospital emergency room right away. When your GENVOYA supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to GENVOYA and become harder to treat.

What are the possible side effects of GENVOYA? GENVOYA may cause serious side effects, including: • See “What is the most important information I should know about GENVOYA?” • Changes in body fat can happen in people who take HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk). Loss of fat from the legs, arms and face may also happen. The exact cause and long-term health effects of these conditions are not known. • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider right away if you start having any new symptoms after starting your HIV-1 medicine. • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking GENVOYA. Your healthcare provider may tell you to stop taking GENVOYA if you develop new or worse kidney problems. • Bone problems can happen in some people who take GENVOYA. Bone problems may include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. The most common side effect of GENVOYA is nausea. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. • These are not all the possible side effects of GENVOYA. For more information, ask your healthcare provider or pharmacist. • Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of GENVOYA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use GENVOYA for a condition for which it was not prescribed. Do not give GENVOYA to other people, even if they have the same symptoms you have. It may harm them. This Brief Summary summarizes the most important information about GENVOYA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about GENVOYA that is written for health professionals. For more information, call 1-800-445-3235 or go to www.GENVOYA.com. Keep GENVOYA and all medicines out of reach of children. Issued: November 2015

EMTRIVA, GENVOYA, the GENVOYA Logo, GILEAD, the GILEAD Logo, GSI, TYBOST, and VITEKTA are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. © 2015 Gilead Sciences, Inc. All rights reserved. GENC0001 11/15

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c o n t e n t s March 2016

44 Cover Human Rights Activist Dr. Mariela Castro Espín Talks to A&U’s Sean Black About How CENESEX Helps Strengthen the Rights of the LGBT Community and Raises Awareness About HIV/ AIDS in Cuba

Departments

Features 32 Re-Gaying the Response The Global Forum on MSM & HIV Fights for Treatment & Prevention Access for Marginalized Gay Men 34 Gallery Photographer David Hilliard Brings Light to Narratives of Possibility, Often Shaded by the Epidemic 38 Building Communidad After Their Trip to Cuba, Members of a Black AIDS Institute Delegation Reflect on Lessons Learned

Frontdesk

Mailbox

NewsBreak

Ruby’s Rap

viewfinder 19

Just*in Time

Our Story, Our Time

Role Call

TYing It All Together

Nonfiction by Hank Trout

50 Survival 101 Artist Steed Taylor Curates a Show that Shares the LGBT Community’s Strategies for Living Well

lifeguide

54 Housing the Kiki Community Housing Works Partners with the Ballroom Scene to Improve Health cover photo by Sean Black

The Whole Perspective

Hep Talk

The Culture of AIDS

Lifelines

Survival Guide

A&U Frontdesk

Children of the Revolution

any moons ago, my father served as an intelligence officer, even briefing President John F. Kennedy during the tense days of the Cuban Missile Crisis after his mission to the Bay of Pigs. (Don’t worry—his stint briefing President Kennedy and the Joint Chiefs of Staff is not longer classified information.) So, it’s a bit ironic, fifty-plus years later, that his son is doing a little intelligence gathering related to Cuba, albeit in a wildly different capacity and in an era of renewed relations between the U.S. and our neighbor ninety miles south of Florida. Thanks to Sean Black, who traveled on behalf of A&U with the Black AIDS Institute’s delegation to Cuba, we have our own intelligence briefing to share with you, dear reader. The stakes between my father’s situation and ours are quite different, but perhaps similarly high. While Cold War-era America was caught up in protecting itself from what it perceived to be the threat of communism, Obama’s America is more interested in seeking out alliances with the Cuban government and its people. By lifting the embargo, President Obama has not only paved the way for economic exchange, but also for informational exchange. And that’s exactly how we approached our trip— seeking to be educated about how Cuba has managed so many successes in the fight against AIDS (the country has the lowest HIV transmission rate in the Western hemisphere), as well as gained momentum in LGBT equality. Although I may never know all of the ins and outs of the Cuban Missile Crisis, we do know as magazine editors that the story of sex education, safe sex teachings, prevention, and drug treatment in Cuba is no longer controversial; indeed, some may call their latest approaches to ending AIDS commendable. One hopes the successes are sustained and ironically they seemingly hinge on the leadership of a Castro— Mariela, that is. Mariela Castro, daughter of current president Raúl Castro and niece of Fidel Castro, is the director of CENESEX, which works to ensure the principles of the revolution apply to individuals of all genders and sexual orientation. But can one government-spon-

A M E R I C A’ S A I D S M A G A Z I N E issue 257 vol. 25 no. 3 March 2016 editorial offices: (518) 426-9010 fax: (518) 436-5354 Editor in Chief & Publisher David Waggoner

sored centralized agency do the work that a multitude of nonprofit organizations in the U.S. have accomplished? Is it better to have a singular vision or a variety of independent perspectives? What are the downsides to the lack of personal liberties in a country which is the opposite of a country like the U.S., where oppositional organizations like ACT UP are allowed to flourish? Whatever the answer, certainly we cannot balk at Cuba’s free, universal healthcare system. In this era of American politics, when some candidates think nothing of emulating racism, sexism, and homophobia for the masses, it is refreshing to hear an actual leader defend human rights. Mariela Castro, in this month’s cover story, takes pains to not only affirm that socialism is a work-in-progress but to insert LGBT individuals and individuals living with HIV/AIDS into Cuba’s project of emancipation. Their inclusion “was due, and would be just, based on these principles,” she tells A&U’s Sean Black. Elsewhere in this issue, thanks to guest editor Phill Wilson, who led the Black AIDS Institute delegation, we learn about Cuba from various perspectives, both American (see “Building Communidad”) and Cuban (see the columns, Role Call and Survival Guide). This issue also features, perhaps as an inadvertent counterpoint, some of the ways that American LGBTers are helping to raise AIDS awareness—Lester Strong interviews photographer David Hilliard about creating art under the long shadow of AIDS in this month’s Gallery; and Alina Oswald uncovers fresh approaches to engagement in testing and care when she reports on New York City’s Kiki community . Whatever your stance on Cuba’s prevention efforts is, we hope you come away from this issue with a deeper understanding of what needs to be true: When it comes to ending AIDS, we need to build bridges. We need strong allies. We need to pool our intelligence for the common good.

DAVID WAGGONER

Managing Editor: Michael Needle Senior Editors: Dann Dulin, Sean Black Editor at Large: Chip Alfred Special Projects Editor: Lester Strong Literary Editor: Brent Calderwood Arts Editor: Alina Oswald Consulting Editor: Nick Steele Copy Editor: Maureen Hunter Contributing Editors: Sarah Churchill Downes, Reed Massengill, Kelly McQuain, Lesléa Newman, Robert E. Penn Contributing Writers: Tyeshia Alston, Noël Alumit, V. Anderson, Heather Arculeo, Larry Buhl, Ruby Comer, Diane Goettel, Sally Hessney, George M. Johnson, Angela Leroux-Lindsey, Mark Rebernik, Dale Reynolds, Elizabeth Rodgers, David Rosenberg, Corey Saucier, Mariel Selbovitz, Justin B. Terry-Smith, Patricia Nell Warren, Chuck Willman, Jeannie Wraight, Robert Zukowski Art Director: Timothy J. Haines Contributing Photographers: Jordan Ancel, Davidd Batalon, Mark Bennington, Tom Bianchi, Sean Black, Adam Bouska, Brian Bowen Smith, Tim Courtney, Duane Cramer, Stephen Churchill Downes, Greg Gorman, Francis Hills, Renée Jacobs, Tara Lessard, Tom McGovern, Nancy Perry, Annie Tritt National Advertising Director: Harold Burdick, Jr. Sales & Marketing: David L. Bonitatibus Advertising Sales Office: (518) 426-9010 National Advertising Representative: Rivendell Media (212) 242-6863 Subscription Info: (518) 426-9010 Circulation Manager: Robert Schelepanow Bookkeeper: Richard Garcia Board of Directors President: David Waggoner Vice President: Harold Burdick, Jr. Secretary: Richard Garcia Founding Board Members: Mark S. Labrecque, 1961–1992, Christopher Hewitt, 1946–2004, Mark Galbraith, 1962–2011 In Memoriam: Bill Jacobson, 1939–2005 Rhomylly B. Forbes, 1963–2011 • Chris Companik, 1957–2012 Nancy Ellegate, 1959–2015 A&U (ISSN 1074-0872) is published by Art & Understanding, Inc., 25 Monroe St., Suite 205, Albany, NY 12210-2743, USA. For A&U advertising information please call 518-426-9010; for subscriptions and address changes please call 518-426-9010; for letters to the editor and unsolicited manuscripts write A&U Magazine, 25 Monroe Street, Albany, New York 12210; fax 518-436-5354; or e-mail: mailbox@ aumag.org. All unsolicited manuscripts that do not have a S.A.S.E. cannot be returned and will not be acknowledged. ©2016 Art & Understanding, Inc. ALL RIGHTS RESERVED. A&U may not be reproduced in any manner, either in whole or in part, without written permission of the publisher. A&U and the graphic representations thereof are the registered trademarks of Art & Understanding, Inc., a 501 (c) (3) nonprofit organization. Individual Subscription rates: $24.95 (12 issues). Institutional rates: $80.00 (12 issues). For subscriptions outside the USA and possessions, $30.95/Canada, $49.95/international, payable in advance in U.S. currency. First North American serial rights revert to contributors upon publication. A&U retains the right to anthologize work in further issues, as well as in microform or reprinting on the Internet within the context of each issue. Statements of writers, artists and advertisers are not necessarily those of the publisher. Readers note: subjects and contributors to A&U are both HIV-positive and HIV-negative. In the absence of a specific statement herein concerning the serostatus of any individual mentioned in, or contributing material to, this publication, no inference is made with respect thereto and none should be implied. Letters written to A&U or its contributors are assumed intended for publication. Art & Understanding, Inc. assumes no responsibility or liability for unsolicited submissions and does not guarantee the return thereof. PostMaster: Please send address corrections to A&U Magazine, 25 Monroe Street, Suite 205, Albany NY 12210-2743, USA

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x o b l i ma The People’s Photographer There is no doubt in my mind that Greg Gorman is one of those iconic

hideous death associated with the earlier days of AIDS, before they came up with [life-saving] medications, it was of tremendous concern to me.” Thank you for a wonderful portrait of one of the world’s premier photographers. —Morris Trevy Dubuque, Iowa

Preparing for PrEP After reading Justin B. Terry-Smith’s article on PrEP, in response to a letter he got, I am totally 100 percent for the use of PrEP as the new alternative to using the condom [Just*in Time, January 2016]. I am not saying that condoms are not good, it’s just that people need to use the new technology that is available to the public. I mean definitely if nothing is available except a condom, please use the condom. Don’t get infected. I think that Truvada is the new way to go. Don’t be afraid of the new and improved approach to protection. —Nathan Bilford Charleston, South Carolina

“I do believe that Greg cares about AIDS and the way the epidemic has evolved over the past thirty-five years. Your article was very right on the money.” Cinderella Liberty

photographers like Bruce Weber, Robert Mapplethorpe, and Richard Avedon [cover story, “Between Shadows and Highlights,” by Alina Oswald, January 2016]. Greg’s work over the years speaks for itself. He is brilliant—a real genius of his times. The key to his success is that he knows how to “get to” people, to expose their inner soul, how he bonds with his subject. He has photographed many famous people, including many who have died from AIDS. He lost many friends to the disease. He says: “Watching them go through the

I was very touched by Greg’s reference to his friend Robert Hayes of Interview Magazine. His description of what happened to Hayes was very sad and really something moving. I could tell that Greg is a very sensitive and caring human being. I do believe that Greg cares about AIDS and the way the epidemic has evolved over the past thirty-five years. Your article was very right on the money. —Shelly Duvarsi Nashua, New Hampshire

Send e-mail to: mailbox@aumag.org Send letters to: Mailbox, A&U, 25 Monroe Street, Suite 205, Albany, NY 12210 Or click on “Mailbox” on our Web site’s home page: www.aumag.org Tweet Us @au_magazine Facebook: http://on.fb.me/AUFANPAGE All correspondence requires name, address, and daytime phone number for confirmation. Letters may be edited for length and clarity.

A&U • MARCH 2016

photo by Sean Black

Hooray for Heather Arculeo’s “Personal Bill of Rights” for women; I was excited and provoked by what she said [A Woman’s Voice, January 2016]. I mean, this could appeal to men also and it should be followed by men. We are all human beings no matter what. But I feel this applies more for women than men. We are still an abused minority. Yeah, I say hooray, hooray for a “Personal Bill of Rights.” Yeah, and “I have the right to…” Thanks, Heather, for liberty. —Ashley Savillia San Diego, California

NEWSBREAK It Feels Good APLA Health and Wellness (APLAHW) has rolled out a new campaign to raise awareness about sexual health and the benefits of PrEP as an HIV prevention tool option. Targeted to Los Angeles residents, the “It Feels Good” ads have begun popping up on buses and rail lines around town. A video was also produced for on-line platforms, and the campaign introduces “It Feels Good” as a hashtag in order to encourage others to respond via social media. APLAHW hopes the public will become educated about the prevention option and seek additional information. As an extension of APLAHW’s mission to educate and break down barriers to care, the campaign features spokespeople offering their personal responses about why an empowered approach to sexual health “feels good”: “It feels good protecting myself against HIV with PrEP,” “It feels good telling my friends that PrEP helps protect them against HIV,” and “It feels good discussing PrEP with my doctor,” for example. PrEP is a one-pill-a-day regimen that has been shown to be up to ninety-nine-percent effective in stopping the transmission of the virus. Used in conjunction with condoms, PrEP greatly reduces the risk of HIV transmission. Awash in vibrant colors, the ad campaign features the photography of one of A&U’s Senior Editors, Sean Black, who participates in many HIV-related projects, like this one, outside of his work at the magazine. “We wanted the ads to have a positive tone and message, while also delivering information that makes it easy for people who have questions to get answers,” Terry Smith, associate director of prevention at APLA Health & Wellness, said in a prepared release. “PrEP awareness is on the rise, but many individuals still don’t know there’s this important HIV prevention tool and that they may easily be able to get it through a medical provider. Removing barriers to PrEP access is very important in the fight against HIV.” APLA Health & Wellness offers an array of services that engage individuals in care and provide culturally competent services, specifically focusing on low-income LGBT people of color living in Los Angeles County. While APLAHW provides general HIV primary care, oral health services, mental health counseling, and testing, among many others, it also provides PrEP-focused services such as PrEP counseling and management and helping clients navigate resources to cover costs. Currently, PrEP services may be accessed at two of its two health centers—the Gleicher/Chen Health Center in Baldwin Hills in South L.A. and the Long Beach Health Center in Long Beach. APLAHW has other area clinics as well as a mobile dental facility. The first phase of the “It Feels Good” campaign runs through March; the second phase, featuring additional ads and videos, will begin in May and end in July. To learn more about PrEP and APLA Health & Wellness’s PrEP services in Los Angeles County, contact the organization by phone at (844) 830-PrEP or visit www.aplahw.org/prep.

Research Gains, Research Cuts Encouraging research news is coming out of 2016 Conference on Retroviruses and Opportunistic Infections (CROI). HIV prevention for women received a research boost with data results from two large-scale clinical trials studying a vaginal ring containing the antiretroviral drug, dapivirine. Two studies, ASPIRE and The Ring Study, looked at the safety and efficacy of this MARCH 2016 • A&U

NewsBreak

vaginal ring. Both found the ring safe to use; both showed reduction in the risk of HIV transmission, by twenty-seven percent in the ASPIRE study and by thirty-one percent in the Ring Study. Among women who were over twenty-one, researchers found that efficacy was significantly higher than in women ages eighteen to twenty-one, who were not as likely to keep the ring in consistently throughout the month. Research into extended-duration or long-acting formulations of antiretrovirals also offered some hopeful news. MK-8591, an investigational agent from Merck, was found to suppress HIV replication for at least ten days in a small number of treatment-naive patients. Study participants received MK-8591 as a single 10 mg dose monotherapy. The trial is an ongoing Phase Ib monotherapy proof-of-concept efficacy trial that is evaluating once-weekly oral dosing. Bone loss in individuals living with HIV has been seen to increase during the first two years of antiretroviral treatment. Phase II study results show that a single dose of the drug zoledronic acid inhibits bone loss, compared to a placebo, and may become an effective prophylaxis. Promising research, however, needs sustained funding to benefit from the momentum created by new insights and potential breakthroughs. Recently advocates and healthcare professionals have been reacting to news that President Obama’s fiscal year 2017 budget proposal for HIV research funding has been stalled at the same level three years in a row. PEPFAR funding has also plateaued. While funding for domestic HIV/AIDS programs have by and large been sustained, advocates like Carlos del Rio, MD, FIDSA, Chair of the HIV Medicine Association, encouraged: “A robust federal response is more critical than ever to effectively respond to the HIV epidemic. Of 1.2 million individuals living with HIV in the United States only an estimated forty percent are in HIV care and just thirty percent to be virally suppressed—the clinical goal of treatment. In addition, close to 50,000 people become infected with HIV each year, an unacceptably high number. Globally, we have made significant progress but the goal of ending HIV that the President cited in the State of the Union address, will not be reached without adequate funding for programs like PEPFAR and the Global Fund.” He continued: “We strongly support the President’s proposal to fund the National Institutes of Health at a $33.136 billion in FY 2017—an increase of $825 million over the FY 2016 enacted level. The FY 2016 enacted level also included a $298 million increase for the National Institute for Allergy and Infectious Diseases as compared with the FY 2015 level. However, at this time of pivotal promise and potential for game-changing HIV research discoveries, it is disappointing that the President abandoned his FY 2016 proposal of a $100 million increase for HIV research at the NIH despite an overall enacted increase of $2 billion in FY 2016. His budget instead freezes HIV research funding at the FY 2015 level for both FY 2016 and FY 2017. Flat funding will slow progress toward the next breakthrough discoveries that hold promise for an HIV vaccine and a cure.”

Break bread with your loved ones on April 28 and help support local organizations dedicated to HIV/AIDS services. An annual event started in 1991, Dining Out for Life hosted by Subaru has this year enlisted 3,000 participant restaurants (in almost sixty cities across North America) that will donate a generous portion of their proceeds to HIV/AIDS care, prevention, education, testing, counseling, and other vital services in their respective cities. Whether you are in Albany or Philadelphia or Vancouver Island, simply show up and enjoy some food and drink! Last year, volunteer spokesperson and renowned chef Daisy Martinez, told A&U: “I love [Dining Out for Life] because it’s a very happy event that’s about something serious. You can feel the solidarity and the hope. The whole journey of HIV has been a long one. There have been great advances but there is a way to go. Living in New York with such a diverse population, I don’t know anyone whose life hasn’t been affected by this scourge one way or another, whether it’s a friend or family member. This really brings to light under a really happy occasion. I think it’s wonderful. The restaurants and restaurateur who have signed on with Dining Out For Life donate a percentage of the proceeds for that day towards HIV research and care.” Dining Out For Life sponsored by longtime This year, Martinez again joins Dining Out for Life’s other volunteer host sponsor Subaru. Pictured are 2016 volunspokespeople—Food Network host Ted Allen, actress Pam Grier, and designer teer spokespeople (left to right) Mondo Guerra, Mondo Guerra—to help get the word out. Daisy Martinez, Pam Grier, and Ted Allen. Dining Out for Life hosted by Subaru raises an average of $4 million annually. For more information about your area’s event, visit www.diningoutforlife.com. Follow on Twitter @DineOut4Life, or Facebook/DiningOut4Life. To participate, please contact Dining Out For Life International Association, Inc. Note that some cities have alternate dates.

A&U • MARCH 2016

photo by Nick D’Amico/15 Minutes Inc.

Dining Out for Life 2016

Benefiting

Rain or shine, this ride is amazing, and so important to the LGBT community living with AIDS/HIV. Being able to bring awareness to the AIDS epidemic before, during, and after the Ride is my reason for riding. I go into the Ride with one goal and finish accomplishing so much more. â&#x20AC;&#x201D; Andrew, Rider No. 109

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brakingaidsride.org 866-858-6877

by Ruby Comer

“HIV Matters: Looking Forward” that helped launch rapid testing at Asian Americans for Community Involvement (AACI). Evan also focuses on issues of affordable housing, education, renewable energy, and civil rights. Both of us are hanging at the majestic JW Marriott in Summerlin, twenty minutes outside LV, and, boy, this lavish five-star is epic! George, the dashing bellman, graciously welcomes me to my one bedroom suite in his congenial Serbian accent. If I weren’t engaged, I might think about inviting him to my irresistible, fluffed-up king-size bed. Oh, Ruby, stop! I have two balconies. Cascading gushing waters below my room offer a rhythmic serenity. I have a spectacular view of the Red Rocks, and at night, the twinkling lights of Vegas can be seen on the horizon. A walk-in closet offers a big enough space to accommodate Ms. Ruby’s cosmetics. The Marriott is big on supporting their community that includes breast cancer, Nevada Children’s Center, the physically challenged, United Blood Services, Make a Wish Foundation, and, every year, the resort donates to silent auctions for various AIDS fundraisers. In the late afternoon, after a full day of speaking and networking at the conference, Evan and I hop into my rented car and motor through the Red Rocks. This place has got to be a “Wonder of the World.” Jaw-dropping. Once back at the hotel, we leisurely stroll through the pristine hotel grounds. We trek across a wooden bridge over a meandering brook, pass through a Zen garden, and settle on a cushioned three-seat swing lounger amidst lush brimming foliage and lofty trees. Ahhh....

Ruby Comer: I wish I lived in a place like this, Evan. It’s a fairy tale! Earlier today we were talking movies. I wanna know what’s your favorite film of all time? Evan Low: Star Wars [he instantly and enthusiastically replies]. Who could argue with that?! (Suddenly the sun glistens on his boyish face flaunting his flawless skin.) Say, what’s your number-one concern about HIV? Prevention. One in eight people don’t know they’re infected. While the rate of AIDS and HIV deaths have been declining in recent years the rate of infections are still increasing. How has all this impacted you? As an openly gay man and a legislator, the AIDS epidemic certainly affects and informs my decisions on public health policy. I must do my part in preventing the spread of the infection by advocating for safe sex and regular testing. It also A&U • MARCH 2016

Ruby illustration by Davidd Batalon; photo courtesy Assemblymember Evan Low

“W

hat happens in Vegas”...does not stay in Vegas—because Ms. Ruby tells all! Beyond the marquee lights, gaming, and lengthy strip traffic lights, this desert town and its environs offer a ton of sightseeing treasures: The Mob Museum, The Neon Museum, the Springs Preserves, which includes the Nevada State Museum, not to mention Titanic: The Artifact Exhibition. At the Nevada State Museum I learned that the “First Lady of Vegas” is Helen Jane Stewart and that Las Vegas was founded in 1905. Helen, who was born in 1854, did not have an easy life. A neighbor murdered her husband and she raised their five kids by herself. She eventually became the largest landowner of that area and the town’s first postmaster (which, until 1903, was called Los Vegas). She was also the first woman to be elected to the school board. Another pioneer is my pal, Evan Low, thirty-two, who’s also in Vegas for an AIDS conference. He was elected to the California State Assembly representing Silicon Valley. At twenty-six, Evan is the youngest Asian-American legislator to be elected to the Assembly in state history, as well as the youngest openly gay mayor (in Campbell, California) in the country. Passionate about healthcare, Evan has been steadfastly involved with the HIV and AIDS community. In 2013, he launched a petition on the Change. org website asking the Food and Drug Administration to lift its ban on gay and bisexual men from donating blood. In a few short months the petition had garnered nearly 50,000 signatures. In the spring of last year, the FDA lifted the lifetime ban. However the updated recommendations still discriminate against men who have had sex with another man within the past twelve months. Evan also served on the 2007 host committee of

EVAN LOW

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Right: Low introduces his father, Arthur Low, during Floor Session.

provides a guiding compass for the moral obligation that I have, not only to the LGBT community, but to all in society. By the way, when did you first hear the words “HIV” and “AIDS”? I was in school in San Jose [California], and I learned about it during sexual education class. Fortunately, they also taught students how to have protected sex. You mentioned during the conference today about your work with the AACI. Please tell me a bit more, Evan. I was proud to support them in obtaining rapid HIV testing in 2007. At the time, Santa Clara County was only supporting blood tests wherein results took a week or more to come in, as patients waited in fear. AACI is a wonderful organization proudly located in my Assembly District, and the leading nonprofit in Santa Clara County providing culturally sensitive health and human services to the Asian Pacific Islander community. Yes, our organization in Los Angeles, APAIT (Asian Pacific AIDS Intervention Team) is extraordinary. Where does your interest in volunteering originate? I was lucky to grow up in a home that valued community service and cared for others less fortunate than us. My father has an optometric practice in Campbell, has always been very active in the community. When I was just a young kid,

Bottom: Front view of JW Marriott Resort and Spa

he would take me to volunteer with him at various nonprofits and community organizations every weekend. It was fun. As I grew older, the real impact of what we had been doing hit me: Silicon Valley is a place of abundance, but it is also a place where many are in need of food, housing, healthcare and additional support services. Spot on! Can you address HIV in the Asian community? Homosexuality in Asian cultures run counter to many spoken and unspoken traditions related to the responsibilities and duties of a child to his or her parents and ancestors, including never shaming the family and producing healthy children to keep the family traditions alive. I believe that I and many other Asian-American children were taught never to disappoint our parents and were held to a higher standard. Rather than constantly looking for praise, I always strive to do my best. When I came out to myself, I immediately thought: “I don’t want to shame my family.” And then, all these questions went through my mind, like how ashamed will my relatives be? How will it affect my parents? Will my relatives blame my parents for being gay? Many of these questions are not specific to Asian-American children. However, I think the level of ingrained fear that goes with these questions is often heightened due to Asian culture. My brother Mikey is gay and he had a helluva time coming out. How old were you when you came out to your family and how did they handle it? I was twenty. My parents are completely loving and kind souls. We’re a close family with strong traditional values.

Evan, what do you want to say to your fellow Asians about prevention? The best solution to increase HIV testing in the API communities is to continue the effort to ensure that LGBTQs are treated equal in society, reducing stigma, sex education, and increasing access to culturally sensitive counseling. Now you’re talking my language, Mister. As a politician you meet many people, like I just met Charlize Theron at the conference yesterday. [We get up and stroll back to the hotel.] What a gem of a humanitarian! I’m interested to know who stands out the most for you? President Obama. He’s a kind man with a compassionate heart. He’s a charismatic guy who cares for his fellow citizens. As an Assemblymember, what are you currently working on? Last year, I had a very successful first year in the State Legislature. Right now, I’m meeting with constituents and stakeholders to look at a variety of issues to create a new bill package for this year.

(Standing in line at the hotel’s Rampart Restaurant, we eagerly anticipate the unlimited amounts of food we can eat at their popular daily buffet! I pose one last question.) What concerns you the most within the HIV community? It’s so important that current and future generations do not become complacent. Too often with news about advanced drugs and prevention, individuals may feel like they’re safe. However, we must recognize and remember the past so that we do not repeat history! We also need a sense of appreciation while remembering the past. [Evan pauses, then his puppy-dog eyes glare directly into mine and he softly declares) Ruby, we… must…not…forget. Ruby Comer is an independent journalist from the Midwest who is happy to call Hollywood her home away from home. Reach her by e-mail at MsRubyComer@aol.com. A&U • MARCH 2016

hotel photo courtesy Marriott; Low photos courtesy Assemblymember Evan Low

Left: Assemblymember Low attempts to donate blood in an effort to raise awareness about an outdated policy that discriminates against gay and bisexual men.

Justin B. Terry-Smith, MPH, has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal. blogspot.com. Presently, he is working toward his doctorate in public health. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at jsmithco98@hotmail.com.

Justin—

Quick question. Since you can still get the other STDs, can HIV hitch a ride on those when they are transmitted? —Vernon Hey, thank you for replying to January’s installment of Just*in Time. This is a very good question and it’s a question I’ve never gotten before. But let me analyze the question before I answer it. I’m guessing what sparked your question was that I spoke of in the last column, which was about PrEP and how someone who is taking PrEP is still susceptible to other sexually transmitted infections (STIs). PrEP is highly effective in preventing HIV, period. As far as what the research says, STIs cannot act like a Trojan horse and smuggle in HIV in the presence of PrEP. But to answer your question about the relationship of HIV and STIs in a general sense: YES, it can go either way. If you have the human immunodeficiency virus (HIV), you can leave yourself open to other STIs; and if you have an STI, you can leave yourself open to HIV. Let me explain further so everyone understands what I’m talking about. The transmission of HIV and STIs are highly similar. If a person becomes infected with HIV they may have put themselves at MARCH 2016 • A&U

risk for other STIs such as chlamydia, hepatitis, gonorrhea, herpes, syphilis, etc. With some STIs you are at greater risk of being infected with HIV. STIs, such as herpes and syphilis can cause open sores on the body. These sores allow HIV an easier pathway to introduce itself into the body through the bloodstream. Even though STIs such as chlamydia and gonorrhea primarily do not show themselves with symptoms of open sores they still leave the body to be more susceptible to being infected with HIV. When the body becomes infected it sends CD4 (cluster of differentiation 4) or helper cells to the infected area to help stop the infection from spreading. But that makes it easier for HIV to introduce itself into the body by attaching itself onto the CD4 cells. Once HIV has attached itself to these cells it will have the ability to infect them and travel throughout the body. So when a person is showing symptoms it is best that a physician check for HIV and vice versa. Also there is an interesting fact that I found in my research, which I already knew but didn’t think of. If someone is HIV-positive and they are infected with another STI, such as herpes, his or her symptoms can be more severe. Herpes is an STI that will on occasion show itself through sores on the infected part of the body, such as the anus, penis, vagina, mouth, or even face. Seeing

as how HIV directly affects the immune system, being co-infected with herpes leaves the body open for more outbreaks of herpes than there would be if there was no HIV infection in the body. If you are already HIV-positive you can also be more infectious to others if you are co-infected with other STIs, such as chlamydia and gonorrhea. Seeing as how the body sends more CD4 cells to deal with the STI co-infection it gives HIV more of a chance to infect more CD4 cells, thereby giving HIV the ability to spread more easily throughout the body. Therefore, when an HIV-positive male is co-infected with another STI, such as gonorrhea and chlamydia, the HIV viral load in the semen increases. BUT when the STI is treated the HIV viral load tends to decrease. In conclusion we have to all remain vigilant about taking care of ourselves and understanding the signs that something might be wrong. Do not ignore signs of infection because you could not only be protecting yourself but protecting loved ones as well. One of the things that I wish to see in my lifetime is one pill that protects against all STIs, something like PrEP but on a universal level. Science and medicine are amazing when they have the ability to work together and work together well. Hopefully the future will see more collaboration and more strides in fighting against HIV and STIs. ◊

Bringing hearts together since 1998

P zMatch.c m

Dear FDA “lifting” the ban on gays is not progress— it’s discrimination

illustration by Timothy J. Haines

et me clear my throat for this one. For months I’ve been mulling over whether I wanted to write about this subject or if I was just going to move on and let live. Yet, weeks later this topic is still weighing heavy on my spirit, and like my grandmother says “when the spirit moves you, you better listen,” so here we go! So back in December the FDA finally decided to lift its ban on gays donating blood or so the headlines would have had you to believe. From CNN to ABC World News Tonight, this landmark decision was viewed as one that was revolutionary and a step in the right direction of the civil rights of gay men across the country. Thankfully, my father always told me to never stop at the BIG WORDS on the page. Like I do with just about everything, I decided to peel back the label to this pill bottle and read the tiny print about this miracle decision. The small print as I like to call it reads: “The FDA is changing its recommendation that men who have sex with men (MSM) be indefinitely deferred...to 12 months since the last sexual contact with another man.” This statement was then followed by: “We have taken great care to ensure this policy revision is backed by sound science and continues to protect our blood supply....” Okay, let me get some Windex out and clean my personality glasses to make sure that I just read that correctly. So in a nutshell, we have reversed our decision from “all you gay, bisexuals, or men or have sex with men are banned” to “you gays, bisexuals, or men who have sex with men who have too much sex by our archaic standards that you shouldn’t be having sex more than once a year are banned.” This is what you call progress? This lifting of this ban, which has been MARCH 2016 • A&U

in existence since 1983, during the height of the HIV/AIDS epidemic, is what you really think pushes you all into a new era of understanding, and not discriminating against a group that could not only help your low blood supply levels but also be saving lives is called progress? Well frankly what you call progress I call discrimination and, at the end of the day, bullshit. As a black gay man, I take offense to any policy that adversely affects a piece of

my existence. Furthermore, I take offense that you are basically denying us the human right to be sexual beings if we choose to want to donate blood. Twelve months of no sex? Really FDA? I would love for us to take a poll of all the hetero folks at the FDA and see how many of them have abstained from sexual relations for over a year. Wait for it. Wait for it. Exactly. You are asking of us as gay men to do something the majority of the country would never be penalized for. Furthermore you stigmatize an entire population of people by perpetuating the stigma that we are highly likely to be testing HIV-positive. Then you go on to say that your policy is backed by science. Really. You don’t say. As someone who works in the field with gay men on a daily basis, I can tell you first-hand that your science is a crockpot full of (run-on sentence full of expletives). Even living in D.C., the rate of infection in the black gay community of new diagnosis

is somewhere around four percent of the total number of people tested each year. So for every 10,000 tests you are getting around 400 newly diagnosed cases. In the past five years, this number has decreased from year to year with a plan in place to have new cases totally eradicated by 2020. Science, you say? Well instead of science, I am going to work with you and discuss what makes sense. So you already have rules, regulations, and standards in place that test the blood for a battery of viruses and conditions to ensure that it is not being transmitted through transfusion, right? So wouldn’t it make sense that when a person’s blood does test for HIV, that you notify the local Health Department in that person’s area to have them come in and test as a way to locate new positives who may not know that they are positive. Wouldn’t it make sense to join the battle against HIV and decreases the amount of the 1.1 MILLION PEOPLE unknowingly infected WHO ALSO HAPPEN TO BE HETEROSEXUAL! Or is it easier to just push the narrative that gay and bi men are the problem. All this to say I won’t stand for what you call progress. I will not allow you to continue to discriminate against a population of people simply because of your homophobia and assimilation to society’s leper-like treatment of people who are HIV-positive, more so those who are more likely to contract the virus because of the community we are in. You can’t get blood from a rock, but you can definitely get it from a gay man. George M. Johnson is an HIV advocate who works for Us Helping Us, People into Living located in Washington, D.C. He has written for Pride.com, Musedmagonline.com, Blavity.com, Rolereboot.org, and Ebony.com. Follow him on Twitter @IamGMJohnson.

COMPLERA is a prescription medicine for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood. COMPLERA can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. COMPLERA combines 3 medicines into 1 pill to be taken once a day with food. COMPLERA should not be used with other HIV-1 medicines.

Just the

one

for me

COMPLERA is a complete HIV-1 treatment that combines the medicines in TRUVADA + EDURANT in only 1 pill a day.*

Ask your healthcare provider if COMPLERA may be the one for you. *COMPLERA is a combination of the medicines in TRUVADA (emtricitabine and tenofovir disoproxil fumarate) and EDURANT (rilpivirine).

Pill shown is not actual size.

COMPLERA does not cure HIV-1 infection or AIDS.

To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them. It is not known if COMPLERA is safe and effective in children under 18 years old.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about COMPLERA?

COMPLERA can cause serious side effects: t Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. t Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. t You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. t Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA?

Do not take COMPLERA if you: t Take a medicine that contains: adefovir (Hepsera), lamivudine (Epivir-HBV), carbamazepine (Carbatrol, Equetro, Tegretol, TegretolXR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek), rifampin (Rifater, Rifamate, Rimactane, Rifadin), rifapentine (Priftin), dexlansoprazole (Dexilant), esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole sodium (Protonix), rabeprazole (Aciphex), more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate, or the herbal supplement St. John’s wort. t Take any other medicines to treat HIV-1 infection, unless recommended by your healthcare provider.

What are the other possible side effects of COMPLERA?

Serious side effects of COMPLERA may also include: t Severe skin rash and allergic reactions. Call your doctor right away if you get a rash. Some rashes and allergic reactions may need to be treated in a hospital. Stop taking COMPLERA and get medical help right away if you get a rash with any of the following symptoms: severe allergic reactions causing a swollen face, lips, mouth, tongue or throat which may lead to difficulty swallowing or breathing; mouth sores or blisters on your body; inflamed eye (conjunctivitis); fever, dark urine or pain on the right side of the stomach-area (abdominal pain). t New or worse kidney problems, including kidney failure. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may also check your kidneys during treatment with COMPLERA.

Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. t Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. t Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. t Changes in body fat can happen in people taking HIV-1 medicines. t Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. t

The most common side effects of COMPLERA include trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Other common side effects include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), and pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking COMPLERA?

All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, mental health, bone, or liver problems, including hepatitis virus infection. t All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking COMPLERA without first talking with your healthcare provider. t If you take rifabutin (Mycobutin). Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take. t If you take antacids. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. t If you take stomach acid blockers. Take acid blockers at least 12 hours before or at least 4 hours after you take COMPLERA. Ask your healthcare provider if your acid blocker is okay to take, as some acid blockers should never be taken with COMPLERA. t If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking COMPLERA. t If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in COMPLERA can pass into breast milk, and it is not known if this can harm the baby. t

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information. What is COMPLERA? COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. COMPLERA is a complete HIV-1 medicine and should not be used with any other HIV-1 medicines. COMPLERA should always be taken with food. A protein drink does not replace food. COMPLERA does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – having stomach pain with nausea or vomiting – feel cold, especially in your arms and legs – feel dizzy or lightheaded – have a fast or irregular heartbeat Severe liver problems. Severe liver problems can happen in people who take COMPLERA. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems: – your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools) – loss of appetite for several days or longer – nausea – stomach pain You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider. – Do not run out of COMPLERA. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone. – Do not stop taking COMPLERA without first talking to your healthcare provider. – If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA. Who should not take COMPLERA? Do not take COMPLERA if you also take any of the following medicines: Medicines used for seizures: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) Medicines used for tuberculosis: rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) Certain medicines used to block stomach acid called proton pump inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) Certain steroid medicines: More than 1 dose of dexamethasone or dexamethasone sodium phosphate Certain herbal supplements: St. John’s wort Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) Do not take COMPLERA if you also take any other HIV-1 medicines, including: Other medicines that contain emtricitabine or tenofovir (ATRIPLA, EMTRIVA, STRIBILD, TRUVADA, VIREAD) Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Triumeq, Trizivir) rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) COMPLERA is not for use in people who are less than 18 years old. What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects: See “What is the most important information I should know about COMPLERA?” Severe skin rash and allergic reactions. Skin rash is a common side effect of COMPLERA but it can also be serious. Call your doctor right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. Stop taking COMPLERA and call your doctor or get medical help right away if you get a rash with any of the following symptoms: – severe allergic reactions causing a swollen face, lips, mouth, tongue or throat, which may cause difficulty swallowing or breathing – mouth sores or blisters on your body – inflamed eye (conjunctivitis) – fever, dark urine or pain on the right side of the stomach-area (abdominal pain) New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA.

Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease. Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA. Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. Changes in body fat can happen in people taking HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known. Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having any new symptoms after starting your HIV-1 medicine. The most common side effects of COMPLERA include: Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, depression Additional common side effects include: Vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), pain Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. What should I tell my healthcare provider before taking COMPLERA? Tell your healthcare provider about all your medical conditions, including: If you have or had any kidney, mental health, bone, or liver problems, including hepatitis B or C infection. If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child. – There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry. If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take COMPLERA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. – Two of the medicines in COMPLERA can pass to your baby in your breast milk. It is not known if this could harm your baby. – Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements: COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV-1 infection. The HIV-1 virus in your body may become resistant to COMPLERA or other HIV-1 medicines that are like it. Be sure to tell your healthcare provider if you take any of the following medicines: – Rifabutin (Mycobutin), a medicine to treat some bacterial infections. Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take. – Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. – Certain medicines to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. Some acid blocking medicines should never be taken with COMPLERA (see “Who should not take COMPLERA?” for a list of these medicines). – Medicines that can affect how your kidneys work, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte). – clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan) – itraconazole (Sporanox) – ketoconazole (Nizoral) – methadone (Dolophine) – posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider. Keep COMPLERA and all medicines out of reach of children. This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com. Revised: May 2015

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners.

lifeguide

by Belkis

Fonseca Medina

Hope Unites Us together we can fight for the empowerment of individuals living with hiv/aids

Jesús Manuel Rodrigues Valle and Belkis Fonseca, both of Centro Esperanza Cuba, alongside Nelson Alvarez Matute, of Afro-Mas back I turned it round and brought down the walls. I never let up. I made sure everyone learned a thing or two about the reality of HIV and about human values. I helped people accept me, made very good friends, and enjoy a plentiful life. I am involved in all types of projects and that keeps me happy. I love nature, especially animals. I love working out and I have healthy habits (good nutrition, no alcohol, no cigarettes, positive thinking, and connection with the universe). Despite the great work made by governments and health programs, the reality of HIV is experienced globally: Stigma and discrimination are true; people still don’t make good use of the condom; many of them are not compliant or do not adhere to the antiretroviral therapy; many healthcare providers are not expert in the issue; acknowledgment of success of mixed-status couples does not happen; and the fact that HIV-positive individuals can be successful in a healthy paternity or maternity is not fully recognized. In Cuba, as in the rest of the world,

the most common transmission of HIV is through sexual contact and, notwithstanding the increasing number of infections among the female population, gay men are the most affected segment of the population by far. Yet, do not assume that the virus is exclusive to homosexuals and marginalized individuals; anybody who has not taken the right steps is at risk and is in actuality vulnerable to any sexually transmitted disease. The best measure in prevention is the right usage of the condom. Take care of your life! Always take care of yourself! Belkis Fonseca Medina is director of Centro Esperanza Cuba, a non-profit dedicated to resource assistance to individuals affected by HIV/AIDS and their families, prevention education, and ensuring psychological support and human rights of individuals living with HIV/AIDS. With its headquarters based in Havana, Cuba, the organization recently launched a safer sex campaign, Una Nueva Esperaza (A New Hope), this past World AIDS Day. For more information, visit: www.centroesperanzacuba.com. You may directly e-mail the organization at: centroesperanzacuba@gmail. com. Contact Belkis at lagateradecuba@gmail. A&U • MARCH 2016

photo by Sean Black

iving with HIV, in all likelihood, is one of the toughest challenges a person can confront. As a health issue it turns life upside-down; but, more than anything else, this condition changes our status in the eyes of society. If we are not strong, if we do not address discrimination and protect our identities and dignity as individual human beings…then… we are left vulnerable, our health deteriorates, and the epidemic spreads. I am a fifty-five-year-old woman, chemical engineer and university professor. Ever since I contracted the virus in 2001, I submitted myself to the noble cause of prevention, to the happiness of supporting and accompanying the HIV-positive community, to the spiritual transmission of teaching the art of living under new circumstances. The commitment of many volunteers, in Cuba and around the world, to do the same has been decisive in the battle with HIV. The organization Centro Esperanza Cuba, of which I am director, is headquartered in Habana and coordinates with its branches throughout the pais. The strength of the organization is drawn from personal commitments, knowledge of the problem, and experience in communicating with HIV-positive communities. It also does an excellent job of integrating fellow volunteers who are not HIV-positive but who are sensitive regarding this matter. At the center, we work closely with the youth, the gay community, and boys and girls infected or affected by HIV. It is important to note that the organization was founded in March of 2015 and a big part of its success will benefit from the exchange of experiences, solidarity of international communities and organizations through direct contact, or events with people whose backgrounds, ethnicity, socioeconomic status, ages, religious, gender and sexual orientation differ. In fact, it would be advantageous for the cause to establish relations and exchange strategies for the betterment of the standard of living and the reduction of infections of this epidemic, at the current state, and for future eradication of the problem. Like everyone, I encountered difficult situations: rejection, incomprehension, solitude…. When “the world” gave me its

Celebrate You

we are sisters & we need to cherish ourselves

esterday, I was hit by another vehicle on the road. Although I had a major set back on my way home I never lost focus on where I was headed and I made it home several hours later. Oftentimes we hear that “trials come to make us strong,” but sometimes it seems as if trials come more often for some than others. As a woman with a child, I like other mothers know that we can not allow anything to hold us down and we have to get back up because we have someone in our home that needs for us to nurture them daily. No matter how bad we have been hit, or how high the level of pain we may be experiencing (and we may have even been broken so to the point that it is hard to adjust and move), mentally we must get back in the game. The game that I am speaking of is called the game of Life. Throughout your lifespan, you will be tested. No doubt about it. The truth is, it does not matter how major or minor the test is, what truly matters is its outcome and how it affected you. Was the test so hard that you went backwards instead of forward, or are you simply at a standstill? Did you yield to temptation or did you make a U-turn and go back to the situation you were fleeing from? Was the test so drastically hard that you are stuck in a ditch which caused a momentary delay because the only way you were able to get out was by the helping hands of someone else; or did the test lead you on a road to suicidal thoughts, where you are now facing a dead end? Well, the one good thing that I have to say about that is that at a dead end you can look in your rearview mirror and put your car in reverse and turn around. In my opinion, getting an HIV/ AIDS diagnosis was a major test and every time an AIDS Awareness Day comes around, it reminds me of the day I received my HIV diagnosis. Being reminded of something is not always a bad thing. It’s like sitting at a red light; it

gives you a moment to think or enough time to reach out to someone. What makes it bad or good is what you do once the light turns green. March 10 is the National Women and Girls HIV/AIDS Awareness Day and you may see a lot of information on the issue of HIV/AIDS on your local news broadcasting station or you may hear about it on your local radio station. Therefore, you will have the choice to get bothered by it and turn the channel, or you can listen and share the information with others in your community. The choice is yours. Like so many others, I’m sure that I may be sitting at that red light with many of my sisters, but when the light turns green, mentally and physically I will be back in the game. I made the choice ten years ago to be a mouthpiece to those in my community by telling my story to the world and I vow to myself that I will encourage others who are now living with the same disease as I am. My goal is to encourage them to live their best life. However, those are my choices. Choices which were not only best for me but for those who were around me. Once again, when that light turns green you have to make the decision to do what is best for you and your family. The choice is yours. Keep in mind that you can live well with HIV/AIDS. I will close by saying these words. It takes courage to be who you are and to love the person you are even with a

disease such as HIV/AIDS. In spite of how others may view you (and some may even try their hardest to change you to fit their needs), at the end of the day you still have to love you and be you. Keep in mind, sometimes others try to change something about you because they see something wonderful in you that they envy because they lack it. We all have to find our gifts and, just like a child, we must nourish those gifts. Don’t take anything for granted because when you are least expecting, someone could enter your lane and hit you so hard that it may require someone else to pick you back up. Cherish everything about you, even your HIV disease. After all, things could be worse. Yes, I said to cherish it because HIV is now a part of you and you, my sister, are beautiful. You are fearfully and wonderfully made. Therefore, celebrate you. Tyeshia Alston is a native of Dallas, Texas, and an HIV/AIDS activist, who “will go anywhere where people will listen.” She has done everything from travel to D.C. to speak with legislators about better healthcare access and how the disease has impacted communities to serving on panels for NMAC and other organizations and bringing her message to talk shows. In 2005 at the age of twenty-five, Alston was diagnosed with HIV and she has been on a mission since 2006 to educate people (especially our youth) about HIV/AIDS. Visit www. saaved.org to learn more about her community-based work. Also, if you have any questions or comments please feel free to email Ms. Alston at saaved2heal@gmail.com. A&U • MARCH 2016

Join Maitri to Celebrate 4pm Sunday, May 1

at Mission Bay Conference Center-UCSF 1675 Owens Street San Francisco, CA 94158

BLISS 2016 Maitri’s Signature Gala and Auction

With Special Guest Leslie Jordan

Emmy awardwinning Actor and Comedian

Maitri Compassionate Care is pleased to announce that Emmy award-winning actor and comedian Leslie Jordan will host this year’s BLISS gala and auction! Leslie Jordan is well known for his success as a dynamic comedic actor, in particular for his roles in “Will & Grace” and “Sordid Lives”. He has enjoyed rapturous reviews for his original stage plays (including “My Trip Down the Pink Carpet”), his roles in the off-Broadway production of “The Lucky Guy” and the hit movie “The Help,” and his HBO special, “Pink Carpet”. But this witty Southern Gentleman, born and raised in the conservative Bible Belt of America, is also an esteemed and generous advocate for equal rights. On Sunday May 1, join Leslie Jordan, the Man Dance Company, jazz vocalist Branice McKenzie, guitarist Andre Morgan and other fabulous guest artists in celebrating the healing power of joy.

Tickets to BLISS—Prescription: Joy are now on sale at www.maitrisf.org

Performances by Guitarist Andre Morgan, Jazz Vocalist Branice McKenzie and Man Dance Ballet Company

Maitri is the only AIDS-specific residential care facility in California since 1987 focusing on the underserved community of those dying of or severely debilitated by AIDS.

nonfiction

Just Another Death Sentence

ne morning in July 1989, I woke up with my right eye swollen completely shut and cysts all over my chest and belly. I went to the emergency room at General Hospital, where I was promptly ushered into a “biohazard isolation room.” After a week of intravenous antibiotics, the swelling and the cysts were gone, and I was about to be released from the hospital. I sat on the edge of the bed waiting for my “exit interview.” Three doctors, two male, one female, huddled in the far corner of the room, their quiet but animated discussion punctuated by furtive glances my way. After a while, the doctors heaved a collective sigh and the female doctor approached me. “I’m afraid I have some terrible news, Mr. Trout. We’ve done a lot of blood tests and, well…you have been infected with the HIV virus.” She very tentatively put her hand on my shoulder, then quickly pulled it back. “I’m so sorry,” she said. I had expected this diagnosis for seven or eight years. We all expected it in those days. Still, at that moment, those words—“you’ve been infected”—shot through me. I felt numb, completely utterly numb from head to toe. My shoulders collapsed inward, my head drooped toward my chest, and for several seconds my muscles refused to pull air into my lungs. The doctor went on talking, but the heartbeat pounding in my ears drowned out whatever she was saying. I stared at the tiled floor, remembering all the hospital beds and hospice rooms where I had watched friends wither and die—all the noisy hospital machines, all the IV tubes and hypodermics, all the beds rumpled by the dying. I saw their bruised and tearsoaked skeletal faces straining to tell me something. “Mr. Trout? Mr. Trout!” My head shook, my shoulders snapped back, and I gulped air back into my lungs. I slid off the bed and stood. “Is that all? Can I go now?” “Is that all?! I must say, Mr. Trout, you’re awfully calm about this! I’ve given this news to a lot of men, but…are you sure you understand what this means?!” How could I tell her that I had already endured the terror of two “false positive” diagnoses and had prepared myself for the one that wasn’t “false”? In just six years, I had watched helplessly as thirty of

by Hank Trout

my friends—men whom I had loved; men I had held in my arms—suffered and shriveled and died. So I knew every inch and every curve and every bump in the road ahead because I had already crawled the length of that road on my hands and knees and licked every inch of the pavement. I knew the diagnosis meant I would be dead very soon. “Yes,” I said, “I know exactly what it means. I’m going home now.” I walked toward the door, waving off her questions about whether I wanted more information. More information?! I thought, Yes! Please! Tell me something I don’t know already! Anything! I stopped at the door and turned. “You see,” I said, “I underwent experimental open-heart surgery in 1958, when I was five years-old. Those doctors told my parents that I would die before I was fifteen. Well, I’m thirty-six now. “This is just another death sentence I have to live with.” Since my diagnosis, I have learned many things about death sentences. For instance, I’ve learned that death sentences can have a very long shelf-life. Twenty-seven years I’ve lived under this one, and I’m still here. I’m still here. Hank Trout edited Drummer, Malebox, and Folsom magazines in the early 1980s. His published writing has ranged from gay “smut” (his term!) to literary criticism of William Blake. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a thirty-five-year resident of San Francisco, where he lives with his fiancé Rick. Hank read this piece at “Still Here 2015,” a program of readings and music honoring long-term survivors, part of the National Queer Arts Festival in San Francisco during Pride Week 2015.

A&U • MARCH 2016

Re-Gaying

the Response

MSMGF (The Global Forum on MSM & HIV) Redirects Focus & Funds Back to Men Who Have Sex with Men by Larry Buhl

hen you think about the global HIV/AIDS epidemic one big funding source stands out, the Global Fund to Fight AIDS, Tuberculo-

sis and Malaria. But there’s an important and little-known organization that’s been connecting big funders and community groups on the front lines of the HIV response for almost a decade. MSMGF (The Global Forum on MSM & HIV) is an expanding global network focused on sexual health and human rights for all men who have sex with men. With a full-time staff of only a dozen, mostly in Oakland, California, it works with a budget under $5 million annually, most of it coming from Levi Strauss and the Elton John AIDS Foundation. Its dollars are stretched far. MSMGF supports programs across fifteen countries—including Nigeria, Cameroon, Ghana, Tunisia, Costa Rica, Vietnam, and Honduras, to name a few— as a middleman to help direct money from the Global Fund to community groups and NGOs that can reach gay men and MSMs. And it also helps regional LGBT and HIV/AIDS groups apply and secure funding on their own, for MSM-specific HIV prevention and treatment programs. It also encourages countries to include MSMs in their national AIDS strategy. All of these efforts are necessary due to what MSMGM’s executive director calls the de-gaying of HIV/AIDS prevention and outreach funding over the past fifteen years. In order to circumvent homophobia and make the AIDS epidemic more palatable to the masses, the focus was aimed at women and children even when gay men bear a disproportionate HIV disease burden.

In 2014 the World Health Organization warned HIV among gay men and non-gay identifying men who have sex with men (MSM) was on the rise around the world. But in many countries, especially in the developing world, gay men or men who have sex with men are stigmatized, even criminalized, if they’re considered at all. That means these men are less likely to receive information on safer sex, less likely to get tested, and less likely to seek treatment if they do test positive. “Around the world it is hard to frame HIV in terms of sexuality. In the late nineties there was a deliberate effort to de-gay AIDS and that was a mistake from the global perspective, because it communicated that it didn’t matter what happened to gay men,” says executive director George Ayala. Ayala says the needs of gay men have never been resourced well enough over the thirty-plus years of the HIV/ AIDS epidemic. “Even in the U.S., state and local officials are reluctant to fund MSM-specific prevention and outreach when you get away from the coasts,” Ayala tells A&U. Advocacy and accountability The Global Fund to Fight AIDS, Tuberculosis and Malaria, often called The Global Fund or GFATM, is a public-private partnership founded in 2002 and is the largest financier of anti-AIDS programs in the world. But it’s not an implementing agency. It’s overseen by Country Coordinating Mechanisms, which includes in-country stakeholders and private sector groups. The Global Fund

recognizes country ownership of the HIV/ AIDS epidemic and lets each country define the nature of the epidemic. That means some countries, specifically those who don’t recognize HIV among MSMs as a problem or countries openly hostile to gay men, are likely to exclude treatment, outreach, and even research focusing on MSMs from their applications to the Global Fund. In a sense the Global Fund doesn’t discriminate. If a country wants money for MSM-specific outreach, it just has to ask for it. But even if a country asks, the Global Fund doesn’t have the oversight to ensure adequate security, for example, to prevent ransacking

of UNAIDS materials (this happens at clinics), or to prevent violence against gay men who seek health services (this happens too). MSMGF wants to “re-gay” the HIV funding in several ways. One is by broA&U • MARCH 2016

photo courtesy MSMGF

kering relationships with these countries at the Geneva-level (where The Global Fund is based), according to Nadia Rafif, MSMGF’s Senior Policy Advisor. “We are not a donor, but we help LGBT-friendly NGOs and local advocates find and apply for the money they [local organizations for MSMs] need,” Rafif tells A&U. “The money goes from the Global Fund to a country’s Ministry of Health, and is directed to local groups. Some of our work involves information sharing. We may hear of an open call for a proposal one month, and we go to the NGO and help them draft a proposal that includes programs specific to gay men and MSMs.” Or a country may say that it has no data on MSMs, and therefore wouldn’t know what to ask in terms of dollars for prevention and treatment. MSMGF will broker the relationship between that country and Geneva to make sure the country has the funds for research, and that the research actually happens. MSMGF also advocates for MSM-specific national training with a country’s Ministry of Health. Rafif points to successes, especially in Morocco, in getting a Ministry to recognize that MSMs are at high risk and that HIV among these populations is a true public health crisis. Swimming against a current of homophobia Any exploration of HIV/AIDS funding priorities can get a little wonky. But while MSMGF acts as a financial middleman and MSM advocate at the highest levels, it also has a substantial impact in helping gay men access testing and treatment services in regions that are either indifferent or openly hostile to gays. Specifically, it offers training sessions for community groups, public health officials and policy leaders, and it trains local activists to advocate for services for MSMs from their governments. It’s a tricky business doing so, due to the politics of the countries involved. That’s one of the reasons MSMGF has such a low profile. The very idea of men having sex with men is verboten in many places MSMGF operates. Take Zimbabwe, where homosexual acts are prohibited as they are in many African nations. President Robert Mugabe has condemned LGBTs, calling them “worse than pigs and dogs.” Gay rights activists in Zimbabwe claimed to have been abused and tortured in police custody, after MARCH 2016 • A&U

A team-building exercise with Speaking Out participants in Vietnam helped remind advocates of the power of unity. After the country’s first Speaking Out training, participants launched a national network to concentrate on the health and human rights of MSM. being accused of possessing gay porn. In such a political and cultural environment only the bravest MSMs will access health care and be open about their sexuality with physicians. “The number-one predictor of access to healthcare or lack of access [for MSMs] is homophobia,” says Mohan Sundararaj, the director of programming for MSMGF. He says his group is constantly “swimming upstream” in the face of anti-gay hostility in Zimbabwe and other countries. The discrimination can be subtle and overt. “Men may go to a clinic for treatment for an STI and be called names and ridiculed by nurses, and there are gay men beaten up in healthcare settings, sometimes by the staff,” Sundararaj tells A&U. But in only two days of pilot testing their healthcare-training curriculum training, coordinated with a local LGBT group and physicians from Johns Hopkins University (the University’s name got top billing in the training, not MSMGF), Sundararaj saw a huge attitude shift among physicians. “There were doctors who said they had never met a gay person before,” Sundararaj says. “But in two days of clinical and cultural sensitivity training, these same healthcare workers understood how to discuss patients’ sexual histories, what the critical issues are for gay men’s health and how to develop networks of understanding physicians and facilities across a region. Nobody at MSMGF thinks that their or-

ganization alone can turn around the fierce antigay cultures that exist in many countries. And the organization is not taking over the role of LGBT and HIV activism in Zimbabwe and other countries it works with. Rather, its role is helping to strengthen local networks, training trainers and facilitating intra-country networks. “We want Kenya and Zimbabwe LGBT and HIV networks and prevention experts to exchange knowledge, for example,” Sundararaj says. The Zimbabwe training Sundararaj participated in was instrumental in developing MSMGF’s “Speaking Out” initiative, a turnkey program to help community leaders across dozens of countries document discrimination in hospitals and ask leaders of NGOs to develop action plans to prevent discrimination. Even with the escalation of homophobia and the expansion of criminal sanctions against HIV transmission and homosexuality, MSMGM says they expect to expand the capacity for gay communities to be proactive in advocating for resources. “But unfortunately, the efforts and money needed to reach MSMs in these countries is still not in proportion to the level of the epidemic,” Sundararaj says. “The Re-gaying of the global HIV Epidemic” is the theme of MSMGF’s pre-conference, part of AIDS 2016 in Durban, South Africa, in July. For more information, go to www.msmgf.org. Larry Buhl writes A&U’s Hep Talk column.

at the STRONG

BROKEN PLACES Photographer David Hilliard Draws on Personal History to Create Panoramas of Possibility by Lester Strong

lance at the photography of David Hilliard and you’ll find yourself immersed in a world of lush color, scenic landscapes, intimate homescapes, and human portraits that are sometimes erotic and at other times soulful—a world, moreover, always tantalizingly suggestive of narratives that are just beyond the ability of the camera’s eye to articulate openly. And while AIDS is not always front and center in his images, as a gay man who came of age in the 1980s during the worst of the

medical crisis, it has informed his work over the years in surprising ways. “My connection with photography was probably deep from the beginning, but took awhile to reveal itself as something more profound,” Hilliard stated when interviewed for this article. “As within many families, taking photographs was always part of every ritual and event, but for my father it was a bit more obsessive. Our every moment was documented, even the most mundane. Every day when my older brother and I came home from school, or

from outside playing, we would become victims of ‘through the door shots,’ as my dad called them. There are hundreds and hundreds and hundreds of images of us ‘coming home.’” He continued: “I myself began making photographs not long after my parents’ divorce. I was around seven. My brother and I were mostly in the custody of my mother, who remarried not long after the split. Swimmers, 2003, archival pigment prints (triptych), 24 by 60 inches

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A&U Gallery I’ve always gotten along well with my own father, but my relationship with my mother’s new husband was anything but warm and accepting. These were difficult years. We moved throughout Massachusetts almost annually as my stepfather climbed the corporate ladder, and as soon as I made new connections with schools, playmates, or even the confines of my new bedroom, they would all be gone and I had to start anew. So I started photographing everything: my friends (usually girls), my brother’s friends (usually boys that I was drawn to but didn’t know exactly why at that point), playgrounds, wallpaper, my favorite trees, the neighbor’s dog, etc., etc., etc. I unknowingly was holding onto things before they could be taken away. This element of image-making is still very much alive and well in my current studio practice: photography as a marker, a keepsake, a medium through which to covet. It allows me to address a world I don’t always understand, fit into, approve of, or enjoy in ‘real time.’ It allows me to edit the world into a kind of psychological and physical submission, one in which things are a bit more palatable and understandable. I don’t know how I’d function on this planet without it really.” The narrative element in Hilliard’s photography came from three influences. “For starters, as a kid I was raised in front of television. Second, in high school, living in Lowell, Massachusetts, I became involved with a local Never the Last Endeavor (detail), 1999, archival pigment prints, 60 by 24 inches

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Sought, 2008, archival pigment prints (triptych), 40 by 90 inches professional theater. That was probably my first introduction to anything truly artistic. Then third, I discovered Hitchcock, Orson Welles, Peter Greenaway, Merchant and Ivory, Scorcese, and my beloved Coen brothers, and became swept away by poignant storytelling and breathtaking imagery in the movies. In college I first thought I’d be a film major, but soon learned that the ‘responsibility’ of that much footage was not for me. What I really loved was the pointed still moment within films, the static signifiers.” Of course signifiers always point to or hint at something, and that is part of what makes Hilliard’s photography so

arresting to the eye. It doesn’t tell a story outright, like a TV show, stage production, or movie. Instead it opens the imagination to possible narratives by inviting viewers to bring their own personal experience into interaction with the photographic images. In much of his work, he helps this process through the use of horizontal or vertical photographic panels that provide panoramic scenes, which tend to draw viewers in as participants, rather than single shots that delimit images, which tend to separate viewers out as observers. A perfect example: his photographic montage Swimmers. This triptych is obviously a nod toward two famous Thomas Eakins’ paintings, The Swimming Hole and Swimming—as Hilliard admitted to photography

critic Vince Aletti in the 2005 monograph on his work, David Hilliard: Photographs. With its broad sweep of images from bicycles fallen on the grass to teenagers swimming in a forest stream, it creates a bucolic mood. Yet the eye is stopped by the young man in the center panel, his back to the camera, sitting slightly slumped to one side of the stream apart from the others, which intrudes an altogether different note into the idyll. As Hilliard explained to Aletti: “Maybe this kid is with the other kids, maybe he’s not. He’s looking down. He’s just not in the moment. He’s not able to be with those boys, for whatever reason.…” In other words, the sense of being an “outsider” has made itself felt, which draws the viewer back to memories nearly everyone has had of not quite fitting in with one’s social world. Clearly Hilliard is drawing on his own personal memories for the feelings he expresses in this montage. And in other work he draws on his personal experiences, fantasies, and relationships. Two notable examples: No More Tears, an homage to his mother and her continuing passion for life into advanced age, and Rock Bottom, a father-son No More Tears, 2012, archival pigment prints (diptych), 40 by 60 inches

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portrait like no other you’ll see, which captures a wistful closeness between two men who, whatever their differences, feel a deep bond with each other. As Hilliard noted in the interview for this article: “In the end, all of the images play into a kind of photographic philosophy/ personal history.” So where does AIDS fit into this picture? “I came of age pretty much smack dab in the epicenter of some of the darkest years of the AIDS epidemic,” he said in the interview. “I lost many friends to the virus, and I often think it’s a miracle I’m here today. The early 1980s are so polarized in my mind: the joy of freeing myself from an oppressive town, a cruel, homophobic step-father, and troubling societal expectations I didn’t fit into. Also, the sheer exhilaration of discovering my own queer identity and the often uncontrollable joy of sex with another man. All this empowering and wonderfully formative stuff colliding head-on with the AIDS epidemic and an often narrow-minded world. It was bad, and I know for a fact it had a profound impact on shaping my identity.” He continued: “I consider myself a strong, openly gay man. I pride myself in making work about it. I’m also a teacher of photography, and am proud to tell my LGBT students to do the same, if that’s what they want to explore in their own work. Anyway, for all my personal empowerment, my identity in some ways is shaky, its foundation dug, poured, and set in the sad and uncertain, sandy soil of AIDS. It’s a kind of fear that will never go away. I wonder if young people today fully understand the feeling of holding someone in the fit of passion on the brink of orgasmic pleasure and at the MARCH 2016 • A&U

same time wondering, fearing, what lies pumping beneath the skin that you’re holding. A person’s mind undergoes some intense compartmentalizing in those moments.” Hilliard has donated work over the years to many auctions raising funds for AIDS-related organizations such as the AIDS Action Committee in Boston and the AIDS Community Research Initiative of America (ACRIA), the latter of which has introduced a number of medicines now taken for granted in treating the disease. In 2008, he participated in ACRIA’s exhibition “For Art’s Sake.” According to Hilliard: “ACRIA was able to convince the Ford Modeling Agency to partner with fine galleries around the country for a collaborative fundraising happening. Selected artists from those galleries were allowed to ‘shop’ the Ford website for models in their area, and the models and artists then donated their time and energies. I chose a soulful, beautiful young man named Paul to photograph. It was very touching to work with a person so full of beauty and life, and to meet his amazing parents, who were very supportive of the project. I’m still very close with all three to this day. The auction of the works produced was held in New York City. The image of Paul I donated was titled Sought. The image sold for quite a bit of money, and the auction was a stellar fundraising event for ACRIA.” Some of Hilliard’s work is visually directly related to AIDS, such as Never the Last Endeavor, which shows an HIV-positive friend coping with his medications. Other pieces are less obvious. For example, he said about Sought: “I was thinking about the physical and

Rock Bottom, 2008, archival pigment prints (triptych), 40 by 60 inches metaphorical weight of blood in this image, along with ideas of guilt, remorse, desire, and the nature of following our instincts.” Not quite the associations most viewers would take away from such an exquisite portrait-within-a-landscape, although tension is clearly introduced in the center panel where the young man is shouldering a rifle. Moreover, Hilliard maintains the disease is always with him, stating in the interview: “AIDS is in my work, my life, my history. Many of the sitters within my work are HIV-positive, but I don’t need the image to necessarily be ‘about’ that. For me AIDS is always there. I’m forever under its shadow. I think that strange mixture of strength and fear I was talking about earlier is embodied very well in a quotation from Ernest Hemingway’s novel A Farewell to Arms: ‘The world breaks everyone and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.’ I like to think that I’m strong at the broken places.” There are two books out on David Hilliard’s photography: David Hilliard: Photographs, 2005, Aperture Foundation, New York, NY (www.aperture.org); What Could Be, 2014, Minor Matters Books, Seattle, WA (www.minormattersbooks.com). Visit Hilliard’s website at: www.davidhilliard.com. Lester Strong is Special Projects Editor for A&U.

BUILDING

COMMUNIDAD The Black AIDS Institute’s Delegation to Cuba Found a Country that Valued Its Past As It Looked Toward the Future photographed exclusively for A&U by Sean Black

raveling to another country, particularly one you’ve never been to before, can be exciting and even a little scary. The Black AIDS Institute was proud to join with A&U magazine to sponsor the first U.S. Gay and HIV/AIDS delegation to Cuba since President Obama started normalizing relationships between the U.S. and Cuba last year. This delegation of fourteen cross-generational, primarily Gay men of color from various sectors was both historic and monumental. The U.S. ratcheted up sanctions on Cuba in 1960. Diplomatic relations between the two countries broke off in 1961. With tensions increasing after Cuba signed a trade agreement with the Soviet Union, President John F. Kennedy made the embargo official in 1962. We arrived on Christmas Day 2015, not knowing what to expect, but still full of expectations and preconceived notions about a country that has legally been cut off from the U.S. for nearly sixty years. Cuba is a beautiful country, but the thing that grabs you and won’t let you go is how beautiful, friendly and resilient the people are. Cuba is a lovely, exhilarating and complicated place. In many ways Cuba is two countries. There is the country with the classic cars from the forties and fifties, and the crumbling Art Deco architecture. There’s also the country where enterprise and entrepreneurship is everywhere, as well as a thriving Gay scene. Everyone we met was excited about building new relationships with the United States while at the same time extremely proud and committed to Cuba. Cuba has a long and storied slave and racial history, but unlike the U.S., Cuba does not appear to be running away or in denial of its history. By facing its past head-on and acknowledging the critical role Black people played in building the country, literally and culturally, Cuba is working to create a Cuba for all Cubans. Phill Wilson, President and CEO, Black AIDS Institute In this issue, we try to give you a glimpse of both the old and new Cuba. We present a round table of some members of our delegation, sharing their insights about Cuba’s fight for LGBT equality, efforts to support individuals living with and at risk for HIV, and embrace of the history and lived realities of Cubans who are part of the Black diaspora. Delegation member Christopher Hucks-Ortiz also weighs in about new opportunities for information exchange between the U.S. and Cuba. At the U.S. Embassy, we met with advo-

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cates, among them Belkis Fonseca Medina and Jesús Manuel Rodrigues Valle, both of whom share their insights about working to secure equality for people living with HIV/AIDS in this issue. And check out our review of VIVA, a new film about Cuba, in The Culture of AIDS. We want to thank our friends at AirBNB for helping with the accommodations, Orly Cowly and the crew at ENLISTA for providing us with ground and logistical support (you have not traveled to Cuba until you’ve traveled with ENLISTA), the folks at CENESEX, Dr. Mariela Castro Espín, this month’s cover story, for spending time with us and for her tireless efforts on behalf of LGBT equality and HIV/AIDS education in Cuba, and the amazing Sean Black for chronicling our trip photographically. As hard as we have tried, no publication can provide an adequate description of all of Cuba in its beauty, majesty, and ambiguities. My advice is to go and to go soon. The Black AIDS Institute is working on another delegation to Cuba following the 2016 US conference on AIDS. For more information, please contact us at info@BlackAIDS.org. We look forward from hearing from you. Until then, please take care of yourself and your blessings. For more information about the work of the Black AIDS Institute, log on to: www.blackaids.org. Yours in the Struggle, Phill Wilson

Top to bottom: Havana skyline at sunset: Museum of the Revolution, former Presidential Palace, in scaffolding; boys playing parkour, a form of tag, around the Monumento a Máximo Gómez, erected in bronze and marble to pay homage to one of the great military leaders of Cuba’s nineteenth-century wars of independence; Phill with Dr. Mariela Castro Espín MARCH 2016 • A&U

We’ll Always Have Cuba A round-table discussion with four members of the Black AIDS Institute Cuban delegation by Larry Buhl

ess than six months after the beginning of the normalization between Cuba and the U.S., a delegation of fifteen gay men (mostly) of color spent fifteen days in Cuba collecting and sharing information on innovations in HIV/AIDS treatment and prevention, sexual and gender identity, and the differences in responses to the AIDS crisis between a for-profit system and a government-controlled healthcare system. The men of the delegation had diverse backgrounds and interests. The majority was black, with one Asian-American, and one white traveler. Two were retired, two worked in education, one in law, one in hospitality and the other nine professionals in various aspects of healthcare research and policy. I spoke with four of the delegation participants after they returned to the U.S. They were: • Phill Wilson, founder of Black AIDS Institute • Wakefield, Director, External Relations, HIV Vaccine Trials Network • Justin Tandingan, Director of the Asian American & Pacific Islander

Initiative at Teach For America • Christopher Hucks-Ortiz, Evaluation Specialist at John Wesley Community Health Institute in Los Angeles and current Chair of the HIV Prevention Trials Network (HPTN) Black Caucus

Larry Buhl: Phill, Wakefield, Director, External Relations, what did you hope to HIV Vaccine Trials Network achieve by putting torace there as it applies to the African Amerigether this delegation? can experience? Phill Wilson: At the point Obama began Wilson: We discovered early on what a to have a conversation about opening relamajor African influence there is in Cuba, tionship with Cuba we at the Institute said and while Cuba has a slave legacy like we there is an interesting story to tell around have in the U.S. and the Americas, one race in Cuba. We were in connection with people who had been doing anthropologthing is there isn’t a running away from ical work around the African-Caribbean that history in Cuba. There are a lot of placand African-Latino and the Afro-Cuban es you go and there is a discourse about experience. We wanted to see what that how this or that was built by slaves. In the looked like. That’s why we decided to sign U.S. there is a reluctance to acknowledge on for the delegation. how much of our country was built on the back of enslaved people that’s a problem What did you find intriguing regarding when we talk about race dynamics in America today. The delegation listens Wakefield: And not only did they to an orientation by acknowledge the role of slavery in their Ariel Causa Menéndez history, but they talked specifically about of CENESEX. how it contributed to economic growth and made their history possible. Part of that was to affirm that they were valid and important people in Cuba’s history, which we don’t hear in the U.S. Not only do we run away from talking about it, I’ve never heard that [slavery] is important to America in completing the infrastructure. Christopher Hucks-Ortiz: What we think about Cubans here in the U.S. is overwhelmingly the voice and experience of white Cubans, who were from the white class, the ruling class or upper class, who had the resources to pull resources out and A&U • MARCH 2016

leave. We were able to engage with two college students from the University of Havana about their understanding of the history of Cuba and about the race and power differential that black Cubans experienced before the revolution and after the revolution. They said [black Cubans] don’t have everything everyone else has right now, but there seems to be more parity than before the revolution and the revolution helped benefit black Cubans. That is a perspective I hadn’t heard. Is there a disparity in who’s impacted by HIV/AIDS in Cuba? Wilson: It’s a little difficult to tease out the demographics of the epidemic in the same way we do in the U.S. What I can say is that the delivery of care and the design of the delivery of care is much more equitable in Cuba than in the U.S. Because they have universal healthcare, no matter who you are, you have access to medication. And you have access to the same medication as anyone else, relative to the services provided by the national healthcare delivery system. But having said that, I’m not so sure that we saw evidence one way or another to suggest people were disproportionally impacted or not on HIV based on race. Cuba has been long touted as a model for how to treat HIV/AIDS from the beginning, while criticized for some of the harsh tactics like quarantining. Do they believe they’ve handled it right? Hucks-Ortiz: Cuba was the first country on the globe certified by UNAIDS to eradicate transmission of HIV from mother to developing child. We asked advocates at the meeting at the [U.S.] embassy whether they had mandatory testing; they said no. I couldn’t figure out how they were able to facilitate access to treatment for every woman who’s seropositive if they don’t require every woman who’s pregnant to get a test. Even though people have access to medical care through their national health service, which I wish we had in the U.S., because it gives everyone a basic access to medical care. But they don’t have the same access to ARV treatment that you would have in the developed western world if you have access to insurance. And there isn’t always enough medication for people who want to stay on treatment. It’s easier in MARCH 2016 • A&U

The delegation met with Cuban activists and embassy staff at the U.S. Embassy. Havana but if you’re living in rural Cuba harder to get access to medications. People who are not as adherent will trade medications with people who are more adherent. Regarding spread and treatment of HIV/ AIDS, how did you see race and identity affecting this crisis? Wilson: One of the things Cuba did was build a robust generic manufacturing capacity on the island. That gave them the ability to make their own ARVs and not be dependent on U.S.-patented ARVs. They’re the same compound. One is branded and one isn’t. But there are shortages in a country that has had a U.S. embargo for sixty years. In theory the medications are available to everyone, but they may not be due to shortages. Wakefield: Testing [for HIV] is routine. You go in for an evaluation you get tested; you talk to your doctor about what you’ve done. There’s not an opt-out and there’s not an additional stigma attached to it. It’s part of your routine healthcare. You get blood drawn, you get your blood pressure checked, you get the HIV test. That’s a very different approach than we have. Here [patients] often don’t want to have that conversation with a doctor and they don’t get tested because of that. Do the healthcare practitioners have a better understanding of men’s health and gay men’s sexuality, and do patients have a lack of stigma in answering these questions? Justin Tandingan: There is quite a bit of stigma around HIV/AIDS and about LGBTQ or coming out as gay or bisexual, and if you’re in a region outside of the city

there may be some insensitivity on the part of the doctors. There are differences between the urban center of Havana and the rest of the island. Hucks-Ortiz: I would agree with that. There was one young man who said that when they find out you’re gay or bi or same-gender-loving there’s an expectation that you’re living with HIV or you’re going to have HIV. That’s interesting because they report a low rate of HIV. Wakefield: There have been papers presented by researchers in Cuba and, based the data they are publishing, it does seem as best we can tell that when we compare what they’ve done to keep the virus under control, they have done a better job than we have done. As to where new infections are happening, we weren’t able to drill down too deeply, other than learn that shortages of meds can happen intermittently. The shortage issue would create an environment of resistant virus and that may be happening in Cuba as well. Did you get any sense of where the trans movement is there? Tandingan: We were at CENESEX [see cover story] and they have many resources for trans folks, like legal and mental health services. The fact those are available and sanctioned by the state, that was interesting. The trans movement led the way as far as LGBT rights and activism. That was different than what we see in the U.S. as far as what is accessible and what is not. It showed me a model of what is possible and how to make those shifts from a govern-

ment perspective. Wilson: Not only are there services available at CENESEX, but there are trans women in position of authority there. It’s a center that’s inclusive of trans people at the highest levels. In our conversation with Mariela Castro, when asked about her reasons for taking leadership in this arena, her reasons were tied to the fact that basic to the manifesto of the revolution was the freedom of everybody, and that had to be inclusive of LGBT people as well. What were the people you spoke with eager to learn about regarding HIV/AIDS? Wakefield: I did not experience much interest in what we in the U.S. were doing around this arena. They know they produce more doctors per capita than anywhere in the world. They know they have an excellent system for training people around this work. I don’t recall at any point anyone suggesting what we were doing could be useful for them. Wilson: As I have traveled around the world, particularly developing countries, there is a hunger for tips and strategies and guidance on how we do things in America, and that they had lots to learn from us. That is not the attitude in Cuba; at least in this space [HIV/AIDS] they have a lot to learn from us. Tandingan: There was a language barrier to get at some of the specifics about what might be applicable to Cuba. In our delegation, in conversations, it was difficult to get to an understanding of what was going on without a translator with us. That level of conversation is nuanced in many ways and that is lost in translation.

Justin Tandingan, Director of the Asian American & Pacific Islander Initiative at Teach For America Was there any concern about increased sex tourism from the U.S. and how that might impact the HIV/AIDS crisis? Hucks-Ortiz: There was a gentleman on the delegation and he asked if they saw a correlation of sex tourism and the spread of HIV in the population. I did not get the sense that, if there was, that it was information we could have accessed easily. There are people who go there for sex tourism. We know it happens. But I didn’t see it like in other countries in the Caribbean. What surprised you the most about Cuba? Wilson: How warm and welcoming the Cuban people were. We did not run into any animus whatsoever. The second surprise is how robust the gay scene is in Havana and even in other places. It may

not have a robust [LGBT] infrastructure as we know it, but even the presence of a gay scene that existed even in the more rural communities [was a surprise]. Hucks-Ortiz: I don’t think I had any negative interactions. Everyone was concerned: “Are you enjoying our country? Are you having a good time?” Tandingan: There is genuineness about the way Cubans build relationships. You need one another to survive there. You’re on an island. There’s an ability to know people for long periods of time. People want to be in each other’s business but also support each other. They wanted to share what they had with us and I appreciated it. As a Filipino-American and it was a unique experience to feel just as welcome as others on the trip. It helped that I spoke a little more Spanish. The problem is, it’s hard to communicate on-line and when you are it’s very slow. I wonder how that will change the community when everyone gets connected. Hucks-Ortiz: This was a really powerful experience for me. I’m willing to bet other men on the trip had similar experiences. I learned about Cuban people but about experiencing myself in a different way. It’s intangible but important. You know that saying, “We’ll always have Paris”? I say, “We’ll always have Cuba,” no matter what else happens. This moment was special. For more information about the Black AIDS Institute, log on to: www.blackaids.org. Larry Buhl interviewed the staff at MSMGF about their work for this issue.

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Starting Dialogue, Ending AIDS by Christopher Hucks-Ortiz

think that when I first talked with Phill Wilson, of the Black AIDS Institute, about this, it was sometime in the Spring of 2015. “I’d like to lead a group of Black gay men on a trip to Cuba,” he had said. “Perhaps I can sponsor the trip through the Black AIDS Institute. Would you have any interest in going?” Would I? Are you kidding? Of course! I should frame this by saying that I am definitely a child of the sixties and seventies. As I was growing up, common notions of Cuba were about Socialism (bad), Castro (bad), and Russian missiles (very bad). When it came to Cuba, all that I recall hearing about were flotillas, airlifts of children, and the possibility of nuclear war some ninety miles away from the United States. And yet, at the same time, there was also something more. I had heard about the Cuban culture, sampled Cuban food, and danced to the tunes of Cuban artists such as Celia Cruz. Something told me that there was more to the story about Cuba and I had always dreamed about someday actually getting to visit the island nation to see it for myself. But it wasn’t until sometime in September that I actually committed to making the trip. I was out of town at a meeting on the East Coast when my phone rang and it was Phill again. “We still have space for additional people for the trip, but if you are interested in going, I will need to know in the next day or so.” Well, in my mind, for the trip of a lifetime, you want to choose carefully who you may be travelling with, so I immediately contacted my good friend, Craig, and said that we should do this. Are you in? He said yes, and so we said yes. And with that, we began to plan for our trip to Cuba. For me, the idea of travelling to Cuba was a little unnerving. At the time that all of this began, the United States government had not yet announced interest in normalizing relations between the two countries and getting rid of the embargo. We were told that we would have to be affiliated with an educational or health exchange group (which we were through our affiliation with the Black AIDS Institute), and we planned to include some specific HIV/AIDS-related programming during the trip so that we would have the opportunity to talk with Cuban HIV advocates and to hopefully exchange knowledge in a

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bidirectional manner. As a Black man, I was interested in learning more about how Cuba addresses race/ ethnicity given our shared histories with the slave trade as part of the African diaspora. But also, as an HIV researcher whose work focuses on both HIV prevention and linkage to care, I was also interested in learning more about the different approaches that may have been used in Cuba with regard to the HIV/AIDS epidemic. Are there different models, approaches, or strategies that the Cuban government has utilized in order to address their local HIV epidemic among the Cuban people? If so, might there be some best practices that we as Americans can bring back home to utilize in our own domestic epidemic? Perhaps through our knowledge exchange, we can all move closer toward the UNAIDS goal of ending AIDS? There were fifteen of us on the trip, most of whom were Black gay men; many of whom are warriors in the fight against HIV. We had the opportunity to interact with the Cuban people, both in the urban center of Havana, but also in rural Vinales, and also in the UNESCO World Heritage site of Trinidad de Cuba. At every encounter, what I learned was that the Cuban people were both beautiful and also really amazing! They have learned to navigate multiple economies in order to survive and were quite welcoming to this delegation of Black Gay men from the United States. We were also afforded the opportunity to

meet with HIV advocates and activists, LGBT advocates, and Afro-Cuban activists who are all working to improve Cuba with regard to discrimination and stigma related to HIV status, LGBT status, and race/ethnicity. With regard to HIV services, it was amazing to be in a place with socialized medicine where every citizen has an equal level of access to medical care, but they were still able to articulate some challenges about the availability of ART treatment, particularly for Cubans outside of the urban areas. Overall, I had an amazing time in Cuba and honestly am eagerly looking forward to being able to return. As neighbors in this part of the Americas, the Unites States and Cuba both have many lessons to share with one another. I for one am looking forward to the opportunity for more open and free exchange if it helps both countries to get closer to ending AIDS as we know it. We will all benefit from the sharing of HIV prevention models, linkage to care strategies, and retention in care strategies which may have developed in “silos.” To my travel companions, I say, thank you for an adventurous trip. And to the people of Cuba, I say, “Thank you, and I hope to see you again soon.” “Gracias, y espero verte pronto otra vez.” Christopher Hucks-Ortiz is an Evaluation Specialist for the JWCH Institute in Los Angeles, California, a Federally Qualified Health Center (FQHC), and the current Chair of the HIV Prevention Trials Network (HPTN) Black Caucus.

A Haven

in Havana

Dr. Mariela Castro Espín, the daughter of Cuban President Raúl Castro and the niece of Fidel Castro, heads up CENESEX, the Cuban National Center for Sexual Education, carrying on the legacy of her beloved mother, Vilma Espín, while building a safer, brighter future for her country’s LGBT Community by Sean Black, with Chael Needle Photographed Exclusively for A&U by Sean Black

“W

e were free, always, to ask questions of our parents,” emphatically states Mariela Castro, through a translator, about conversations between her parents and their children when she was growing up. “We did it frequently,” she adds. “My parents always taught us that the absence of the protection of the rights of all people was a tragedy that should be resolved.” “All people,” she learned, included individuals who are LGBT and those who are living with HIV as well. As a child, she was shocked to hear of a man who had been disowned by his father because of his sexual orientation and subsequently ended his young life in a suicide, she shares. One might surmise that her impetus for her active role in politics and equality was in part forged by these domestic dialogues

and early experiences. And it might also explain why CENESEX (the Cuban National Center for Sexual Education), part of Cuba’s National Ministry of Health, has become a home base (emphasis on “home”) for many in the LGBT community in Havana and even beyond. Several walking blocks southwest of Cuba’s famed El Malecón, a four to five mile seafront promenade cradling Central Havana’s coastline sits a cozy fortress in the charming Vedado neighborhood known as CENESEX. Although a quainter stronghold than the city’s monumental Castillo de los Tres Reyes del Morro (El Morro), a sixteenth century fort begun in 1589 that impressively rendered Havana as the safest port in the Americas during the heyday of pirates and imperial invaders, CENESEX is nonetheless an organization and notable landmark, dedicated to Cuba’s

comprehensive sexual health programming with a major focus on the LGBT population. CENESEX is led by Mariela Castro, the fifty-three-year-old mother of three, an academic and rising political figure of her own accord; she is an internationally heralded advocate and expert specializing in the rights of transgender individuals. She holds a PhD in the social sciences with a specialization in Transgender Studies. Over the course of two days, A&U was invited to this safe haven, along with friends and delegates, mostly gay men of color. Acting as a photojournalist, I was honored to be asked to travel with the Black AIDS Institute delegation spearheaded by Phill Wilson, BAI’s founder, President and CEO, and this issue’s guest editor (see Wilson’s “Building Communidad”). CENESEX, meticulously maintained, is flanked by once-elegant stately mansions A&U • MARCH 2016

MARCH 2016 • A&U

in various states of disrepair, still quite opulent despite their crumbling facades and weathered windows agape and swagged in lace and brightly colored fabric. Neighboring structures with air-drying linens and clothing strung ledge-to-ledge imbue old-world charm over Cuba’s transitioning socio-economics, the balconies punctuated by the occasional, friendly onlooker with smart device in hand. Arriving early on the first day, under the care of our trusty En Lista drivers, we pass freely through a wrought-iron gate following a tidy path up to a gracious satin-white wrap-around porch, sundrenched seating areas abounding with lush foliage and manicured botanicals. Interior and exterior walls are awash in fresh coats of soft yellow paint that blend aptly with an ambience that’s calm and soothing amid the non-frenzied buzz of people of all ages, genders and sexualities working the grounds. Gardeners, office staff, security and cooks alike tend to tasks efficiently and dutifully yet never forgoing the passing chance to offer warm smiles and glimpses of kind eyes, all meant to acknowledge and affirm visitors. “Everyone’s work at CENESEX is important,” proudly notes Ariel Causa Menéndez, an enthusiastic, bright young man and head of CENESEX’s International Relations Group, during our welcome orientation. It’s an idea that spills over to his love of American football. When I learned his favorite team was the Patriots, I singled out Tom Brady knowing how sports fans love their heroes, but he demurred in an aside, shifting the spotlight from the quarterback to the team. Point taken. It’s a team effort, like CENESEX. That explains why Ariel, who is straight, so easily embraces his role as an LGBT ally. And that helps explain why Mariela Castro, who is also straight, is so confident and comfortable in her role as an LGBT ally, too. Cuba’s mission is the emancipation of all human beings; advocating across identities is par for the course in the nation’s people-centered approach to organizing life, work, and play. Still, I wanted to know Castro’s specific reasons for her commitment to the LGBT community, and by extension, HIV/AIDS work. Mariela explained, with Ariel acting as translator throughout our interview, that she focused on this community because essentially LGBT rights up until recently were not included in the Cuban political agenda. Although her mother had always been worried about and cared for these matters up till the time she became seriously ill, it was Mariela who, when she became the

director of CENESEX, made it her mission to incorporate the human rights of the LGBT community into the country’s larger social-political dialogue, as the Cuban Revolution was built on the principles of justice. She resolutely says about the fight for LGBT inclusion, “It was due, and would be just, based on these principles.” She first began working with the trans community because its members came to her, and from those interactions, discovered that part of the LGBT community remained outside of the revolutionary project. The fight for rights, thus, has been a mixing of outsider grass-roots and insider government politics in a way not known in the United States. It sounds very complicated—individuals who were not recognized by the establishment now are suddenly embraced by the establishment and must work with the government. I should note that, historically, the trans liberation movement in Cuba preceded and in effect paved the way for the country’s LGBT movement. While trans activists have always been a part of the United States’ LGBT movement, on the front lines of California’s Compton’s Cafeteria Riot and Dewey’s Lunch Counter Riot, and New York City’s Stonewall Riots, all during the 1960s, they have often been overshadowed and in many ways marginalized by white gay male activists and how our history of LGBT equality and that of AIDS activism has been told. When she started working on LGBT issues, she was fortunate to have the support of the Communist Party, she says. However her father has been quieter on this stance. “He has always, nevertheless, encouraged my siblings and me to fight for our own beliefs and causes. I am forever

grateful to my father for his advice,” she shares. CENESEX, as its mission statement conveys, encourages these types of “open, knowledgeable dialogues,” perhaps echoing Mariela’s early upbringing. As an institution devoted to education and research in the field of human sexuality, CENESEX “promotes scientific research” and “fosters the exchange of experiences.” CENESEX’s intersectoral approach to human rights and sexual education can be traced back to early efforts of the Cuban Revolution that were later formalized through a collaboration of the Federation of Cuban Women (FMC), the Ministry of Public Health, and different sectors of the state and civil society in the early seventies. The National Work Group on Sexual Education (GNTS), created by the FMC, which for many years was directed by Mariela’s mother, Vilma Espín, took up the charge of training and educating professionals and the general public. GNTES became its own legal entity in 1977, working with the Commission for the Attention of Rights Equality for Women, Family, Childhood and Youth to establish a firmer scientific basis supporting sexual education; support the expertise of therapists and sexual educators; and provide specialized care to transsexual people, among other actions. CENESEX along with serving as the governmental advisory institution in all issues related to sexual health was founded in 1989 to continue the work of GNTES with a gender-centric approach. A recent example of its gender-based services is counseling and identifying Cuban transgender individuals who might want to consider sex-reassignment surgery; the procedure is now state-spon-

Ariel Causa Menéndez, head of CENESEX’s International Relations Group A&U • MARCH 2016

sored under Cuba’s universal healthcare system after the government lifted the ban on the procedure in 2007. CENESEX’s various activities also now include post-graduate education; education for physicians, sociologists, psychologists, specialists and activists, among others; substantial research and teaching initiatives; various publishing activities (of note is the organization’s quarterly publication, Sexologia y Sociedad); and international partnerships for training and social networking for the equality and advancements in all areas of sexual health. Its programming includes a maternity and paternity campaign, which runs between Valentine’s Day and Father’s Day and is committed to ensuring gender equality; a campaign about AIDS awareness on World AIDS Day held December 1; and other campaigns targeted to educating about women’s rights, domestic violence, and violence against children. The legal department works in tandem, and oversees and investigates complaints in all areas in regards to discrimination and abuse. Visually reinforcing this stance, the walls of CENESEX’s atrium serve as gallery space reflecting the Center’s bold campaigns, networks, and outreach initiatives. Significant work by internationally prominent MARCH 2016 • A&U

artists such as Italian photographic artist Giuseppe Klain, whose exhibition “I Miserabili” was on display during my visits. Klain’s powerful work aligned with Cuba’s stance on the protection of women and their rights. Past exhibitions have included work by Los Angeles-based artist Byron Motley and images from his book Embracing Cuba. These efforts reflect the spark of the Cuban Revolution more than fifty-five years ago. But socialism is open to revision— that’s also why CENESEX has evolved to include educational components around community-tailored sexuality education and prevention and promotion of sexual health; HIV/AIDS awareness; and advocacy for individuals who are lesbian, gay, bisexual, and transgender, among others. Presently, CENESEX offers direct support to five social community networks, including Youth Network for Health and Sexual Rights, Transgender People Network (TransCuba), Network of Lesbian and Bisexual Women, Humanity for Diversity (HxD) and the Network of Lawyers for Sexual Rights. “Socialism has been a bad word not just in the U.S., but elsewhere in the world because of political interests that have tried to demonize it, make it bad,” says Manuel Vázquez Seijido, Chief Legal Advisor at CENESEX, during one of our CENESEX meet-

ings, with Ariel Causa acting as translator. Indeed, socialism has cropped up in recent years in the United States’ healthcare arena. Opponents of President Obama’s Affordable Care and Patient Protection Act have long labeled his approach as “socialist,” meaning to scare up an antiquated Cold War ideology that pitted Americans against Soviets and to highlight more recently claimed “failures” of Canada and various European countries’ systems to provide gold-standard care. And now Presidential candidate Bernie Sanders is taking heat for his stances as a democratic socialist, including universal access to healthcare. He continues about defining socialism in this context of demonization, “However, our experience [involves] not just constructed socialism but learning how to construct socialism because it is not something we have already figured out as a whole.” In other words, it is not a static concept or practice, frozen in time as many in the rest of the world would have it. “It doesn’t mean that we are perfect; it doesn’t mean we have done each and everything right—we have discovered along the way that we have made mistakes; they are mistakes we hadn’t discovered and we are working on solving those that we know [about] and we are perfecting the work we

are doing. However the key value of socialism, the most important thing, is to put the human being in the center of the spotlight. “Hence, in order to put the human being in the center of the spotlight his or her [inherent] rights must be placed in the center of whatever project you build, in a process of liberation that will secure the right to enjoy freely these very rights.” Manuel and Ariel pause to compare the terms “liberation” and “emancipation” in translation. “I know you are a harsh public,” half-jokingly mentions Ariel. Continuing, Manuel adds, “Socialism has been an important strategy for the Cuban Government and Cuban people to develop a response that addresses people with these kinds of limitations—people living with HIV, including those seropositive within the LGBT community. “There are two key principles of our healthcare system in its development and implementation, which are universality, which means everyone has the right to receive attention, and the entire intervention must be delivered for free. So the state takes part and assumes the responsibilities of preventing people from getting infected, working on prevention as a key way to avoid people getting infected and if the person gets infected guaranteeing that that person will have the kind of respect and dignity that anyone deserves including medical attention to people living with HIV. That is an example of how socialism helps people living with HIV.” Manuel asks, “Do you happen to know that Cuba was declared—we are very proud of this—[to have eradicated] the vertical transmission of the disease?” Just last year, news of this breakthrough on the AIDS front came around the time that the United States began its first steps in lifting its embargo on Cuba. In June 2015, Cuba received validation from the World Health Organization that the country’s efforts to reduce mother-to-child transmission of HIV and syphilis was a stellar

Sexual health and anti-stigma posters created by CENESEX celebrate diversity. success—the nation became the first in the world to eliminate new infections by this mode of transmission. According to WHO, the success stems from an integration of maternal and child health programs with HIV/STI programs, as well as abundant and equal access to free universal healthcare, in this case, tailored to reproductive and sexual health. This success is mirrored in other aspects of HIV education, testing, treatment, and support, which benefits from an approach that threads together governmental institutions and agencies, the media, and health and education organizations under Cuban Ministry of Public Health’s National Strategic Plan for Sexually-Transmitted Infections–HIV/AIDS as implemented by the National STI–HIV/ AIDS Prevention Center. Cuba boasts the lowest rate of HIV infection and the highest level of HIV/AIDS treatment among all Caribbean nations. According to 2014 estimates from UNAIDS, the prevalence rate of HIV among adults aged fifteen to forty-nine is 0.3 percent. By comparison, Haiti is at 1.9 percent for the same population; Jamaica at 1.6. One of the most impactful and longest campaigns for public wellbeing was HIV messaging targeting young people and MSM. Notes Manuel: “The Campaign takes physical expression in many many ways; education materials, brochures, flyers, magazines, our magazine. The trainings I have been telling you about with the activists in order for them to deliver the campaign guidelines and spread it all through the country. We generate trainings here. We prepare the activists to address this issue.” Condom distribution is widespread, through public campaigns and purchasing them at pharmacies and cafeterias, and the like. Because of governmental subsidizing, condoms can be purchased for five cents for

three condoms. Access to condoms is almost universal. “In Cuba the government puts a very large part of its budget to the attention of HIV issues,” says Manuel. I ask if Cuban researchers are working toward a cure. “Of course [but] because of the blockade, it is hard for us to gain access to supplies for medicines and supplies for the treatment so in many cases we’ve had to produce them ourselves which means also that we have had to put our specialists that would be otherwise researching for a cure and put resources in order to create our own versions of antiretroviral medicines in order to come up with the needs we had at the moment,” explains Manuel. The CENESEX representatives also say if Cuban researchers find a cure, they would share it freely with the world. Today, while access to HIV-related and LGBT-centered care is not a barrier, engagement in care is still stymied. The primary cause? Arguably, it’s stigma and discrimination. Cuba’s early response to the first wave of the epidemic may have inadvertently propelled this stigma. Although President Fidel Castro responded to the epidemic much earlier and more robustly than President Ronald Reagan, the creation of sanitariums for people living with (or, at that time, sometimes dying of) AIDS mandated the quarantining of positive individuals by governmental policy and arguably supported the notion that individuals living with HIV/ AIDS were an Other to be kept outside of society. Now fourteen AIDS Sanitariums remain and since 1994 they have been voluntary. But also, in general, Cuba, like the rest of the world, has not been immune to heteronormativity, homophobia and transphobia, longstanding drivers of stigma and discrimination in patriarchal cultures. One of the ways CENESEX works hard to end this stigma and discrimination A&U • MARCH 2016

Safer-sex messaging is threaded throughout performances at clubs like Las Vegas. is through the transformative power of art. Ariel, on behalf of CENESEX, echoes A&U’s mission that art is an effective cultural tool in disseminating critical information effecting change within societies especially when targeted successfully to those at risk for HIV infection. “We use art as a key strategy of delivering HIV prevention messaging in our campaign posters, designed by our Communications Department and placed in public spaces.” Continuing he adds, “We also organize prevention events in nightclubs and in other social hubs of the LGBT community, and use venues that have major social impact against homophobia.” For example, this May, CENESEX is planning a slate of activities against homophobia and transphobia in Havana and Matanzas, including a lecture by Mariela, activist panels, photo exhibits by Paolo Titolo (husband of Dr. Castro Espín) and Byron Motley, parades against homophobia and transphobia, diversity celebrations, and anti-stigma galas, among other events. Included in this messaging are coveted “Calendar Boy” calendars raffled at clubs and events, one of which Mariela presented to me along with a warm hug upon my arrival. Additionally, at the gracious, impromptu invitation and arrangement of Manuel, I was welcomed the night before my return to the U.S. to Cuba’s colorful and extravagant nightclub, Las Vegas featuring the MARCH 2016 • A&U

famed performer Imperio, who made a point to give a shout-out to A&U magazine as a special guest. “We do what we call ‘prevention from the stage’ through transformista artists who deliver messages of prevention while doing their performances,” shared Manuel. Cuba’s gay nightlife venues encourage light-hearted exchanges between transformistas and the audience about safer sex at performance intermissions along with interspersed animation videos depicting scenarios for sexually active, gay individuals. The graphics reinforce plausible situations, which hopefully appeal and make impressions on the crowd’s energized spectators. Several transformistas and a troupe of scintillating dancers turned out brilliant performances in legendary Cuban form under superb artistic direction going late into the early hours of the following morning. At the conclusion of our meetings, on day two of our interviews following a balcony photo shoot that nicely captured a sunny backlighting as warm as her demeanor, Mariela Castro acknowledges the importance of CENESEX’s work and reemphasizes her further commitment to its future and to those who find resources, shelter and safety under its roof. In closing, she made clear her message to A&U: “I am well aware of the ethical-philosophical contradictions that ‘move’ in the [socio-political] matters we have discussed,” clarifies Castro, a student of Socialist-Marx-

ist thought. She affirms however that Marxism is a coherent and progressive alternative to capitalism, a system from which the Cuban Revolution sought to liberate the Cuban people. “On this basis, the Revolution must uphold its historic, social responsibility to eliminate segregation, discrimination and social exclusion.” She continues, “The revolution succeeded in dismantling many of the mechanisms of domination but lacked clarity on this issue of LGBT equality, as did most other countries in the world, but if we want to strengthen socialism [and our mission] we have to address it head on. By changing global consciousness and educating entire populations we shall surely succeed; no doubt.” Special thanks to Dr. Mariela Castro Espín, Ariel, Manuel, Miguel and the entire staff of CENESEX (www.cenesex.org), Phill Wilson for including A&U and the travelers of his historic delegation and most especially the many new friends who made my trip remarkable and unforgettable including Andy Sanchez, my guide at the drop of a hat, David our chauffeur, Anita y Ariel, Omar, Restaurante Torresson, Orly, Orlando Sr., Idada, Rubén, Miguel, Arturo, Nicholas, Sulema, Vivianna, Barbara, Jorge, and many other remarkable individuals who opened their doors, their minds and their hearts to me. Muchas gracias! Sean Black interviewed Niecy Nash for the February 2016 cover story. Chael Needle is Managing Editor of A&U.

SURVIVAL101 ARTIST STEED TAYLOR DISCUSSES EQUAL RIGHTS, HIV/AIDS, AND CURATING “LGBT SURVIVAL GUIDE, STRATEGIES FOR SURVIVAL AND CONNECTION IN AN UNSUPPORTIVE WORLD” by Alina Oswald

“T

hese images are not only documents,” contemporary artist and filmmaker Sebastian Lifshitz writes in the Introduction of his book, The Invisibles: Vintage Portraits of Love and Pride, a collection of candid photographs of gay couples taken before the Stonewall Riots. “These photographs,” Lifshitz continues, “are like manifestos thrown into the oppressors’ faces.…I was under the strange impression of connecting the past with the present. Of being in the continuity of history. And I was able to partially verify my hypothesis: despite the difficulties, happiness did exist in the life of these homosexual men and women and continues still to run through their veins.” Lifshitz’s book, and film with the same name, resonate with the new exhibit hosted at The Lesbian, Gay, Bisexual and Transgender Center, in Manhattan. “LGBT Survival Guide, Strategies for Survival and Connection in an Unsupportive World” offers, in an artistic way that is, a much deeper, multifold experience of the life and history of the LGBT community from the Great War (WWI) days to present time. Curated by Visual AIDS board member and New York City-based artist Steed Taylor, the new exhibition captures a sample of the LGBT archives, through print copies of artwork (not originals), such as letters, journals, diaries, and photographs of the gay rights movement and the broader history of the LGBT community. “The idea of the show is so important to our moment, if you will,” Taylor explains, “[and] that is, LGBTQ people were looked at as mentally ill, undesirable, and evil. There was no protection not so ever. If someone would find out [that someone else was not straight, they] could be put

in jail, kicked out of [their] apartment….” He pauses, maybe to reflect on those days, as they unfolded, not too long ago, in this very country. “And now, in our current time,” he adds, “most of the LGBTQ people have protection in the United States, but not all of us do, in particular people who are transgender [and who] don’t have protection in many areas.” He jogs my memory, mentioning the preacher who came on-line saying that he thought we should kill all gay people by the end of the year. “That was the end of the year that just ended, and that is in this country. What I think it’s so heartbreaking is that in other countries in the world it is much worse—persecution, torture, and death. And I think of how people like me are being killed for just being themselves.” Taylor goes on to say that this kind of hostile environment was typical for LGBT people who preceded us, and yet, they still figured out a way to exist and make a life for themselves. “So, although that happened in the past, it’s very necessary and relevant today,” he adds. “One thing that I think touches on Black Lives Matter is the idea that everyone deserves respect,” Taylor points out, talking about the exhibition. “Most people who are black or minority can’t really hide. You can see that they are [black or minority]. [LGBTQ] people are somewhat unique, in that they do have the chance to blend

and hide [that part of them], and figure out a way to get away from that [hostile] environment, and [find] an environment where [they can be accepted as they are].” In order to survive, LGBT individuals who came before us came up with several survival strategies, which, in turn, make the basis of the exhibition. The survival strategies are divided in four groups: “Be true to yourself even if you cannot be truly yourself with others.” This could mean keeping a diary, for example. The curator recalls a diary he found while looking through the archives, in which a teenage gay man writes about his kid crush, infatuation, and other thoughts and experiences A&U • MARCH 2016

that he couldn’t share with anybody else. “Survive by blending in or hiding, but know the secret codes for connecting.” Taylor comments that he did not focus too much on this strategy, because it is pretty well known. Older photographs in the archive show groups of gay male friends going out, and bringing with them a few women friends, in order to blend in and look like any other group of possible couples. But there were secret codes for connecting—a woman offering another woman violets meant that her feelings for that other woman were more than just of friendship; men would offer carnations to express the same feelings, or some of them would wear red ties, as a secret code. The third and fourth strategies are quite important, too. They include: “Find people who accept you as you are and stay connected to them”; and “Find a supportive community, join it and develop relationships within it.” The “LGBT Survival Guide” exhibition offers, perhaps, an in-depth look and yet only a snapshot of the LGBTQ archives. While housing the exhibi-

tion, The Center displays only print copies of the artwork, not originals. “The Center doesn’t have the insurance to insure the work that’s in the show,” Taylor explains, “because what you actually have is A-list super-expensive artwork, so we have copies of the artwork. By showing part of the archives at The Center, which is open every single day, people have the opportunity to stop by and see artwork that otherwise they would

Top: Zanele Muholi, Anele ‘Anza’ Khaba, KwaThema Community Hall, Springs, Johannesburg, 2011, Silver Gelatin Print, Edition of 8, 30 by 20 inches © Zanele Muholi. Courtesy of the Artist and Yancey Richardson Gallery Left: Zanele Muholi, Mpumi Moeti, Kwanele South, Katlehong, Johannesburg, 2012, Silver Gelatin Print, Edition of 8, 30 by 20 inches © Zanele Muholi. Courtesy of the Artist and Yancey Richardson Gallery only be able to see in a museum. Lots of people are coming through The Center, especially now that it’s newly renovated. This way, The Center offers its visitors a novel way to learn more not only about art, but also, and most importantly, about LGBT history. The “LGBT Survival Guide” exhibition opened MARCH 2016 • A&U

on January 27, and will run through the end of April. The timing for the show is perfect—right after Visual AIDS shows such as Postcards From the Edge and Love Positive Women—in order to keep alive the conversation surrounding equal rights. The exhibition has two parts—the show housed at The Center, featuring art pieces by contemporary artists that respond to or investigate the topic of survival in their work, and also an on-line gallery that covers a broader timeframe of LGBT history. Although the contemporary part of the exhibit is more specific to LGBTQ culture and doesn’t address, specifically, HIV and AIDS, the epidemic and its effects on the LGBTQ community is definitely present throughout the show, at times in a more

Clockwise from top left: Chloe Dzubilo, Untitled (I Never Developed), 2008, ink on paper, 9 by 12 inches; Chloe Dzubilo, Untitled (Surrender), 2008, ink on paper, 9 by 12 inches; Chloe Dzubilo, Untitled (T-Girls), 2008, ink on paper, 9 by 12 inches; Chloe Dzubilo, Untitled (Woman of Trans), 2008, ink on paper, 9 by 12 inches

A&U â&#x20AC;˘ MARCH 2016

subtle way, as an underlying theme. “I think any time you bring a group of LGBTQ artists together, HIV/AIDS is a topic that comes up in their work,” Taylor comments, “because that’s what they experienced, what they know it’s around them.” There are fourteen artists featured in the show, some exhibiting one, others, up to four pieces of artwork. Out of the featured artists, three artists in particular show work that deals specifically with HIV and AIDS. One of these artists is a South African activist and photographer, Zanele Muholi, whose body of work, Faces and Phases, brought her international attention. It all started with Muholi photographing her friend, Busi Sigasa, a poet and political advocate who was raped by a man she knew. The corrective rape did not make Sigasa straight. Because of that rape, she contracted HIV and died within a year after the portrait was taken. Since then, photographer Muholi moved on to capture other faces, and to start “building a supportive community, one photograph at a time,” as part of her “ongoing series documenting black African lesbian and trans men.” She also included a portrait of herself, because, she recently told Taylor, “I’m one of us. I’m not observing from a distance.” Over the past eight years, she has captured more than 250 individuals that “have gazed frankly, shyly, proudly, defiantly” at her camera, “making their own history.” Another artist, Anthony Viti, uses codes “to keep information from unsympathetic viewers.” In his series Elegy (After MH’s Iron Cross), he refers to the encrypted, coded messages used during WWI as a source of inspiration for using codes within the LGBTQ community. To make his art, he uses bodily fluids, including blood, hence referencing the idea of the human body going through the dangers of wars to that of going through dangers related to HIV and AIDS. A third artist, and also AIDS and transgender activist, is Chloe Dzubilo. She died in 2011, but she left an undisputable legacy. Dzubilo came to New York City and became an artist of many talents—she was lead singer in a punk-rock band, a writer, performer, model, and “a muse for multiple A-list designer.s” She was someone who really had that rare kind of life many might MARCH 2016 • A&U

Top to bottom: Anthony Viti, Elegy #57 (After MH’s Iron Cross), 1993, human blood and oil on masonite, 15 by 15 inches Anthony Viti, Elegy #81 (After MH’s Iron Cross), 1994, human blood and oil on masonite, 15 by 15 inches Anthony Viti, Elegy #96 (After MH’s Iron Cross), 1994, human blood, urine, powdered charcoal and oil on masonite, 15 by 15 inches

only dream of. She was a transgender person accepted and embraced by many people. But while she was well respected and living a busy public life, she used her art—either drawing pictures of herself or writing down memories—to express her more candid, intimate side, and to reconnect with herself, and as a way to convey her personal struggles. To the world, Chloe Dzubilo wanted to present that she was a fighter, while in her artwork, her personal struggles. “Those items came to New York University,” Taylor explains, “and then to our archives.” The “LGBT Survival Guide” show is important, especially to younger LGBTQ people. It offers them the opportunity to see contemporary work that addresses their own issues—trying to find a community that accepts them as they are. Through this show, The Center offers a novel way to see their struggles, and also a history of contemporary art. The exhibition has a powerful, timeless message that crosses generations. The four survival strategies it expresses do stand the test of time. Steed Taylor encourages LGBTQ youth of today to embrace these strategies, if needed. “It could be very scary to hear that a preacher online is saying that the country you live in should kill everybody who’s like you,” Taylor comments, directly addressing today’s LGBTQ youth. “In the past it was much worse, but [people] did survive.” He urges individuals to remember: “Be true to yourself, no matter what others are telling you. That is the most important thing. It doesn’t matter that people tell you that God doesn’t love you. You know God loves you. You know that you’re made this way. You know that you’re perfect as you are. And if you don’t [know] somebody that supports that, then keep it to yourself, and find people who do. In the meantime, make sure you’re safe. Stay connected with a community that accepts and values you as you are. And then make a life for yourself.” To visit the online chapter of the “LGBT Survival Guide, Strategies for Survival and Connection in an Unsupportive World” exhibit, go to https://gaycenter.org/archives#archive-gallery. To learn more about Steed Taylor, visit him online at www.steedtaylor.com. Alina Oswald is Arts Editor of A&U.

Housing the

Kiki Community

Housing Works HOUSE Project and members of the Kiki ballroom scene help educate youth about HIV and AIDS by Alina Oswald

photos by Joshua Kristal

he International Ballroom Convention [A&U, June 2014] took place in New York City, in the spring of 2014. The weeklong event opened at Chashama Gallery in Harlem, New York, and was organized by and large by award-winning activist and filmmaker Wolfgang Busch. The convention brought together many activists and artists associated with the ballroom scene, and also outreach workers from Housing Works HOUSE Project, to have a candid and open conversation about the history of the ballroom scene, and also about HIV/AIDS, as it’s so tightly related to this community. As some might be aware, the ballroom community (or scene) represents a subculture of the LGBTQ community, and primarily includes individuals who, while not accepted by their biological families, find new families, homes and acceptance in the “houses” so iconic to the ballroom scene—the House of Ultra Omni, House of Ninja or the House of LaBeija, to name only a few. A subculture of the ballroom community is represented by the Kiki scene—

Kiki means “shade,” which comes from “reading” as interpreted in the ballroom scene as reading a person to highlight all of their perceived flaws. Throwing shade has been a longstanding rhetorical strategy, often playful but always cutting, and informed by the need to empower oneself and survive as a person of color. As mentioned in a Vimeo video on the subject, the Kiki ballroom scene is a much younger scene, in terms of history—it has been around for only about ten years—and also in terms of members, which are mainly young African-American individuals, between the ages of sixteen and twenty-four. Housing Works HOUSE Project works with young people, ages eighteen

to twenty-nine, and also offers programs that specifically target a slightly younger population, thirteen to twenty-four years of age. Based in New York City, the nonprofit helps its clients find housing, medical care, HIV prevention and/or treatment, and also jobs. “We’ve been developing youth services for the past five to six years,” explains HOUSE Project’s own program coordinator Lindsay Slay. “[We’re] just now getting traction with the ballroom community and the Kiki community more specifically, because that’s a way for us to connect with a community of young people that are often not seeking out care.” Housing Works’ annual fundraising event Fashion for Action raises money for youth programs that, in turn, help support these young individuals. “It’s about being aware of how young people, in particular young African Americans, are disproportionally affected by HIV, still,” says Slay, explaining the decision for Fashion for Action proceeds to go to these programs, “and how high the HIV infection rates, and also substance and mental health issues are within this community.” She adds that it’s a little different working with the Kiki community, because, Slay says, “the Kikis have formed out of the need to address the issues that they saw in a community with high HIV rates. A&U • MARCH 2016

So, early Kiki members have connected with service providers and nonprofits that were supportive in order to create these collaborative relationships,” hence, the collaboration with nonprofits such as Housing Works. What stands out is that the Kikis are actually more exposed to HIV services than others, and they are offered to be tested everywhere they go. Through its outreach program, members of the Housing Works HOUSE Project go out into the places where these young individuals might hang out. It might be out on the street, at drop-in centers and clubs, or places popular with those who escort. Housing Works HOUSE Projects works with members of the Kiki scene who have knowledge and understanding of this community. They stay connected primarily using social media, like Facebook, for example. “Keeping people in these [HIV prevention] services [means] staying in touch,” Slay emphasizes. “And when some of these people don’t have a stable [physical] address, being in touch on Facebook has been key for us, and maintaining these relationships and checking in with people, reminding them that they have services available or that if they have housing needs they just need to send our outreach staff a message. They can always reach us on Facebook, no matter where they are.” While Housing Works primarily works with individuals from and around New York City, at least in part because of social media the organization has started to receive messages from all over the country, from people in need of care. “We focus on people in New York,” Slay reiterates, “but we know that this young population is moving around a lot, and just by chance, we started to get a steady referral stream from the South.” People from around the country can check to see if they’re eligible for housing or while trying to get their names on the list, to receive medications paid for by ADAP, for example. Maybe these individuals find themselves in an environment where they cannot be openly gay or about their HIV status and don’t have a supportive community. So they contact Housing Works, which, in turn, helps facilitate their transition to the New York City area, and helps them get housing and treatment, if needed. Usually then word goes out to those they leave back home, and so others get to find out about the services Housing Works has to offer. Many people are willing to move to New York City area for housing and healthcare. MARCH 2016 • A&U

The work that Housing Works and HOUSE Project do to support the community is interconnected, in a way, with the Black Lives Matter movement. “We’re almost working exclusively with African American youth,” Slay explains. “Our program focuses on this [particular] population. We see people come in with all kinds of trauma [caused by] family or others—homophobia, transphobia, but also harassment on the street or police violence. This is a part of young people’s life, [young people] which we’re working with. And we hear stories from our youth being gay-bashed or harassed in all kinds of ways. It’s something that we’re very aware about. We want to support young people, connect them with counseling and mental health services that are sensitive to the things that they go through around their race, sexuality, and gender.” She goes on to say, “If we can’t help them feel safe here around these needs, it will be challenging keeping them engaged in HIV care or help them stay HIV negative. We have to be aware of how all that trauma impacts [our clients]. I think [Black Lives Matter and our work] are very connected.” To emphasize this connection, Slay shares an example. Housing Works was working with a young man from the South, who was HIV-positive and struggling with health issues, shuttling in and out of healthcare. With the help of Housing Works, he was able to move to the New York City area and find a place to live. But, as a recent transplant here, he felt isolated, having a difficult time adjusting to his new environment. In addition, he heard that another black gay man who was living in that same building had been beaten up. So, he decided to go back to the South,

where he did not have access to healthcare. Stories like this are too common. They are real-life stories of young people facing harassment and stigma, lack of access to housing or jobs or healthcare. They are stories Housing Works deals with every single day, and problems the organization tries to better address by reaching out to connect with the communities at risk, learn from them, and work with them to solve their needs. The youth, represented by members of the Kiki scene, were highlighted at last year’s Fashion for Action fundraising event. “Instead of just talking about the youth,” Slay says, “that we’re raising money for the youth, we [got] to have some of them come out and be the guests of honor, and share a little piece of their talents and interests.” This way, people could better connect and understand these individuals. “We’ve chosen [to feature] leaders in the community,” she adds, “[leaders] who have cooperated with us, helping us. We successfully work with this community because we let them lead and give us an insight of what’s going on in the community.” When Kiki community members bring up PrEP or jobs, Housing Works takes notice. “We’re very excited about PrEP,” Slay says. “We have just now expanded the PrEP services to increase our PrEP involvement and education, displacing some myths. We have a new patient navigator to help patients have access to PrEP and help destigmatize [it], which I think it’s already happening.” Learn more about Housing Works by visiting www.housingworks.org. For a peek preview at the Kiki culture, visit: https://vimeo.com/131471824. Alina Oswald is Arts Editor of A&U.

Going to the Mat

n my time in the field of complementary and alternative medicine, I have often heard a variety of practitioners remark that good health and healing is partially a state of mind. If I look at this theory from a conventional, western point of view, I am inclined to agree. How many times have you had a bad week or gone through a particularly stressful period in your life and found that you have become ill? It makes sense. In general, stress has a negative physiological impact on the body and the way our assorted systems function. But stress also releases hormones into the body that suppress the immune system. In our quest for greater wellbeing we may seek out options that strengthen the body. Whether you lift weights, run, engage in sports or partake in any athletics that bring about physical strength and stamina, it is often for the sake of enhanced health. In addition, we may delve into practices that nurture the spirit and the mind, that bring about relaxation and erase anxiety. I can safely say that many of my own clients see me for stress and anxiety reduction. But whether you use massage therapy, meditation, or any other means of relaxation, we often do so in pursuit of good health. In yoga, we find a practice that encompasses both the building of the body and the mind. Yoga is rooted in ancient Indian philosophy. It is a form of complementary and alternative medicine that falls under the heading of mind and body practices. Yoga is a very popular practice and growing. In 2007, the National Health Interview Survey found that yoga is one of the top ten complementary and integrative health approaches used among U.S. adults. According to the analysis of data from the 2012 National Health Interview Survey, yoga users reported the most positive health benefits, compared to users of natural products and spinal manipulation. The analysis by the National Center for Complementary and Integrative Health was published in a National Health Statistics Report by the National Center for Health Statistics. Yoga users were much more likely than users of other approaches to report specific wellness-related outcomes, such as feeling better emotionally. They were also the most likely to report exercising

more, eating better, and cutting back on alcohol and cigarettes. While the analysis did not show why yoga users reported greater wellness, more than seventy percent of yoga users reported a “focus on the whole person—mind, body and spirit” as a reason for practicing yoga. Specific findings of the analysis included that nearly two-thirds of yoga users reported that as a result of practicing yoga they were motivated to exercise more regularly, four in ten reported they were motivated to eat healthier and more than eighty percent of yoga users reported reduced stress as a result of practicing yoga. Yoga is something that people living with HIV may practice to promote wellbeing for the body, mind, soul and spirit. Having the ability to take control, of these aspects of yourself is a positive and empowering experience for anyone, especially individuals dealing with a chronic illness. There is no shortage of yoga options and there are many different styles of yoga that one can practice. In fact, there are yoga studios that offer classes specifically for people living with HIV. Although the styles will differ in some ways, they all tend to combine physical postures, stretching, breathing techniques, and meditation or relaxation. There is a popular opinion that yoga is an ideal exercise for people living with HIV. Not only does it help to build muscle and energy, but it also reduces stress. Some opt for forms of yoga that challenge the body and others believe that gentler forms of yoga, which focus on simple poses and breathing techniques, versus exercises that overly tax the body, are the best course of action. I had the opportunity to talk with Paul Adam Sanchez who is both a yoga instructor and personal trainer. Paul explained that the most important thing about yoga is breathing and learning to breathe properly is paramount to good health. Emotions get stored in the body and can

have an impact on health. Shallow breathing is a defense mechanism; a means to anesthetize ourselves. When we learn to breathe properly it can get the bodies energy systems working, and with a proper flow of energy and our systems working at their best, we can start to heal from longstanding issues. Many people live in a sympathetic nervous system state, or in a “fight or flight,” stressed state. Proper breathing, at a slow and relaxed pace, helps to activate the parasympathetic nervous system or the “rest and digest” response. This is a healing state that aids in sleep, circulation, digestion, elimination of waste and toxins and helps the body to achieve a homeostatic balance. Balance itself is another important concept of yoga—balancing the body helps to balance the mind and spirit. Should you decide to explore yoga, there are many studios and organizations that offer free classes. Of course, as with any undertaking to enhance your health, it is important to seek out qualified practitioners, speak to your medical professionals, and partake of practices within safe and healthy limits for your individual experience. After a lengthy career in the arts and LGBT activism, Robert Zukowski pursued his goal of a career in complementary and alternative healthcare. He is a New York State licensed Massage Therapist, a Certified Medical Massage Therapist and is certified by the National Certification Board for Therapeutic Massage and Bodywork. In addition to his hands-on work, he is a writer and lecturer in the field of therapeutic massage therapy. A&U • MARCH 2016

illustration by Timothy J. Haines

for the mind, body and spirit, yoga improves wellness

lifeguide

Risky Business? hcv transmission scares in healthcare settings cause concern

HCV transmissions in healthcare settings mostly came from accidental needle sticks, and primarily infecting the healthcare worker. The hepatitis C virus is spread from blood-to-blood contact. In the U.S. the risk is very low for contracting hepatitis C (or hepatitis B or HIV) while undergoing medical procedures at a nonhospital medical setting. However there is some evidence that health scares based on unsafe procedures at freestanding clinics for colonoscopies and dialysis is increasing. There were forty-four outbreaks (consisting of two or more cases) of viral hepatitis related to healthcare transmission reported to CDC during 2008-2014. Of those outbreaks, forty-two (ninety-five percent) occurred in nonhospital settings. But those statistics might not quell anxiety, even when all patients are cleared from possible exposure to infectious diseases, like 12,000 pediatric patients at risk from improperly reprocessed surgical instruments at the Seattle Children’s Hospital in 2015, none of whom have tested positive for HIV or hepatitis so far. And the publication of a new study of standard precautions for infection prevention, published in the January, 2016 issue of the American Journal of Infection Control (APIC), is raising some concerns as well. That study showed fewer than one in five nurses comply with standard safety precautions. Researchers from Northwell Health surveyed 116 ambulatory care nurses to measure self-reported compliance with standard precautions, knowledge of the hepatitis C virus (HCV), and behavioral factors influencing compliance. The survey found that nurses complied with standard safety procedures in these percentages: • always wearing gloves (ninety-two percent)

• always wearing a face mask (seventy percent) • always washing hands after removing gloves (sixty-three percent) “Self-reported data might be an overestimate of actual compliance and that makes these results of particular concern for potential exposure to bloodborne diseases,” concluded the study authors. The survey also showed that nurses’ knowledge of HCV varied. More than a quarter of nurses (twenty-six percent) believed, incorrectly, that HCV is typically spread through sexual contact, twelve percent didn’t know HCV antibodies could be present without an infection, and eleven percent didn’t know about multiple HCV genotypes. The authors also say that ambulatory care nurses who choose to implement some safety behaviors and not others is more likely to put them at risk for acquiring a bloodborne infection than other patients. Besides the low risk of infecting patients with improperly sterilized equipment or lax safety procedures, there is a much higher risk of lawsuits for healthcare facilities. Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. A&U • MARCH 2016

illustration by Timothy J. Haines

n February, Swedish Medical Center in Englewood, Colorado, revealed that it told nearly 3,000 former surgery patients that they should get tested for hepatitis B, hepatitis C, and HIV after it found out a former employee may have exposed patients to these three viruses. The hospital did not say how the patients could have been put at risk. It also said it had no evidence of any patient exposure to the viruses but wanted to err on the side of caution. In January, Baystate Noble Hospital in Springfield, Massachusetts, began notifying colonoscopy patients that the equipment might not have been properly disinfected. The hospital said that 293 patients who had colonoscopies at Noble between June 2012 and April 2013 could have been exposed to hepatitis and HIV during their procedures. In 2013, Buffalo VA Center in Buffalo, New York, said the hospital may have exposed more than 700 of its patients to HIV, hepatitis B, or hepatitis C by mistakenly reusing its insulin pens. In 2010 John Cochran VA Medical Center in St. Louis, Missouri, notified nearly 2,000 veterans that they were at risk of contracting hepatitis B, hepatitis C and HIV after visiting the medical center for dental work during a thirteen-month period. The VA told local media that health authorities found the problem during a routine inspection. These HCV and HIV scares in healthcare settings raise the question: How risky are hospitals and nonhospital medical settings? The U.S. Centers for Disease Control and Prevention (CDC) says that as long as standard precautions and other infection control practices are consistently used, medical and dental procedures generally do not pose a risk for the spread of HCV. Those standard precautions include using clean, non-sterile gloves, wearing fluid-resistant gowns, wearing a face mask when there’s a risk of respiratory secretions, eye protection or face masks when there’s a potential for splashing of bodily fluids, washing hands for twenty minutes with soap after any patient contact, and strict injection safety procedures. The CDC says the small number of occurrences of

E R U T L U C S THE

AID OF

BOOKS

Until My Heart Stops by Jameson Currier Chelsea Station Editions

n Until My Heart Stops, his collection of more than fifty “intimate writings” culled from forty years of non-fiction writing, Jameson Currier addresses topics familiar to gay men—sex and the search thereof, love and relationships, AIDS and loss—all rendered in vivid details that ring with the clarity of Truth. Primarily a novelist, Currier employs the techniques of fiction in these non-fiction pieces. He is particularly good at short, cinematic scenes with finely crafted, believable dialogue. In “Threads” he recounts meeting a friend whom he hasn’t seen for two years at a viewing of the AIDS Quilt in 1992. …[H]is eyes narrow and he rocks his legs nervously, and says, softly, his best friend died this morning. I answer I am surprised he is here of all places, but I understand why he is. I know exactly what he is thinking and feeling. “How could I stay away?” he says and stops rocking and then looks at the ground. “I have it,” he adds, and I know not to ask, “Are you sure?” No histrionics, no melodrama, just a quiet, truthful scene rendered simply with great power and emotion, like so many scenes in this excellent collection. Alongside the tragic, Currier’s humor informs these pages. He says of one partner, “His dick was wide and chubby and looked like it should have a nickname.” He refers to “The Liberace Museum” as “an homage to a man and his closet.” Currier writes in one piece that AIDS “has changed me even though HIV has not infected me. It has, nonetheless, impacted my world….I write about AIDS

because I am still alive.” Until My Heart Stops, achingly poignant and full of humor, left me eager to read the follow-up collection that Currier hints at in his introduction. —Hank Trout

BOOKS

Based on a True Story by Jameson Currier Chelsea Station Editions

he phrase “loving someone to death” is an inherently disturbing one. There’s something almost oxymoronic about it: After all, shouldn’t we be loving that person to life, not to death? It evokes images of violent crime, not of great love. Which brings us to Jameson Currier’s Based on a True Story, a novel about both. Tom, the narrator, is “an accidental writer” who has published a book of “short, episodic stories of my ex-boyfriends and ex-lovers—optimistic and dauntless young men like myself who had come to the city and been caught up in the unfortunate AIDS epidemic.” He and his partner, Harley, have invited Scott and

his younger lover, Aidan, to stay at their place in the country. Initially, Tom’s not all that comfortable with Aidan, who strikes him as being pretentious and too young—“almost a member of another generation”—to “have personally experienced the changes that the AIDS epidemic had so tragically and unexpectedly wrenched upon myself and Scott.” He can’t possibly have that sense that they do of “carry[ing] ghostly baggage strapped to our backs.” But Aidan has some ghostly baggage of his own, as it turns out. During the course of the visit, the couples begin talking about Perry, Aidan’s nephew, and his older obsessive partner, Neil. Tom, who knew Neil many years earlier, is trying to connect the dots between the “non-descript” guy he once knew and the one all too willing to harm his lover. The story-within-a-story device is probably one of the oldest ones ever known. Currier handles it well, using the inner story to subtly bring buried emotions and fresh insights to the surface in the outer one. In trying to make sense of the tragedy, Tom comes to understand his own story—which is not one about “loving someone to death” but about love. —T.J. Banks

FILM

VIVA: Find Your Voice Directed by Paddy Breathnach Magnolia Pictures

“W

hy is everyone on this island addicted to drama?” Luis Alberto Garcia’s character, Mama, asks, rather rhetorically, in the new movie, VIVA, which could be described, at least in part, as a dramatic take on The Birdcage set in Havana, Cuba, and also as a journey of self-discovery, acceptance (and self-acceptance), and, ultimately, as a story of triumph. Using drama, passion, and that inner fire and ardor so specific to the Latino community—and that come through so eloquently in the equally passionate music and performances that strike a chord with A&U • MARCH 2016

photo courtesy Magnolia Pictures

Héctor Medina in VIVA, a Magnolia Pictures release. many of us—VIVA tells the story of Jesus (Héctor Medina) a young hairdresser who works in a Havana nightclub that showcases drag performances. While Jesus dreams of becoming a performer himself, he has no family to support him and meanwhile struggles to make ends meet. Fortunately, he finds a mentor in the owner of the nightclub, Mama, who encourages him to take the stage. “In the time you have [on stage], be fully yourself. It’s not about mouthing the words,” Mama tells Jesus. “You have to do them with feeling. Show us something real.” And yet, when he finally has the chance to be himself while performing on stage, his dream seems to be shortlived and his life is turned upside-down when his estranged father, Angel (Jorge Perugorria) comes back into his life. As a result, Jesus finds himself at a crossroads, faced with hard choices that could shape his life forever, for better or worse. Medina gives a powerful, memorable and heartfelt performance, which the actor describes, as mentioned in a Tweet, as “a film necessary for everyone who wants to find their inner voice.” And in VIVA, Medina’s character does just that, in a most compelling way. “I want something for myself, Mama,” Jesus tells his mentor when asked why he wants so badly to become a performer. MARCH 2016 • A&U

“All my life I’ve been made to feel sorry for who I am,” Jesus continues, “and then, just stand[ing on stage] honest and strong. To sing out. I’[ve] never felt that before.” At its core, VIVA tells a story about finding one’s true self and having the courage to show that true self to the world, but VIVA is much more than that. It also tells a passionate story of life and its struggles, of acceptance, and also of love. The emotional and unexpected story of love between a father and his son shines through, woven together in the life-changing journeys they each decide to ultimately take, journeys that bring them together, and also pull them apart. VIVA has already received rave reviews— Indiewire calls it “an emotion-filled drama that uncovers an authentic Cuba,” while The Guardian describes it as “vivid and fresh.” There is something fresh about VIVA, maybe in part, because it is set in Cuba, a country and an island that has been, in many ways, intriguing and yet out of reach for many, until recently. VIVA interlaces Jesus’s story with scenes of daily life as they unfold in Havana, Cuba, offering a glance into a way of living seemingly stuck in time, sketching out facets of life that might seem unfamiliar, and yet marked by struggles, laughter, drama and passion, feelings we all know too well. HIV/AIDS, although not mentioned in the movie, has a subtle role, more as an underlying motif, a constant and intense threat. While it’s true that performers in

some nightclubs, such as Havana’s Las Vegas Club, incorporate HIV and STD awareness messages in their exotic shows, unfortunately there is no trace of these kinds of messages or any other more direct references to HIV/ AIDS in VIVA. Under the microscope, some scenes showing characters involved in risky sexual behaviors might hint at the connection between HIV and unsafe sex, but these messages are rather more implied, written between the lines. In that sense, HIV could be interpreted as part of the “social allegory” that Breathnach talks about. Director Paddy Breathnach tells Filmmaker Magazine that VIVA captures “stories of pain and personal struggles” of drag performers, and, some would say, of people living on the island. When asked, at Sundance Film Festival, about the secret story of his film, Breathnach says, “There is, too, to some extent an element of social allegory at work in [VIVA]. It was a theme that our cast picked up on in rehearsal. It is perhaps the ‘secret’ they enjoyed playing the most.” Nominated for the Irish Academy Award in Foreign Languages, VIVA opens in the U.S. theaters on April 29. —Alina Oswald Hank Trout edited Drummer, Malebox, and Folsom magazines in the early 1980s. His published writing has ranged from gay “smut” (his term!) to literary criticism of William Blake. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a thirty-five-year resident of San Francisco, where he lives with his fiancé Rick. He read two of his pieces at the National Queer Arts Festival in San Francisco last June. T. J. Banks is the author of Sketch People, A Time for Shadows, Catsong, Houdini, and other books. Catsong was the winner of the 2007 Merial Human-Animal Bond Award. Alina Oswald is Arts Editor of A&U.

A Calendar of Events

he National Week of Prayer for the Healing of AIDS, organized by Balm in Gilead, is set for March 6–13, 2016. As faith communities can play a vital and compassionate role in HIV prevention, education, service and advocacy, the purpose of the Week of Prayer is to set aside time for HIV advocates to mobilize and educate faith communities across the country to initialize a response to HIV/AIDS or fine-tune their ongoing local and/or national efforts. The Balm in Gilead, a faith-based nonprofit dedicated to HIV/AIDS awareness and creating resources like its recent Let’s Talk About It! Youth & HIV in America guide, has several ways to participate: register your participation on its Shine the Light National Map; use the week to tailor your worship experience to HIV awareness, compassion, and action; use customized Week of Prayer Sunday bulletins and inserts; hang a national campaign banner in the front or inside your place of worship; make HIV awareness the theme

of a sermon; pray for the healing of AIDS; and organize a community-wide candlelight and prayer vigil or HIV education and testing activity. During the Week of Prayer, the Real Talk Webinar series will offer important discussions about HIV/AIDS. Faith, HIV & Youth on March 8, from 2 to 3 p.m.; led by Rev. Anthony Sullivan, Associate Pastor, Community Outreach & Development, God Can Ministries UCC, Chicago, Illinois. Young(er) MSMs: A Parent’s Guide to Understanding Youth Sexuality on March 9, from 2 to 3 p.m.; led by Dr. Ullysses Burley, III, Program Associate (ELCA) Strategy on HIV and AIDS, Evangelical Lutheran Church in America, Chicago, Illinois. HIV/STDs on College Campuses on March 10 from 2 to 3 p.m.; led by Rev. Dr. Rebecca Branch-Griffin, Pastor, Oak Street AME Zion Church, Retired Director of Student Health Services, Virginia State University, Petersburg, Virgina. For more information, log on to: www.balmingilead.org/nwpha.

A&U • MARCH 2016

MARCH 2016 • A&U

Survival Guide

[a portrait by sean black]

Jesús Manuel Rodrigues Valle “The only mistakes in life are the ones we do not make.”

I Can Find You

The altruism of all science, in the infinite of great works I can find you. I can find you in the simple giving of a detail, in all acts of faith, I can find you. I can find you in the transparent aureola of a smile, in all dreams absorbed by my truths. In your flash of light, I can find you.

Sean Black is a Senior Editor of A&U. 64

Jesús currently serves as the provincial coordinator of Centro Esperanza Cuba (Hope Center) in Sancti Spíritus province. Trained as a veterinary technician, the native of Guasimal served in the military as a teen, devoted himself to a Pentecostal Church pastoral ministry in the nineties, and has spent the past sixteen years in the retail trade. Diagnosed with HIV in 1986, the fifth in Cuba, Jesús first found his activist voice when he was forced to live in the Santiago de Las Vegas Sanitorium and realized the system needed to be more responsive to the needs of individuals living with HIV/AIDS. In 1989, in Guantanamo, he founded an organization to educate about HIV prevention and the realities of living with the disease, and to fight against the violation of rights of individuals living with HIV/AIDS, a fight he continues to undertake to this day. A&U • MARCH 2016

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Walgreens HIV-specialized pharmacies can coordinate your prescription refills so you can pick them all up on the same day. Plus, we can remind you about medication doses and refills. Itâ&#x20AC;&#x2122;s our way of helping you simplify your busy life. To learn more, visit HIV.Walgreens.com.