HIV Plus 98 Jan. Feb. 2014

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Back in Black

The Real Reason HIV Rates Are Still Rising Among African-American Gay Men

JARED LETO

How the actor channeled a woman and helped make Dallas Buyers Club one of the greatest AIDS movies ever filmed

january/February 2014

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Editor's Letter

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spent a year studying at Xavier University, the only predominantly black Catholic college in America. What I learned there could fill up this whole issue, but one thing that struck me the most was the economic and health disparities between African-American students at Xavier and the predominantly white students at Tulane University—a school I also attended that's just a couple of miles across town in New Orleans.

Kids at Tulane just had better access to health care. So I'm not surprised but am always saddened to see how much HIV has ravaged black communities, especially young gay or bi men. But I was surprised to discover the disparities that lead to those increasing HIV infections are marked not just by the usual mix of factors (economics, racism, homophobia) but also by the size of the population in which gay and bisexual African-American men are dating in. Our editorial director, Lucas Grindley, investigates this issue in his article, "A Perfect Storm," on page 20. We continue looking at African-American issues from a decidedly lighter side as well, in two features on women: in "Everything You Need To Know Before You're Expecting," on page 31, Michelle Garcia and I offer tips on having a healthy pregnancy (and HIV-negative babies) even if you're positive; and on page 29 our "Black Woman's Guide to Dating With HIV" is a bit of a ladies' FAQ, like when to disclose to a date, what to do if the condom breaks, and what to tell his kids if you're lucky enough to hook up with a single dad. There's plenty of other good stuff here, including our interview with the very dreamy actor Jared Leto. I think the film, Dallas Buyers Club, in which he plays a transgender woman with HIV, is one of the best AIDS films ever made, in part because of his star turn. Let me know if you're crushed out too.

Diane Anderson-Minshall

bradford rogne photography

Editor in Chief | Editor@HIVPlusMag.com

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IN THIS ISSUE

JANUARY/FEBRUARY 2014

buzzworthy

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ARt for education A street performer and a book for kids.

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Faith and Healing Programs using religion and communication for black couples.

9

Positive planning Financial planning especially for HIV-positive people?

10 All under one roof HIV testing for teens in Idaho.

11 e xtraordinary vision Eduardo Bar talks about life as a blind, HIV-positive actor in Hollywood.

TREATMENT CHRONICLES

16 DRUGS for Prevention

Understanding pre-exposure prophylaxis, or PreP. more

18 Ask & Tell Ross Mathews talks about gay men, HIV testing, and his new campaign.

50 MESSAGING FAILURES HIV is no longer a death sentence, so why do our prevention ads still say it is?

56 curewatch Mushrooms, cats, and monkeys lead the way in new discoveries.

40

Rock star Jared Leto took off several years from acting to tour with his band until the Dallas Buyers Club role came along and he couldn’t resist taking it on.

THE AFRICAN-AMERICAN ISSUE

20 The Perfect Storm

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29

A Black Woman’s Guide to Dating

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Knocked Up

47

HIV infection rates are skyrocketing among young gay black men. One theory why will surprise you.

ge t t y images

31

When and what to tell him (or her), what to do if the condom breaks, and the scoop on kids, sex, and more.

Everything you need to know before, during, and after you’re expecting a little bundle of joy.

Body Counts

Poz magazine founder Sean Strub talks about the early days of AIDS and finding community in New York City.

Beautifully Sad Film

Mark S. King explains why Dallas Buyers Club is an exceptional film that portrays AIDS in a way rarely seen.

Action Hero

Comic book author and publisher Darren Davis gave us the first comic super hero with HIV.

On the cover: Jared Leto in Dallas Buyers Club; photo courtesy Focus Features

back talk

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Editor in chief

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Diane Anderson-Minshall ART DIRECTOR Boo Jarchow copy chief Trudy Ring

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Svp, group publisher

E Joe Valentino

senior VP, marketing & Br and str ategy

Stephen Murray

senior director, integr ated marketing

Amanda Johnson associate Editors Daniel Reynolds, Sunnivie Brydum creative director, integrated marketing Robert Hébert senior manager Kevin Lesser editorial interns Nicholas Cimarusti, Michael Regula, Jonathan Carmona MANAGErs, integr ated marketing Steven O’Brien, Sasha Rodriguez creative director, digital media Dave Johnson senior director, media str ategy Stewart Nacht director, digital media Scott Ragan circulation Director Jeff Lettiere senior online producer Christopher Harrity fulfillment manager Argus Galindo manager, application development Alex Lim Production director John Lewis front end developer Mayra Urrutia Advertising Production Manager Heidi Medina tr affic manager Kevin Bissada HERE MEDIA

Stephen P. Jarchow ceo Paul Colichman cfo Tony Shyngle executive Vice Presidents Bernard Rook, Joe Landry editorial director Lucas Grindley chairman

Christin Dennis, John Mongiardo, Stephen Murray, Alex Paul, Josh Rosenzweig, Joe Valentino vice presidents Greg Brossia, Eric Bui, Steven Capone, Justin Garrett senior vice presidents

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I wanted to write and tell you that your July/August issue of HIV Plus magazine was one of the best issues ever! The "HIV Treatment Guide" was outstanding. I have been HIV-positive since 1988 and I was able to go through the list of medications and locate the 20 that I have taken over the years and create a list. (I had lost track over the 25 years.)

Your ADAP state-by-state listings were also very helpful. Thank you for doing an excellent job in keeping HIV information available. Keep up the good work.

Jack Cole Florida EDITOR'SNOTE: Thanks. Jack! We also turned that issue into a mobile app, HIV Plus Treatment Guide, that you can get on Android or Apple phones.

coming next issue Madonna backup dancer turned actor, author, and HIV-positive speaker (and our cover guy) Carlton Wilborn talks about how he learned to be happy and healthy. Plus: Why trans women are hit hard by HIV laws, why Native American survival rates are lower than others, Israel's top HIV researcher talks about HIV-fighting antibodies, and we tell you everything you need to know if you've just been diagnosed with HIV.

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Buzzworthy

Can a Life-Size Grindr App Change HIV Stats?

Getting people to pay attention to hookup risks takes a little ingenuity these days

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Modern Family Volando Cometas, a Spanish-language kids book, introduces children to HIV

jake fink

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fter hearing that the World Health Organization declared HIV the number 1 cause of death globally for women of reproductive age, Lawrence Schimel decided to write a children’s book. Volando Cometas is a delightful Spanish-language story in which life with an HIV-positive relative is presented in a way that promotes knowledge, honesty, and acceptance and, Schimel says, helps “normalize the reality of HIV, and especially the existence of women with HIV, for children.”

Daniel is a young boy whose Aunt Nieves invites him and his parents over to her beachside house for the weekend. Before the trip, Daniel overhears his parents say that Nieves is sick. The story explains Daniel’s learning process about his HIV-positive aunt. With the help of Nieves and her supportive boyfriend, Enrique, Daniel gains a greater understanding of HIV. Schimel’s Volando Cometas has been well-received by an international audience that hopefully includes, as Schimel says, “educators and librarians, who can use the book to help spark dialogues with their students and patrons.” In addition to the published versions in Spanish and Catalán, Schimel is also launching a Slovenian translation. Núria Fortuny’s whimsical illustrations help lighten the mood, but the book’s primary goal is to enlighten children without underestimating their capacity to comprehend tough issues.

“I wanted to tell a story from a child’s point of view,” explains Schimel, “that would serve as a vehicle to address HIV, but without creating a didactic tale that hits readers over the head with its message, as if the book were titled My Aunt Has AIDS.” The book’s clever symbolism and simple structure enhance the overarching message: Children should learn about HIV and AIDS through honest and open dialogues with educated adults because, as Nieves says, “Ignorance does the most damage.”—Nicholas Cimarusti

eads turned last fall when a giant cell phone was spotted wandering the streets of Provincetown, Mass. Artist Tim McCarthy and a costumed friend resembling a Grindr app profile on a giant iPhone took to the streets hoping to raise both eyebrows and awareness about HIV. The costume reveals the artist’s own half-naked body, while the man inside the life-size iPhone—who asked to remain anonymous—handed out fake samples of HIV-positive semen and blood to curious onlookers. The entire campaign was an attempt to raise awareness of the risks that online hookups pose to users in the form of sexually transmitted infections.

McCarthy captured the spectacle on camera, recording audience reactions, then posting the clips online as part of a new awareness project dubbed “R U the 1?” The campaign is meant to get people talking about the prevalence of HIV among users of online hookup apps. Along with an accompanying Facebook page, the project is presented with the intentionally equivocal tagline: “Are you the one I’ll spend a night with? The rest of my life with? Or the one who gives me HIV?” “The concept is meant to be disturbing,” McCarthy says of the project, which started with a conversation at a the New England Alliance on Gay and Bisexual Men’s Health conference.

“We want to engage guys—especially young guys—in a conversation about HIV that seems to have lost momentum,” explains McCarthy “The Internet and smartphones have changed gay culture

and how we meet one another. There’s no shame in meeting online for sex. But if guys knew about the prevalence of new HIV infections, they might do more to prevent its transmission.”

Along with the test tubes filled with “blood” and “semen,” McCarthy and his accomplice also passed out a pamphlet detailing some statistics concerning HIV, and some helpful tips for safe online dating.

“Overall, the reaction is positive, or at least, not negative, if that makes sense,” the anonymous artist inside the phone costume says. He and McCarthy wanted to “catch people off-guard and snap them out of HIV [messaging] fatigue,” though he admits that many straight onlookers wanted to take pictures with him just because they saw a giant iPhone with legs.

—Michael Regula

87%

The number of people who didn’t realize herpes can cause a severe, sometimes fatal inflammation of the brain, called encephalitis Source: polyDNA, 2013

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Buzzworthy

Healing Faith The Balm in Gilead works to educate and activate religious leaders to become the first line of defense in the fight against HIV and AIDS in African-American communities and abroad in Africa about leading interventions and messaging strategies.

In fact, one of the Balm in Gilead’s newest endeavors, the Couples Counseling Community Mobilization, was introduced in the U.S. last fall after widespread success in Africa.

“What we’re doing,” explains Seele, “is we are highlighting couples and helping pastors and religious leaders and people who work with couples of all sexes to begin to address couples and their relationships and getting them tested and support.”

The Couples Counseling Community Mobilization is open to couples of all gender identities, sexual orientations, and religious backgrounds, Seele says, and has had success reaching serodiscordant couples. She says that after the program’s impressive success in Tanzania—where the incidence of HIV is now lower than it is among African-Americans—“it’s time to bring it back home.”

Seele argues there’s a moral responsibility within African-American faith communities to lead in the fight against HIV and AIDS, and actively work to combat the stigma that still prevents people from being tested, seeking treatment, and getting informed.

“So many more religious communities are opening their doors to people living with HIV/AIDS and are tackling the stigma of it,” she says. “We must have them as advocates in this fight and education.” —Sunnivie Brydum

Less than 1% The risk of transmitting HIV to their babies if HIV+ women take antiretrovirals during pregnancy 8

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Source: CDC/AIDS, 2008

J

ust as the classic African-American spiritual promises, “there is a balm in Gilead.” While the original song— and the biblical stories it references—discuss spirituality as a means to heal a nation’s ills, one international nonprofit is taking that connection and utilizing it to fight HIV and AIDS in the United States and Africa.

The Balm in Gilead began its work 25 years ago, developing educational and training programs designed specifically to meet the health and education needs of African-American and African communities of faith. Over the past two and a half decades, the group has proven itself adept at building strong partnerships between religious communities and health experts, connecting spiritual leaders with leading doctors and scientists.

“Religious leaders are among the most important influencers in our community,” says Pernessa C. Seele, the founder and CEO of the Balm in Gilead. “We must make sure they have the right facts, that they are educated, so that they can influence people not only in their faith and in their religious beliefs, but in their health and the importance of taking care of their bodies.”

The Balm in Gilead is an international nonprofit organization (BalmInGilead. org) with offices located in Richmond, Va., and Dar es Salaam, Tanzania. The dual headquarters allows Balm supporters to exchange important information

Couples Therapy Turning intimacy into intervention for African-American couples

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progr a m th at helps couples reduce the rate of HIV transmission and grow closer emotionally is so successful it’ll soon spread across California. The initial program, conducted by researchers at the University of California, Los Angeles, asked 535 straight African-American serodiscordant couples to take part in Eban practices, a Nigerian concept encouraging communication and safer behaviors.

Researchers found the Eban intervention encouraged safer sex and prevented dozens of participants from contracting HIV. Now, thanks to a $2.5 million grant from the National Institute of Mental Health, the Eban program will be utilized by community-based agencies throughout California.

“The Eban II Project aims to deepen our understanding of how to best help African-American couples enhance their health,” lead investigator Gail Wyatt says in a statement. “We hope the project will create a comfortable space for romantic partners to talk about their health concerns while encouraging each other to lead healthier lives.”

If Eban II succeeds, the project is likely to go national. —Neal Broverman

Positive Planning New York Life’s first-of-its-kind program aims to establish long-term financial wellness for HIV-positive people

By Daniel Reynolds

opposite page: photos.com; this page: photos.com

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ast fall, New York Life Insurance Company, one of the world’s largest life insurers, launched a program to assist HIV-positive individuals in planning for their financial future and retirement.

Dubbed “Positive Planning,” this first-of-its-kind program is helmed by Aaron Baldwin, an HIV-positive agent based in New York Life’s San Francisco office, as well as managing partner Kevin Choi and LosAngeles-based senior director Anthony Conde.

For Baldwin, 46, launching this new project seemed like a natural extension of the Fortune 100 company’s mission, which is, according to its website, “to provide financial security and peace of mind.” Yet considering that for decades HIV-positive people were refused insurance products, the move from a corporate America stalwart is a remarkable one.

“In conversation with people living in the [positive] community, it became obvious that there was a need for this type of planning, because they deal with unique situations,” says Baldwin, pointing to issues such as ineligibility for health insurance and high medical expenses as longstanding obstacles to long-term care for HIV-positive individuals. “They could wind up potentially losing their estate in the process of attempting to manage their long-term care expenses.”

Baldwin began training 11,000 New York Life agents last fall, providing education about the unique situations faced by HIV-positive clients.

The company used online seminars known as “webinars,” involving agents across the United States, in addition to the company’s other employees and managers. By educating agents, Baldwin hopes to be able to pass on knowledge and protections to HIV-positive clients and the larger community.

The CDC predicts that more than 50 percent of the HIV-positive population will be over age 50 by 2015. Throughout the past two decades, medical developments have given the gift of longevity to people with HIV, but many are financially and mentally unprepared for the rising costs of aging.

“For many years, the community has spent money as if none of us would make it to retirement,” Baldwin says. “And obviously now we’re seeing that the mortality rate, if you adhere to the drug regimen, is pretty much normal. ‘No plans for planning’ no longer works. How are we, as a community, going to absorb all of these people who begin to retire and are basically not prepared for retirement?”

While insurance agents have historically struggled with providing services to HIV-positive clients, the reality of longer HIV-positive lives has created an evolving playing field, where new services and opportunities are continually becoming available. If, as Baldwin hopes, health care providers begin to acknowledge HIV as a manageable chronic illness like diabetes rather than a terminal condition, these opportunities may multiply 10-fold.

“At one time, diabetes was an uninsurable condition to have, but we know that, with years and years of understanding the condition, it’s easier to provide protection,” says Baldwin. He says that life insurance offered by AARP to LGBT seniors is one example of new benefits New York Life provides.

“As a company, we want to make sure that we stay on the forefront of what our clients are needing. And since we work in the [LGBT and HIV-impacted]

community as much as we have been, we see this as an opportunity to educate people as to what might be available.”

As an HIV and AIDS activist for 20 years, Baldwin, who has been HIVpositive for 12 years, has been on the front lines of the fights for both survival and systemic change. He sees the next natural step in this battle as supporting financial health, which will not only pay for cost of living and medical expenses in the long term as well as retirement, but also provide an individual with legacy after death. Conde, the LGBT marketing director for New York Life and a collaborator with Baldwin on the “Positive Planning” program, also cites legacy and community as key components of the initiative.

“When I lost my family to coming out as a gay man, I didn’t lose a family per se, because I gained the LGBT family,” he says. “We’re trying to leave that same legacy to our LGBT family. I know so many individuals who are suffering with HIV, but know that they want to leave their legacy to help other people who are suffering with the disease—people they don’t even know. Planning has always been about finding the right financial tools and processes to do two things: protect your assets and leave a legacy. ” Conde and Baldwin are working with the U.S. government and various nonprofits to ensure that the “Positive Planning” program can provide the greatest amount of protection to the highest numbers of HIV-positive people. In that effort, New York Life reached out to LGBT activists and HIV and AIDS organizations, including California state senator Mark Leno’s staff, activist Cleve Jones, Neil Giuliano of the San Francisco AIDS Foundation, and regional LGBT and HIV groups.

Understanding the resources available in the local community is essential to New York Life’s outreach program, says Conde, and information about such resources is part of the training received by agents. But ultimately, the path to long-term financial health begins with the individual.

“Individually, it all starts with having that financial conversation with yourself,” Conde says. “If you’re in a relationship, you’ll want to have it with your partner. If you need help, seek out a more knowledgeable person, be it a financial [representative] or an attorney, or a service that’s local.”

And how will he know if “Positive Planning” is a success?

“Success comes with a greater knowledge of the fact that we, as a community, are changing,” Baldwin says. “This big dark cloud that has been over the community the past 30-plus years is starting to move again. What used to be considered a terminal condition is now a chronic condition, a condition that one can live with, a condition that one has to prepare for.… This is a condition that you may live with all your life, but your life may be as long, as fruitful, and as wonderful as anybody else’s. But you have to plan for that.”

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Buzzworthy

Coffee, Tea, or Tolerance?

An LGBT youth center that offers free HIV testing is making a difference for young people in conservative Pocatello, Idaho

By David Artavia

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n the small city of Pocatello,

Idaho, there is a place where LGBT teenagers are encouraged to be themselves. In this town with a large Mormon population, one man is attempting the seemingly impossible— to change the hearts of his community.

Tom Nestor, founder of All Under One Roof, has become a mentor to the young people of the town. In the back of the coffee shop they own, he and his partner, Kevin Lish, have built a center where all LGBT youth in the community can have a place to be free and have an open dialogue about HIV. “This being the religious area it is, we don’t talk sexual education or testing in any of the high schools,” Nestor explains.

“So we built a room. There’s a nurse that comes down and does HIV testing at any major function that we’re doing. The people can walk in and have free testing.”

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Since its founding in January 2012, partly in response to the suicide of a local youth who had been bullied, All Under One Roof has been a major force behind the slow but sure progress for LGBT people in eastern Idaho. Evidence of that progress and its pace: In June the Pocatello City Council adopted an ordinance banning discrimination based on sexual orientation or gender identity, but only after months of debate and the defeat of an earlier version of the measure in April.

Not that all is rosy in the city; in February two gay men were brutally beaten while walking home from Pocatello’s only gay bar, an attack that some citizens believe was motivated by antigay bias.

Nestor is dedicated to making life safer for LGBT young people in this city of about 55,000. “I think it’s really rough [for the kids],” says Nestor. “I think the Internet makes it a lot easier for them, because they can go online and do research, or meet people—which I think is very dangerous.”

Part of the effort to keep youth safe involves educating them about HIV. One of All Under One Roof’s board members is pharmacist and Idaho State University professor Dave Hachey, who oversees the area’s HIV clinic. “He is a large part of HIV prevention here in Pocatello,” Nestor says.

Educating LGBT youth about HIV, however, is just one thread in the giant quilt that is All Under One Roof. Besides giving them a place of refuge and an education on HIV, Nestor encourages LGBT young people to get involved in their community, to show everyone they are no different from straight residents.

But despite All Under One Roof’s myriad accomplishments, Nestor doesn’t think he’s a hero. “My partner and I had our [coffee shop] that we could donate,” Nestor explains. “We just decided that if we could prevent one young person from committing suicide, it would be worth every moment we put into it.”

Can This Ring Prevent HIV? Yes, but don’t toss your condoms just yet, ladies

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cientists and doctors from the University of Utah and Northwestern University have developed an intravaginal ring to protect against HIV transmission and are growing increasingly confident it can prevent HIV infection in women.

The small device, when inserted for about a month, successfully delivered a precise amount of the antiretroviral medicine tenofovir disoproxil fumarate, to monkeys in testing.

The ring’s distinctive polymer construction allows it to swell in the presence of fluid, delivering up to 1,000 times more of the drug than current intravaginal devices. The ring offers a sustained delivery method, unlike other methods that requiring daily ingestion of pills or application of topical gel prior to sex, and has been shown to block HIV. The device will soon be evaluated in human trials, where 60 women will test the product. But don’t toss your condoms just yet, says researcher Patrick F. Kiser, Ph.D (pictured above). He says “moving the ring to the market will take several years.” —Michael Regula

Text your five-digit zip code to “Know-It” (5669-48) and you’ll receive a text message with the address of an HIV testing site near you. AIDS.gov

Extraordinary Vision Actor Eduardo Bar navigates both life and Hollywood with an admirable and unique perspective

opposite page: photos.com (map); northwestern universit y (ring); this page: Boo jarchow

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By Michael Regula

hile fortune and fame can seem blinding in unforgiving Tinseltown, neither attraction has misguided this most uncommon man from Buenos Aires. Perhaps it’s because he’s already blind. Eduardo Bar doesn’t consider himself disabled; he considers himself lucky. Then again, words don’t mean much to this man, who sees most labels as just another means to stereotype people we hardly know. But that’s precisely why it’s worth getting to know this man, whose red hair masks his Latin blood in much the same way his outstretched smile hides his daily struggle.

It’s been nearly 20 years since Bar hopped a plane to Los Angeles, embarking on a journey that’s less about where he’s settled, and more about the ground he’s covered. And while it’s not uncommon for kids in Bar’s native Argentina to chase their dreams, not many chase them 6,000 miles away.

As a self-taught adolescent actor, Bar honed his craft alone in his small childhood bedroom, playing out scenes from his favorite movies: pretty much anything starring

his beloved Shirley McLaine. And though he practiced alone where no one could see, he was secretly hoping that someday many would. Starting with the small stage, then moving to soap operas, then to stadiums, he worked his way through South America until finally landing at Los Angeles International Airport, pockets still weighted with childhood dreams.

In 1997, Bar went for a hair restoration appointment, only for the doctor to come back with the news that he was HIVpositive. He had already figured as much but didn’t want to deal with the reality of change—a pill he would soon swallow both figuratively and literally.

“I’m an alien. I didn’t want to be kicked out,” says Bar. “I didn’t want to lose my job. I didn’t want to lose my insurance. I didn’t know. I was totally uneducated and I was terrified.”

And so Bar did nothing with his new diagnosis. By the time he finally did see a specialist in July of 1997, his T-cell count was just 15.

A normal T-cell count is closer to 1,000.

By October of that year, Bar had contracted

bacterial meningitis, causing an inflammation in the protective membranes covering the brain. If not treated promptly, meningitis can be fatal. Bar cheated that dire prediction at first, and he did not know how seriously ill he was until he was rushed to the hospital. And though he staved off death, within days the swelling in his brain had placed such great pressure on his optic nerves that he quickly lost nearly all his vision.

But in losing his sight, Bar was able to find something else. “To be honest, I kind of found spirituality in all of the journey I’ve been going through,” says Bar. “And I realized that everything we go through is just an excuse for spirituality. I don’t regret a second of it. [Going blind] was painful, but it made me who I am today, and I’m very happy of who I became—who I’m becoming—because it’s not finished.”

When he was strong enough, Bar started working on independent short films and continued to perform regularly at the Braille Institute and at private parties— which he does to this day. After landing auditions for both blind and sighted characters, he laughs at the absurdity of having more luck with the latter.

He also laughs at the idea that he’s disabled. He sees himself as just a person taking on the challenges that fall in front of him, unaware that he’s humbly exceeding all expectations but his own.

“I call myself crippled,” he says with a laugh. “To me, words are just silly. To me it’s irrelevant, really. I don’t consider myself— how can I put it—you can call me ‘faggot,’ I don’t care. It’s not about the words; it’s who I am. And I’m more than just blind. I’m more than just gay. I’m more than HIV-positive.

To me, HIV is something written on paper.”

Soon Bar will be seen alongside American Horror Story’s Jamie Brewer in My Next Breath, a documentary that highlights David Zimmerman’s award-winning Meet the Biz workshops, which are aimed at making diversity in Hollywood commonplace.

For a man lacking most of his sight, Bar has a remarkable way of seeing the world around him. And that’s what makes this man anything but normal. It’s certainly not the accent, nor the hair, not the virus, nor the cane. What makes this man incredible is his inability to observe the world that the rest of us do, while somehow seeing what most of us don’t.

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What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete single-tablet regimen and should not be used with other HIV-1 medicines.

STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. 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.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about STRIBILD? STRIBILD 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 STRIBILD 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 STRIBILD, your hepatitis may suddenly get worse.

Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health.

STRIBILD is not approved for the treatment of HBV. Who should not take STRIBILD? Do not take STRIBILD if you: t Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort. t For a list of brand names for these medicines, please see the Brief Summary on the following pages. t Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®).

What are the other possible side effects of STRIBILD? Serious side effects of STRIBILD may also include: t New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD. 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 STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking STRIBILD? t All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection. t All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD 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 STRIBILD without first talking with your healthcare provider. t If you take hormone-based birth control (pills, patches, rings, shots, etc). t If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. t If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. 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 STRIBILD can pass into breast milk, and it is not known if this can harm the baby.

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.

STRIBILD is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD does not cure HIV-1 or AIDS.

I started my personal revolution Talk to your healthcare provider about starting treatment.

STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if it’s right for you.

Patient Information STRIBILDTM (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets #SJFG TVNNBSZ PG GVMM 1SFTDSJCJOH *OGPSNBUJPO 'PS NPSF JOGPSNBUJPO QMFBTF TFF UIF GVMM 1SFTDSJCJOH *OGPSNBUJPO JODMVEJOH 1BUJFOU *OGPSNBUJPO What is STRIBILD? t STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. 453*#*-% JT B DPNQMFUF SFHJNFO BOE TIPVME OPU CF VTFE XJUI PUIFS )*7 NFEJDJOFT t STRIBILD does not cure HIV-1 or AIDS. :PV NVTU TUBZ PO DPOUJOVPVT )*7 UIFSBQZ UP DPOUSPM )*7 JOGFDUJPO BOE EFDSFBTF )*7 SFMBUFE JMMOFTTFT t Ask your healthcare provider about how to prevent passing HIV-1 to others. %P OPU TIBSF PS SFVTF OFFEMFT JOKFDUJPO FRVJQNFOU PS QFSTPOBM JUFNT UIBU DBO IBWF CMPPE PS CPEZ þ VJET PO UIFN %P OPU IBWF TFY XJUIPVU QSPUFDUJPO "MXBZT QSBDUJDF TBGFS TFY CZ VTJOH B MBUFY PS QPMZVSFUIBOF DPOEPN UP MPXFS UIF DIBODF PG TFYVBM DPOUBDU XJUI TFNFO WBHJOBM TFDSFUJPOT PS CMPPE

t %P OPU TUPQ UBLJOH 453*#*-% XJUIPVU ý STU UBMLJOH UP ZPVS IFBMUIDBSF QSPWJEFS t *G ZPV TUPQ UBLJOH 453*#*-% ZPVS IFBMUIDBSF QSPWJEFS XJMM OFFE UP DIFDL ZPVS IFBMUI PGUFO BOE EP CMPPE UFTUT SFHVMBSMZ GPS TFWFSBM NPOUIT UP DIFDL ZPVS )#7 JOGFDUJPO 5FMM ZPVS IFBMUIDBSF QSPWJEFS BCPVU BOZ OFX PS VOVTVBM TZNQUPNT ZPV NBZ IBWF BGUFS ZPV TUPQ UBLJOH 453*#*-% Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: t BEFGPWJS )FQTFSB®

t BMGV[PTJO IZESPDIMPSJEF 6SPYBUSBM®

t DJTBQSJEF 1SPQVMTJE® 1SPQVMTJE 2VJDLTPMW®

t FSHPU DPOUBJOJOH NFEJDJOFT JODMVEJOH EJIZESPFSHPUBNJOF NFTZMBUF % ) & ® .JHSBOBM® FSHPUBNJOF UBSUSBUF $BGFSHPU® .JHFSHPU® &SHPTUBU® .FEJIBMFS &SHPUBNJOF® 8JHSBJOF® 8JHSFUUFT® BOE NFUIZMFSHPOPWJOF NBMFBUF &SHPUSBUF® .FUIFSHJOF®

t MPWBTUBUJO "EWJDPS® "MUPQSFW® .FWBDPS®

t PSBM NJEB[PMBN

What is the most important information I should know about STRIBILD?

t QJNP[JEF 0SBQ®

STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). -BDUJD BDJEPTJT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% PS TJNJMBS OVDMFPTJEF BOBMPHT NFEJDJOFT -BDUJD BDJEPTJT JT B TFSJPVT NFEJDBM FNFSHFODZ UIBU DBO MFBE UP EFBUI -BDUJD BDJEPTJT DBO CF IBSE UP JEFOUJGZ FBSMZ CFDBVTF UIF TZNQUPNT DPVME TFFN MJLF TZNQUPNT PG PUIFS IFBMUI QSPCMFNT Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: t GFFM WFSZ XFBL PS UJSFE t IBWF VOVTVBM OPU OPSNBM NVTDMF QBJO t IBWF USPVCMF CSFBUIJOH t IBWF TUPNBDI QBJO XJUI OBVTFB PS WPNJUJOH t GFFM DPME FTQFDJBMMZ JO ZPVS BSNT BOE MFHT t GFFM EJ[[Z PS MJHIUIFBEFE t IBWF B GBTU PS JSSFHVMBS IFBSUCFBU 2. Severe liver problems. 4FWFSF MJWFS QSPCMFNT DBO IBQQFO JO QFPQMF XIP UBLF 453*#*-% *O TPNF DBTFT UIFTF MJWFS QSPCMFNT DBO MFBE UP EFBUI :PVS MJWFS NBZ CFDPNF MBSHF IFQBUPNFHBMZ BOE ZPV NBZ EFWFMPQ GBU JO ZPVS MJWFS TUFBUPTJT Call your healthcare provider right away if you get any of the following symptoms of liver problems: t ZPVS TLJO PS UIF XIJUF QBSU PG ZPVS FZFT UVSOT ZFMMPX KBVOEJDF

t EBSL iUFB DPMPSFEw VSJOF t MJHIU DPMPSFE CPXFM NPWFNFOUT TUPPMT

t MPTT PG BQQFUJUF GPS TFWFSBM EBZT PS MPOHFS t OBVTFB t TUPNBDI QBJO You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time.

3. Worsening of Hepatitis B infection. *G ZPV IBWF IFQBUJUJT # WJSVT )#7 JOGFDUJPO BOE UBLF 453*#*-% ZPVS )#7 NBZ HFU XPSTF þ BSF VQ JG ZPV TUPQ UBLJOH 453*#*-% " iþ BSF VQw JT XIFO ZPVS )#7 JOGFDUJPO TVEEFOMZ SFUVSOT JO B XPSTF XBZ UIBO CFGPSF t %P OPU SVO PVU PG 453*#*-% 3Fý MM ZPVS QSFTDSJQUJPO PS UBML UP ZPVS IFBMUIDBSF QSPWJEFS CFGPSF ZPVS 453*#*-% JT BMM HPOF

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t UIF IFSC 4U +PIO T XPSU Do not take STRIBILD if you also take any other HIV-1 medicines, including: t 0UIFS NFEJDJOFT UIBU DPOUBJO UFOPGPWJS "USJQMB® $PNQMFSB® 7JSFBE® 5SVWBEB®

t 0UIFS NFEJDJOFT UIBU DPOUBJO FNUSJDJUBCJOF MBNJWVEJOF PS SJUPOBWJS $PNCJWJS® &NUSJWB® &QJWJS® PS &QJWJS )#7® &Q[JDPN® ,BMFUSB® /PSWJS® 5SJ[JWJS®

STRIBILD is not for use in people who are less than 18 years old.

What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: t 4FF i8IBU JT UIF NPTU JNQPSUBOU JOGPSNBUJPO * TIPVME LOPX about STRIBILD?” t /FX PS XPSTF LJEOFZ QSPCMFNT JODMVEJOH LJEOFZ GBJMVSF :PVS IFBMUIDBSF QSPWJEFS TIPVME EP CMPPE BOE VSJOF UFTUT UP DIFDL ZPVS LJEOFZT CFGPSF ZPV TUBSU BOE XIJMF ZPV BSF UBLJOH 453*#*-% :PVS IFBMUIDBSF QSPWJEFS NBZ UFMM ZPV UP TUPQ UBLJOH 453*#*-% JG ZPV EFWFMPQ OFX PS XPSTF LJEOFZ QSPCMFNT t #POF QSPCMFNT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% #POF QSPCMFNT JODMVEF CPOF QBJO TPGUFOJOH PS UIJOOJOH XIJDI NBZ MFBE UP GSBDUVSFT :PVS IFBMUIDBSF QSPWJEFS NBZ OFFE UP EP UFTUT UP DIFDL ZPVS CPOFT t Changes in body fat DBO IBQQFO JO QFPQMF XIP UBLF )*7 NFEJDJOF 5IFTF DIBOHFT NBZ JODMVEF JODSFBTFE BNPVOU PG GBU JO UIF VQQFS CBDL BOE OFDL iCVGGBMP IVNQw CSFBTU BOE BSPVOE UIF NJEEMF PG ZPVS CPEZ USVOL -PTT PG GBU GSPN UIF MFHT BSNT BOE GBDF NBZ BMTP IBQQFO 5IF FYBDU DBVTF BOE MPOH UFSN IFBMUI FGGFDUT PG UIFTF DPOEJUJPOT BSF OPU LOPXO t Changes in your immune system *NNVOF 3FDPOTUJUVUJPO 4ZOESPNF DBO IBQQFO XIFO ZPV TUBSU UBLJOH )*7 NFEJDJOFT :PVS JNNVOF TZTUFN NBZ HFU TUSPOHFS BOE CFHJO UP ý HIU JOGFDUJPOT UIBU IBWF CFFO IJEEFO JO ZPVS CPEZ GPS B MPOH UJNF 5FMM ZPVS IFBMUIDBSF QSPWJEFS SJHIU BXBZ JG ZPV TUBSU IBWJOH BOZ OFX TZNQUPNT BGUFS TUBSUJOH ZPVS )*7 NFEJDJOF

The most common side effects of STRIBILD include: t /BVTFB t %JBSSIFB Tell your healthcare provider if you have any side effect that bothers you or that does not go away. t 5IFTF BSF OPU BMM UIF QPTTJCMF TJEF FGGFDUT PG 453*#*-% 'PS NPSF JOGPSNBUJPO BTL ZPVS IFBMUIDBSF QSPWJEFS t $BMM ZPVS IFBMUIDBSF QSPWJEFS GPS NFEJDBM BEWJDF BCPVU TJEF FGGFDUT :PV NBZ SFQPSU TJEF FGGFDUT UP '%" BU '%"

EJHPYJO -BOPYJO®

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þ FDBJOJEF 5BNCPDPS®

þ VSB[FQBN þ VUJDBTPOF 'MPWFOU® 'MPOBTF® 'MPWFOU® %JTLVT 'MPWFOU® )'" 7FSBNZTU®

JUSBDPOB[PMF 4QPSBOPY®

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MJEPDBJOF 9ZMPDBJOF®

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IFQBUJUJT # JOGFDUJPO QFSQIFOB[JOF t *G ZPV BSF QSFHOBOU PS QMBO UP CFDPNF QSFHOBOU *U JT OPU LOPXO JG ® 453*#*-% DBO IBSN ZPVS VOCPSO CBCZ 5FMM ZPVS IFBMUIDBSF QSPWJEFS QIFOPCBSCJUBM -VNJOBM

JG ZPV CFDPNF QSFHOBOU XIJMF UBLJOH 453*#*-% QIFOZUPJO %JMBOUJO® 1IFOZUFL®

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t *G ZPV BSF CSFBTUGFFEJOH OVSTJOH PS QMBO UP CSFBTUGFFE %P OPU SJTQFSJEPOF 3JTQFSEBM® 3JTQFSEBM $POTUB®

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QBTTJOH )*7 UP ZPVS CBCZ TJMEFOBý M 7JBHSB® UBEBMBý M $JBMJT® PS WBSEFOBý M -FWJUSB® 5XP PG UIF NFEJDJOFT JO 453*#*-% DBO QBTT UP ZPVS CBCZ JO ZPVS 4UBYZO® GPS UIF USFBUNFOU PG FSFDUJMF EZTGVODUJPO &% *G ZPV HFU CSFBTU NJML *U JT OPU LOPXO JG UIF PUIFS NFEJDJOFT JO 453*#*-% DBO EJ[[Z PS GBJOU MPX CMPPE QSFTTVSF IBWF WJTJPO DIBOHFT PS IBWF QBTT JOUP ZPVS CSFBTU NJML BO FSFDUJPO UIBU MBTU MPOHFS UIBO IPVST DBMM ZPVS IFBMUIDBSF 5BML XJUI ZPVS IFBMUIDBSF QSPWJEFS BCPVU UIF CFTU XBZ UP GFFE QSPWJEFS PS HFU NFEJDBM IFMQ SJHIU BXBZ ZPVS CBCZ UBEBMBý M "EDJSDB® GPS UIF USFBUNFOU PG QVMNPOBSZ BSUFSJBM Tell your healthcare provider about all the medicines you take, IZQFSUFOTJPO including prescription and nonprescription medicines, vitamins, UFMJUISPNZDJO ,FUFL®

and herbal supplements: UIJPSJEB[JOF t 453*#*-% NBZ BGGFDU UIF XBZ PUIFS NFEJDJOFT XPSL BOE PUIFS WPSJDPOB[PMF 7GFOE®

NFEJDJOFT NBZ BGGFDU IPX 453*#*-% XPSLT XBSGBSJO $PVNBEJO® +BOUPWFO®

t #F TVSF UP UFMM ZPVS IFBMUIDBSF QSPWJEFS JG ZPV UBLF BOZ PG UIF GPMMPXJOH NFEJDJOFT [PMQJEFN "NCJFO® &EMVMBS® *OUFSNF[[P® ;PMQJNJTU®

)PSNPOF CBTFE CJSUI DPOUSPM QJMMT QBUDIFT SJOHT TIPUT FUD

Know the medicines you take. ,FFQ B MJTU PG BMM ZPVS NFEJDJOFT BOE TIPX JU UP ZPVS IFBMUIDBSF QSPWJEFS BOE QIBSNBDJTU XIFO ZPV HFU B "OUBDJE NFEJDJOFT UIBU DPOUBJOT BMVNJOVN NBHOFTJVN OFX NFEJDJOF %P OPU TUBSU BOZ OFX NFEJDJOFT XIJMF ZPV BSF UBLJOH IZESPYJEF PS DBMDJVN DBSCPOBUF 5BLF BOUBDJET BU MFBTU IPVST 453*#*-% XJUIPVU ý STU UBMLJOH XJUI ZPVS IFBMUIDBSF QSPWJEFS CFGPSF PS BGUFS ZPV UBLF 453*#*-% .FEJDJOFT UP USFBU EFQSFTTJPO PSHBO USBOTQMBOU SFKFDUJPO PS IJHI Keep STRIBILD and all medicines out of reach of children.

CMPPE QSFTTVSF 5IJT #SJFG 4VNNBSZ TVNNBSJ[FT UIF NPTU JNQPSUBOU JOGPSNBUJPO BNJPEBSPOF $PSEBSPOF® 1BDFSPOF®

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Treatment chronicles

Everything You Need to Know About PrEP

C

The 411 on the drug regimen that HIV-negative people can take to prevent infection

onversation around HIV prevention breakthroughs in pill form has permeated brunch tables, newspapers, and doctors’ offices.

But even though pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been approved as methods to prevent the transmission of HIV through sexual intercourse or intravenous drug use, some of those who could benefit from PrEP and PEP are still not quite sure how they work. Here are answers to some of the most frequently asked questions about PrEP.

What is PrEP? PrEP is administration of an HIV medication, Truvada (the only one approved for this use to date), to people who are HIV-negative but at high risk of getting the virus.

The daily, one-pill regimen has been proved to reduce the risk of HIV transmission, but it must be taken consistently. The Food and Drug Administration approved the use of Truvada, manufactured by Gilead, for prevention of HIV transmission in 2012. The drug has been found to prevent HIV transmission among both same-sex and opposite-sex intimate partners. A study released last June found that PrEP also works to prevent HIV transmission for drug users who use contaminated needles.

Can I take it only on days I have sex? Do I have to take it forever?

No. Some studies indicate that a certain percentage of users do not take PrEP as prescribed, which can lead to HIV infection. The bottom line is that the pill must be taken daily, like birth control, as a preventive measure. And like birth control, which women sometimes take for years then, go off of for years, you can stop taking PrEP when your risk factors change—for example, you aren’t having sex regularly anymore.

Who should start a PrEP regimen?

PrEP should be prescribed only to HIV-negative people, which is why people are tested before beginning a regimen. Men who frequently have sex with men without condoms may want to consider PrEP, as well as HIV-negative people with positive partners. HIV-negative pregnant women may also choose to use PrEP if their partner is HIV-positive. Intravenous drug users are also good candidates for PrEP, which can be prescribed only by a doctor or other health care professional.

Is it OK to use PrEP as the only method of HIV prevention?

Doctors still caution that PrEP, even with consistent daily use, should be accompanied by consistent use of condoms or, for drug users, sterile needles. But let’s face it, if condom use was consistent, there would be no need for PrEP. This is just a reminder that while it’s very useful in preventing HIV transmission, it’s still not 100 percent effective (just like birth control).

What are the side effects of PrEP? During clinical trials of PrEP, some people said they experienced diarrhea, nausea, abdominal pain, headache, and weight loss. A small segment of users experienced kidney problems. —Michelle Garcia

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• j a n u a r y/ f e b r u a r y 2 0 1 4

Our Morning-After Pill It’s been in the news lately, but few know how PEP really works

what is pep?

Ideally, any adult who is HIV-negative would use PEP after having a risky sexual or drug encounter, or an assault or rape, in which he or she may have been exposed to HIV. Health care professionals also use PEP if they’ve come into contact with the virus. The treatment regimen must begin within 72 hours of exposure (that’s three days), before the virus has time to grow within a person’s system.

Essentially, the person exposed to HIV would have to take two or three antiretroviral medications for 28 continuous days. The drugs prescribed would vary based on how the person was exposed to HIV. After going through the PEP regimen, the user would be asked to return for more HIV testing about a month and a half later, then three months and six months later. Like PrEP, it’s not 100 percent effective in preventing HIV, but it can greatly reduce the possibility of infection if taken quickly and consistently after a person has been exposed to the virus.

How can someone get PEP when they need it?

Once you know you need PEP, immediately contact your most convenient hospital or health clinic, or your doctor. The first visit will require a medical evaluation, a rapid HIV test, blood testing, risk-reduction counseling, and testing for other sexually transmitted infections. From there, you would be prescribed a treatment regimen and required to follow up with a doctor or other health care provider a few more times. Because of a recent incident in New York in which an emergency room patient wasn’t initially given PEP, there are fears that it’s not available, but at this point most hospitals and clinics do have access to the drugs.

What are the side effects of PEP? PEP’s most common side effect—nausea—is not life-threatening, but it has been known to be severe, which makes it difficult for some people to finish the program.

If I’m on PEP, does that mean I can ditch the condoms for 28 days?

No. And if you’re taking PEP because of a risky sexual encounter that was consensual, it might be time to think about changing your behavior patterns to lower your risks or start taking PrEP.

People With HIV Want to Talk to Their Doctors About…

74% 71% 51% Their meds

HIV’s impact on their lives

HIV’s physical impact on their bodies

Clinic Hopping Isn’t Good for Your Health

T

New numbers back up what doctors have long told us here’s new evidence

p hoto s .c om (2)

that having a consistent relationship with only one HIV care provider is good for your health, according to a study out of Philadelphia. The study, which followed 13,000 patients from 2008 to 2010, found that those who received care at multiple clinics had worse outcomes— they were less likely to receive antiretroviral drugs and to achieve viral suppression. Multiple providers treated about 1,000 of the subjects; only 69 percent of them received antiretroviral meds and 68 percent achieved a suppressed viral load, compared with 83 percent and 89 percent, respectively, for those who kept going to the same clinic.

Those who visited multiple clinics

Just a Click Away

tended to be younger and were more likely to be black, female, uninsured or on public insurance, and in their first year of care than those who only went to one clinic, researchers reported.

“It’s about retention in care but also continuity, two related but distinct processes,” says senior author Kathleen A. Brady, MD, an infectious disease physician at Pennsylvania Hospital and medical director– medical epidemiologist for the Philadelphia Department of Public Health’s AIDS Activities Coordinating Office.

The study, published in the journal AIDS and Behavior, used data from the health department on patients at the 26 Philadelphia HIV clinics that receive federal funding through the Ryan White CARE Act. It was conducted by Penn Medicine, which

26% 15%

HIV’s impact on their sex lives

HIV’s impact on their relationships with their loved ones or family online survey for merck

& co. by global research firm kelson, 2013

includes the University of Pennsylvania’s Perelman School of Medicine, several hospitals, and other institutions.

There’s no definitive word in this study on why some HIV-positive folks see multiple care providers, though researchers suggest that poverty, stigma, the presence of other health problems, and limited access play a role.

“I’m hopeful that by providing this data to HIV clinicians,” says Brady, “we can get a better understanding of why patients see multiple providers and make improvements to the system.” —Trudy Ring

When you’re researching the cost of your medications on NeedyMeds.org, you’ll now be able to find out how Consumer Reports rates those meds. NeedyMeds.org, which provides information on programs that help pay for drugs and other health care needs, will now carry the venerable consumer magazine’s latest recommendations on the safest, most effective, and least expensive prescription and over-thecounter medications. One click will get you the Consumer Reports Best Buy Drugs report on any brand-name drug on the site that has a “Drug Info” icon. —T.R.

j a n u a r y/ f e b r u a r y 2 0 1 4 •

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ask & t e l l

Well,Hello

Ross!

TV’s funniest new talk show host wants you to know that HIV tests don’t have to be scary

bradford rogne photography

By NEAL BROVERMAN

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oss mathews has come a long way from being Jay Leno’s intern. It’s been more than a decade since Mathews first appeared on The Tonight Show, endearing himself to late night audiences with sketches highlighting his good nature, quick wit, and general likability.

Mathews soon landed more TV gigs—interviewing A-listers at the Oscars, guest-hosting The View, and joining Chelsea Handler’s panel of snarky commenters on her E! series, Chelsea Lately. Mathews has been on a roll this year, releasing the best-selling memoir Man Up! Tales of My Delusional Self-Confidence and landing his own E! talk show, Hello Ross. Now he’s working with the maker of OraQuick, the first in-home rapid HIV test, on the “Life as We Know It” campaign to get gay and bi men talking and testing. We spoke with Mathews about why this cause is important to him and how OraQuick helped change his thoughts on HIV. How did you get involved with the OraQuick campaign?

With the new show and being on Chelsea so often, I get to talk to millions of people every week, but my biggest connection is to the LGBT community. I have a direct connection with them because I, of course, am gay. I travel the country, go to different pride events, speak all the time to the community. But when you look at the rates of HIV, 63 percent of the new cases are gay men, and I don’t understand that because there’s so much marketing to us about how to have safe sex and how important it is, but still those numbers are there.

When OraQuick came to me, they explained that people are afraid of the [standard HIV] test. It’s a two-pronged fear: One, people are scared of the results, and two, the test itself and the waiting period between the test and getting the answer and having to go to the doctor. What I wasn’t aware of is the new technology. I didn’t know OraQuick existed, which is available at every pharmacy; you can order it online, it comes to your house. You just swab your mouth, there are no needles, no blood, and in 20 minutes you know your status.

That changes everything because you can meet someone and before you have sex you can find out each other’s status.

How has the perception of HIV changed since when you were first coming out?

I remember at the end of elementary school and the beginning of junior high, they really started teaching AIDS awareness, and they were telling you if you get it, you’re dead. Thank God so much has changed and people are living long lives with HIV. But what’s scary and really unacceptable is that that number [of new infections] is going up in gay men even though we have all these tools to keep us safer than ever.

How do your friends talk about HIV? Their awareness of HIV is the same as everyone else’s. When my partner and I got together, before we ever had sex we were both tested. We were negative; that was our story. There are

friends of mine who have not been tested in a very long time and who are sexually active. And when I started working with OraQuick, I asked my friends why [they haven’t been tested] and the answer is: “Because it’s scary, I think about it all the time, but I’ve managed to put it out of my mind.”

What more can be done to remind bi and gay men that HIV remains an issue?

I live in Palm Springs [Calif.] part-time, and one thing I love about it is that there’s such a connection to the generation before of gay men who lived through a very different time.

Many of the men in Palm Springs lost their best friends to HIV, and because I hear their stories and I really value that connection, I feel I have a better understanding of how lucky we are that we have technologies available to us. So I feel an obligation to continue that story—that’s part of why I’m doing this, to tell our generation, “Don’t take it for granted.”

We are really fortunate we can take care of ourselves better than we ever have before.

You’re hilarious, but HIV is a serious subject. Do you think OraQuick was trying to make the test less scary by working with someone like you?

I think they thought that people would trust me. I never lie to people, and that’s why I have a talk show, because I have a real relationship with the audience; I tell it like it is whether it’s about pop culture or HIV. When I saw those stats and I saw this product, I thought, This is something I better use my platform to help get out.

Tell me about Hello Ross.

It’s the most fun you’ll have all week. It is really the place for pop culture and people to come together. I think there are so many shows that just tear apart pop culture and talk about how stupid it is. But I love this stuff. And we just got picked up for new episodes until the end of the year. I’m so happy. ◆

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The perfect

storm What’s really behind the high HIV rates for black gay men?

By lucas grindley

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f nothing changes, the federal government estimates that in 30 years, 70 percent of 20-year-old black gay men will have HIV. That jarring statistic was presented by the Centers for Disease Control and Prevention during the 2013 National Gay and Lesbian Task Force conference.

But what is driving that rate of infection—the highest of any demographic group—has so far puzzled researchers.

Studies find that black gay men aren’t any more likely to engage in risky sexual behavior than their white peers. So simply ignoring condoms doesn’t explain it. The same goes for other risk factors.

Black gay men are actually less likely to use drugs before or during sex, for example.

The White House’s top researcher on this topic, Greg Millett, senior policy adviser in the Office of National AIDS Policy, analyzed seven studies from Canada, 13 from the U.K., and 174 from the U.S., and found that black men who have sex with men (MSM) were no more likely than other gay or bisexual men to have unprotected sex. And despite societal problems, such as the fact that black men face higher rates of unemployment than other races or are less likely to graduate from high school, the analysis points out that black gay men are actually 40 percent more likely to do simple protective things like wear a condom during sex. The results of the analysis were published in The Lancet in 2012 and presented at that year’s International AIDS Conference.

Then in 2013, a Centers for Disease Control and Prevention analysis of four studies noted that black MSM had fewer unprotected sexual encounters than white MSM—an average of three for receptive sex and six for insertive over six months for black men, compared with 11 and 12, respectively, for whites.

None of the usual reasons for high infection rates seem to apply to black men’s high HIV rates. So a recent study from researchers at Northwestern University looked carefully at a theory that might explain what’s happening.

The Northwestern research team asked 143 gay and bisexual men, all single or nonmonogamous, to keep a diary of all their sexual activity for 12 weeks. The men tracked what they had done and whether it was with someone of the same race. Like previous research, it indicated black gay and bisexual men were no more likely to have unprotected sex than others. But they were 11 times more likely to have sex with black men.

Researchers have long wondered whether black gay men are dating within a smaller social network. This study seems to confirm that idea. Among black MSM, 45 percent of sexual encounters were with other black men. By comparison, Latino MSM had their largest percentage of encounters with white men.

Although white men were the most likely to have sex with those of the same race, accounting for 56.7 percent of encounters, the study points out the obvious—that the pool of black gay men is much smaller than that of white gay men. A 2012 study by the Williams Institute and pollster Gallup found that African-Americans and other minority groups were more likely to identify as LGBT than white people, but it’s still a smaller pool.

The Northwestern researchers published their findings, “Racial Differences in Same-Race Partnering and the Effects of Sexual Partnership Characteristics on HIV Risk in MSM: A Prospective Sexual Diary Study,” in the Journal of Acquired Immune Deficiency Syndromes in 2013.

Still, if black gay men are no more likely than others to engage in risky sexual behavior, it shouldn’t much matter who they are having sex with. The study’s principal investigator, Michael Newcomb, an assistant professor at Northwestern University’s Feinberg School of Medicine, considers condom use crucial.

“That’s still the best way to protect oneself,” he says, but when your network of sex partners is small and at higher risk to begin with, “your risk of acquiring HIV Continued on page 27

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Dating Continued from page 21

would be higher.” Eventually the risk rate would “overwhelm” protection, Newcomb adds, because everyone in the network isn’t perfect about condom use and other forms of protection.

The researchers concluded that a single case of HIV in a small social network “would allow HIV to penetrate the networks of black MSM,” and it would travel through the network, infecting these men “more efficiently” than it would white men, for example.

including familiarity with partners, as indicators of HIV risk.” That would be “a poor indicator when making decisions about condom use,” researchers warned, because “the majority of new HIV infections occur in the context of these types of main, serious, or repeated partners.”

The study doesn’t address why black gay men have a smaller network of sexual partners in the first place.

Likely there are many reasons. But

expand the sexual network of young black gay men, Newcomb says.

The Northwestern study considered the tightly knit network as just one of a series of factors at play. And the analysis presented by the White House’s Millett leaned toward the likelihood that society’s structural inequities could account for the disparity in infection rates. HIV-positive black gay men are three and a half times more likely to make less than $20,000

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Research showed that black gay and bisexual men were no more likely to have unprotected sex than others. But they were 11 times more likely to have sex with black men.

Although their study didn’t address this possible explanation, the researchers wondered if young black men who got into monogamous relationships were abandoning condoms.

Young black men, for example, are more likely to have unprotected sex with older partners, which is statistically more risky than unprotected sex with younger partners.

“It may be that black MSM are aware that they are at increased risk for acquiring HIV,” they wrote. “Subsequently, they may be using certain sexual partnership characteristics,

there is one preventative measure researchers agree upon.

“I think what this and other studies indicate, on an individual level, [is that] the safest way to protect oneself is to use condoms constantly during anal sex.

But we know that approach alone isn’t solving the problem,” says Newcomb.

“So there are more structural and societal things that need to happen.”

Working to reduce poverty and the infrastructure problems that come with it for neighborhoods, reducing racism, and specifically fighting racism among LGBT people would likely

in annual income, are 50 percent less likely to have access to health insurance, and are less likely to visit health care providers than are white gay men.

The Lancet’s analysis points out that young black gay men also have a 65 percent greater chance of becoming sexually active early in life than their white peers, and they have an 82 percent greater risk of childhood sexual abuse. It’s a long list of hurdles for black gay and bi men to overcome.

“There are all of these issues that unfortunately come together in a perfect storm,” Millett says. ✜

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A Black Woman’s guide

Dating is tough in general, but being a woman who is HIV-positive presents a whole host of unique questions and issues.

We answer some of your most pressing relationship questions, from dating to marriage to babies By diane anderson-minshall

photos.com

Are there dating sites for HIV-positive women? Yes, there are a handful of dating

sites that are for people with HIV or, in some cases, another sexually transmitted infection, like herpes or hepatitis.

HIVDatingOnline.com, PozMatch.com, and PositiveSingles.com all welcome women who are straight, gay, or bi. Some sites, such as HIVNet.com, began as community sites in the ’90s and grew into dating sites as more members joined; that kind of start offers a sort of friendly, self-policing (no spam!) environment. Plenty of sites specific to other parts of your identity make disclosing your status easy. It’s not uncommon to see profiles that begin with “I am HIV-positive” and go on to list the poster’s

other interests, as they do on the pet-lovers personals site LoveMeLoveMyPets.com, or JDate.com, which is for Jewish singles.

Remember, though, there’s no reason you can’t use Match.com or SheWiredPersonals. com or any other mainstream dating site.

Do I disclose online or wait until I meet the guy (or girl) I’m interested in? This is a

personal choice, really, but many women say that disclosing on a website is an easy way to take the fear of rejection out of meeting new potential dates. It lets you screen out the losers who can’t handle a woman like you.

Am I required to tell my date I’m HIV-positive?

You do need to come out about your status

before you have oral, anal, or vaginal sex, not for their safety as much as yours. According to the Center for HIV Law and Policy, 36 states and two U.S. territories have HIVspecific criminal statutes. Each of those states has reported proceedings in which an HIV-positive person has been arrested and/ or prosecuted for consensual sex, biting, or spitting, and in some states even a hand job can be a risky act if you haven’t told your sexual partner your status. A report from the group documents 80 prosecutions in a recent two-year period, such as that of an HIVpositive Iowa man who had used a condom (he had to register as a sex offender and is not allowed unsupervised contact with young children, including his nieces and nephews)

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and a Georgia woman who was sentenced to eight years in prison for failing to disclose her HIV-positive status, even though two witnesses told jurors that her sexual partner was aware of her diagnosis. Knowing the laws is important, protecting you from prosecution even more so. Disclose first, fool around after. These laws are outdated, prejudicial, and more harmful than protected sex with a person with HIV, but for now you have to protect yourself from them.

When should I tell my date I have HIV? Look,

you don’t have to tell anyone about your HIV status until you’re ready emotionally or are about to engage in behavior that could put someone at risk (such as sex). There’s no one way that works for everyone. Some women like to come out casually between dinner and dessert, while others mark it as a serious conversation to be had after the first date but before things get serious. What is important to remember is that you are not alone: You are one of the nearly 1.2 million Americans living with HIV, according to the latest data available from the U.S. Centers for Disease Control and Prevention. Yes, you have a disability, but living with HIV is like living with any other chronic disease. While you can’t transmit diabetes or fibromyalgia to a sexual partner, there are incredibly effective ways to ensure that potential partners are never at risk of contracting HIV from you, including treatment as prevention and proper condom use. Just remember, there’s no shame in having HIV and being honest with a prospective date about it. If he or she balks, that’s just not the right person for you.

How do I get over my fear of rejection?

Everyone in the dating world is afraid of rejection, whether it’s because we have baggage (kids, exes, trauma), we don’t fit social expectations (of age, size, appearance, cultural background), we’re awkward at socializing (nerdy, shy, introverted), or have one of the myriad of other characteristics that make us unique. Women get judged for what they look like from the moment they’re aware of the world, so insecurity can often be our fallback position, with or without a chronic medical condition. For people with HIV, dating can be intimidating and fear of rejection might keep you from disclosing your status to dates.

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Experts at AIDSInfoNet.org recommend that you remember every situation is different and you don’t have to tell everybody. If you aren’t going to be in a situation where HIV could be transmitted, there’s no need to tell your date, but sooner or later, in any relationship, “it will be important to talk about your HIV status. The longer you wait, the more difficult it gets,” they note. For many folks, like Greater Than AIDS ambassador Marvelyn Brown, having that conversation is easier over the phone early in the relationship. She says that way she hasn’t invested too much energy in the relationship before finding out whether having HIV makes her a no-go for a potential partner. Smart advice.

If we’re both HIV-positive, do we still need to use condoms? This depends on whom you

ask. Some doctors say that different strains of HIV can be passed between two positive people, and this can make existing treatment ineffective. It’s called reinfection, it can up your viral load, and it’s why many experts want you to continue using condoms (plus they also prevent other sexually transmitted infections). But, says Alex Garner, a program coordinator at the National Minority AIDS Council, “So many people are still confused and conflicted by [reinfection info]. If it happens it probably happens in the first couple of years of infection, and after that it’s rare.”

That’s one reason that if your viral load is undetectable in each of you, some doctors now say that you do not need to use condoms, because an undetectable viral load means you cannot pass along HIV—whether your sex partner is positive or not. This is fiercely debated in some circles, so talk with your doctor for her recommendation.

What if the condom breaks? Don’t panic. If it

breaks before ejaculation, have him pull out and put on a new condom. If it breaks after ejaculation, pull out slowly and carefully, then go take a nice soapy shower or bath.

But do not douche or use an enema; both set the stage for infection. If you’re both HIVpositive, you should both see your doctors and talk to them about possible reinfection.

If you’re the only person with HIV, your partner should explain to their doctor that they had unprotected sex with an HIV-positive person. Either way, this info helps your physi-

cian monitor your treatment and, if needed, order tests or medication to prevent further complications. But if this is your spouse, partner, long-term main squeeze, or someone you plan to be in a serious relationship with, it’s time to talk pre-exposure prophylaxis.

What the hell is “pre-exposure prophylaxis”? In a nutshell, “pre-exposure pro-

phylaxis,” or PrEP, is basically the concept of giving an antiretroviral medication to HIV-negative women and men to keep them from contracting HIV. Research has shown anti-HIV drugs can reduce the risk of HIV infection in the negative partners of serodiscordant heterosexual couples and gay male couples. (Rates for female-female couples are so low no research has been done.) Truvada is the only drug so far approved for PreP. It is recommended for partners of HIV-positive people and those at high risk in other ways (sexually active gay men, sex workers, IV drug users). The user takes the medication daily, and it helps prevent them from getting HIV. Meanwhile, you, as the HIV-positive person, can lower your viral load to undetectable levels, and you’re doubly safe. Health experts warn that PrEP should not be the first line of defense against HIV infection, instead recommending regular condom use as well. Some activists and doctors disagree.

We’re engaged! Can I get a marriage license if I have HIV? Yes. Most states have stopped

requiring blood tests for couples getting married. Many states do require that anyone applying for a marriage license be offered an HIV test or information on HIV, but no state requires a premarital HIV test. If you’re going to put a ring on it, you need to tell your future spouse, but you won’t have to tell the government.

How do we handle being a serodiscordant couple? Serodiscordant simply means one

of you has HIV and one of you doesn’t. Some people now call themselves part of a “magnetic couple” as well, which sounds a lot less clinical. There’s very little research on how successfully serodiscordant, or magnetic, couples cope with the complications of HIV. According to TheBody.com, an online HIV Continued on page 51

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Becoming A

mom in six easy steps

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What to expect before, during, and after you’re expecting your own little bundle of joy

By Michelle garcia & diane anderson-minshall

With better medication and keener understanding of the virus, people with HIV who want to be parents are finding ways to make it happen safely. With proper care, you can reduce the risk of transmitting HIV to your baby to less than 1 percent. Here is a road map for moms to-be.

step one: determine how you want to grow your family

If you’re an HIV-positive woman who wants to get pregnant, there are treatment regimens available that make it very unlikely you will pass HIV along to your child. If you have a male partner who is also HIV-positive, a procedure called sperm washing can literally wash the HIV from his sperm, making it safe to then inseminate you. It means utilizing a physician all along the way, which may not sound as romantic as Barry White and a bottle of Pinot Grigio, but it’s the safest and most reliable way to ensure everyone stays healthy while building a family.

Remember, adoption is always an option (even for single women and same-sex couples). While some adoption agencies are known to kick out prospective parents who have HIV, the Americans With Disabilities Act makes it illegal for adoption services to disqualify prospective adopters based solely on an HIV diagnosis. According to AIDS Beacon, agencies “are allowed to reject the applicant if other factors exist that determine the prospective parents are unqualified.” Several adoption providers, such as the Independent Adoption Center of Los Angeles, have placed children with HIV-positive individuals who’ve been rejected by other agencies, so it’s good to talk with several agencies, being open about your status, and find the one that’s the best fit.

For the purposes of this article, we’ll assume you want to have a baby the old-school way, by getting knocked up.

step two: find your doctor right Ladies, you must find and consult with an obstetrician who specializes in HIV care and preconception counseling. General obstetricians often do not have the knowledge to properly care for an HIV-positive woman who is trying to conceive. Likewise, HIV specialists may not have much experience in gynecology or childbirth. Find someone who specializes in both and has worked with antiretroviral therapy to reduce mother-to-child transmission of HIV so you don’t have to spend time educating your doctors when it should be the other way around.

There are many well-known programs like the Johns Hopkins HIV Women’s Health Program, which has an obstetrical care program known as Halo, whose doctors are experienced in the use of HIV medications in pregnancy to treat you and to prevent you from transmitting HIV to your child. Moreover, they are prepared to deal with nursing case management, social services, support groups with other pregnant poz moms, and referrals to medical providers specializing in HIV management in infants after your child is born. Don’t assume that because a program is run out of a prestigious hospital or university that it is out of your reach financially; at Johns Hopkins, for example, no one is turned away for lack of funds.

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step three: conception time

op p o si t e page: p hoto s .c om; t his page: p hoto s.c om (2)

If you have a male partner who is also HIV-positive, you may be tempted to get pregnant the old-fashioned way: through unprotected sex. However, in doing so you risk reinfection or superinfection (where you get a second strain of HIV), even if both of you have a low or undetectable viral load. In either case, you may be reinfected with a more drug-resistant form of the virus.

HIV-positive men may opt for sperm scrubbing. Since HIV occupies the seminal fluid and not the sperm itself, the process essentially separates the sperm from the seminal fluid. The sperm is then deposited in the woman’s body by a physician using artificial insemination during a peak period of fertility.

If you have a husband, boyfriend, or baby daddy who is HIVnegative, you have a couple of options, including pre-exposure prophylaxis, or PrEP, a relatively new strategy in which the antiretroviral medication Truvada is given to the negative partner of an HIV-positive person to prevent transmission of the virus.

There are no conclusive tests that show PrEP’s success rate in preventing infection during conception, however. But a Spanish study published in 2006 found that serodiscordant couples who had unprotected sex only during high-fertility days, were closely monitored by a doctor, and in which the positive partner took highly active antiretroviral treatment without fail and had consistently low viral loads were able to have a baby without transmitting HIV to the child. Talk to your obstetrician about what this means for you.

Also, talk to your doctor about costs. Pregnancy and delivery are expensive, and so is HIV treatment. But you may have more coverage under new Obamacare rules and you may be able to use Medicaid to help cover costs, depending on your state.

being treated for her HIV during pregnancy, labor, or delivery has a 25 percent chance (1 in 4) of passing the virus to her baby.

According to the U.S. Department of Health and Human Services, when an HIV-positive mother receives antiretroviral drugs during pregnancy, labor, and delivery, has her baby by cesarean section, and avoids breast-feeding, the chance of passing on the infection falls to less than 2 percent (fewer than 2 in 100).

That doesn’t mean you must have a C-section, though, if you are already on highly active antiretroviral therapy (HAART). Once doctors discovered that HAART reduced the mother-to-child transmission rate by 70 percent, the need for cesarean births for HIV-positive mothers diminished. Whether you have vaginal or C-section birth will depend on your drug adherence and your viral load.

Either way, you’ll receive an IV drip of the anti-HIV medication AZT, which is a way to pre-load the baby with the drug to prevent transmission of HIV from your genital fluids or blood during labor and delivery.

step six:

step four: you’re pregnant!

you have a bouncing baby boy or girl

If you haven’t begun to do so already, you must start taking extra folic acid supplements, even if your prenatal vitamins include folic acid.

Talk to your doctor about all your supplements and which you should cut out or beef up. One you may need to cut down is vitamin A. Though some doctors recommend high doses of vitamin A for HIV-positive women, it could actually cause birth complications if you take more than the standard 5,000 milligrams per day.

If you aren’t on antiretrovirals already, see a doctor immediately, because you will need to take them during pregnancy. If you’re off them, you may not be able to restart the drugs safely until the second trimester—your doctor can determine that. But if you’re on them already, do not go off. Your doctor will make sure you’re on the safest medications, but it’s up to you to stay solid with your treatment regimen. Remember, with proper medication, your risk of passing HIV along to your child is less than 1 percent.

Remember, just as you have special needs during pregnancy, your baby will have some extra needs as well. After the baby is born, he or she will be treated with antiretrovirals immediately and then will be tested to ensure that there was no HIV transmission.

The HIV test for babies is different from the one done for adults and different from the at-home HIV test you can buy at the pharmacy. So don’t do this yourself; make sure your health care provider is administering the baby’s HIV test. Generally your doctor will test your baby three times between the ages of 14 days and 6 months. In 95 percent of cases, testing can show whether a baby has HIV by the time he or she is 3 months old.

A pediatrician may also prescribe a medication plan to cut the infant’s risk of HIV infection by 50 percent. Even if the baby is HIVnegative, she or he will still need long-term care, so make sure to get a referral to a pediatrician who is familiar with HIV care.

Normally, doctors recommend breast-feeding, but usually not for HIV-positive moms. If an HIV-positive woman does breast-feed, she puts her child at a 14 percent risk for transmission. Reliable formula, using clean water, is much better for your newborn.

step five: you’re in labor If you’re far into your pregnancy, don’t panic. You can still get HIV treatment during labor and delivery. Tell the hospital staff immediately that you are HIV-positive so they can give you the treatment needed to prevent transmission to your baby. Your baby will be treated with antiretrovirals, and the doctor will most likely recommend you not breast-feed. An HIV-positive mother who is not

finally: family time Remember, in all of this, it may be a bit more work having a baby when you’re HIV-positive, but the payoff of being a mom is the same.

Enjoy it. ✜

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People

Like Us

In Sean Strub’s remarkable new memoir, Body Counts: A Memoir of Politics, Sex, AIDS and Survival, the founder of Poz magazine, producer of The Night Larry Kramer Kissed Me, and first openly HIV-positive candidate for U.S. Congress charts his remarkable life—a story of politics and AIDS and a powerful testament to loss, hope, and survival. In this exclusive excerpt, the author finds community at a drop-in center in New York City

By Sean strub

op p o si t e page: Nick L at imer ; t his page: Gr eg gor m a n

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n november 1985, I read in the Native that the People With AIDS Coalition had opened a small office and drop-in center, and I decided to visit. The address was an old town house on a tree-lined street in the West Village.

Several buzzers were positioned next to a wrought-iron gate at the side of the building. A handwritten label said “PWAC Living Room.” I pushed it, and a raspy buzz unlocked the gate. A tunnel-like horse walk ended in a garden area, where there were once stables. I stepped into bright sunlight, surrounded by lush plantings.

Inside the center I found a collection of chairs and couches that looked like flea market rejects. Every surface was piled high with gay newspapers, medical journals, and AIDS pamphlets. A balding man with glasses was talking on the phone at a makeshift desk. He put his hand over the receiver to welcome me with a mock whisper, mouthing, “Just a minute.” When he got off the phone, he stood up and stuck out his hand. “Hi, I’m Michael Hirsch.”

Hirsch was friendly and campy, but I could see how careful he was to avoid making assumptions about why I was there. He never asked my name. Hirsch filled my knapsack with a small stack of AIDS reading material. Until that day, I had read little about the epidemic from the perspective of those with the disease. I realized the voice of PWAC’s membership wasn’t desperate and despondent; nor was it strident or didactic. It was thoughtful, practical, and often funny. Members wrote about their lives and health without assuming death was imminent.

At PWAC, my eyes were opened to a world of people with AIDS— mostly but not entirely gay men—who were living vibrant lives. Others, often including HIV-negative or untested gay men, sometimes didn’t get it. I heard one sweet guy who was very thin and clearly ill talking about how he was opening a florist shop in Brooklyn. When he was out of earshot, a guy who didn’t know I had HIV said, “He’s delusional; he’s not opening any shop, he’s got AIDS!” I was shocked, because when I heard the plans, I thought, “You go for it!”

I saw people with AIDS who retreated from their lives, while others struggled for survival. Some did so in private, in contrast to those whose path was gladiator-like and public. It sometimes seemed like the more powerful and influential a person’s position in life was at diagnosis, the more poorly he handled the news. A “master of the universe” Wall Street banker might crumble in defeat, while a struggling actor, waiter, or retail clerk often found new courage.

One day at PWAC, I ran into Joe Foulon, a friend I hadn’t seen in four or five years. We had dated around 1980 and seen each other occasionally at parties or nightclubs. Seeing him was a relief—he was alive—but it also had me worried: Being at the PWAC office meant he was probably sick. When I saw a postage stamp–size purple KS* spot in the middle of his forehead, I had no doubt.

Joe was stunning to look at. He had thick, straight dark hair and perfect skin, with amazingly high cheekbones. His eyes at first seemed brooding and soulful, but once you got to know him, they were equally impish. He was one of those genetically blessed men who turned heads wherever he went. If he hadn’t been so nice, he would have been easy to dislike. The lesion on his forehead was an imperfection that gave him an appealing touch of vulnerability.

Joe told me he was on PWAC’s board and in 1983 had helped launch the National Association of People with AIDS. I was impressed. I knew Joe as a beguiling waiter/actor; I’d thought I was the political activist. Hearing how involved he was and how much

Scenes from Body Counts: Strub with his former partner Michael Misove (left) circa 1980s, shortly before Misove’s death, and (above) the author now

time and effort he had given to fighting AIDS made me realize how little I had contributed. I felt like I had been asleep for several years while this horrific tragedy was unfolding around me.

A few months later, I invited Joe to join me at a big party on East Eleventh Street. It was crowded and noisy, and the loft had no airconditioning. At one point, Joe and I climbed through a window and sat on the fire escape to cool off. We held hands, watched the night sky, and listened to the muffled sounds of music and laughter coming from inside. “Doesn’t it seem like a really long time ago that we met?” he asked. “It’s a whole different world now.”

We were talking about AIDS but just as easily could have been talking about finding PWAC, which is where I learned how to live with the disease. Through PWAC, I met a large circle of guys like Joe who had been involved in AIDS work for several years. They weren’t from the upwardly mobile circle of ambitious professionals I knew best, who served on the boards of GMHC and other community organizations. They were aspiring artists or actors working in service jobs. They were members of the Gay Men’s Chorus or played on gay softball teams. They shared holiday celebrations and lived in New York’s emerging “gayborhoods” such as Chelsea, the East Village, or Hell’s Kitchen. They ate in gay restaurants, patronized gay stores, and when they went to Jones Beach (Fire Island was out of their price range), you were sure to find them in the gay section. They shared bonds far deeper than the political interests I shared with many of my first gay friends.

As I made friends with the PWAC men, my misconceptions fell away. I began dropping in at the Living Room regularly, to pick up new literature, lend a hand, or just to say hello to the two Michaels—Hirsch and Callen. The Michaels were fun, outgoing, and intent on keeping track of PWAC members’ social and especially sexual lives. When Hirsch told Callen I had dated Joe Foulon, Callen declared Joe was the sexiest man with AIDS in New York.

Hirsch then blurted out an unforgettable response: “He’s so cute, I’d lick his lesions!” ✜ Excerpted from Body Counts by Sean Strub. Copyright © 2014 by Sean Strub.

Excerpted with permission by Scribner, a division of Simon & Schuster Inc.

*K a p o si’s S a rc om a , a c ommon AID S - def ining c ondi t ion

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The Time of Her Life

Jared Leto takes on the role of a lifetime: Rayon, a charming but fragile transgender woman battling AIDS and bureaucracy in 1980s Texas. Come Oscar time, Dallas Buyers Club should send Leto home with the gold statue. Here’s why By diane anderson-minshall

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here’s a moment in Dallas Buyers Club when actor Jared Leto slips quietly away. Instead a transgender woman named Rayon is in a hospital room, pulling back Jennifer Garner’s hair like teenage girlfriends do, especially girlfriends who’ve known each other since middle school and one is now dying of AIDS. It happens so early in the film that you forget until the credits roll that this is Jared Leto, the front man for the rock band Thirty Seconds to Mars, the guy who first entered the public consciousness playing hunky high schooler Jordan Catalano in the ’90s TV drama My So-Called Life opposite current Homeland star Claire Danes.

While he was beautiful and talented, with amazing eyes and outstanding pecs, there was little in his performance as Jordan to prepare viewers for the career that would follow.

A “food-stamp poor” kid from Louisiana, Leto had been in Los Angeles only two years when he got the gig on My So-Called Life, and he followed it with a series of film roles that required transformation and total immersion, from Olympic athlete Steve Prefontaine in 1997’s Prefontaine (which got the actor running) to an emaciated heroin addict in 2000’s Requiem for a Dream (which required weight loss) to John Lennon’s killer, Mark David Chapman, in Chapter 27, a role for which he gained 67 pounds, causing him to develop gout and need a wheelchair to cover long distances.

But no role has been as immersive as that of Rayon, a transgender woman in 1980s Texas whose relationship with the once-transphobic main character, Ron Woodroof, is essentially the heart of Dallas Buyers Club. For the role, Leto dropped to 116 pounds, almost skeletal proportions, to play a woman whose body is under siege not just from AIDS but also from drug addiction.

The other investment Leto made was to get into character as Rayon before he even got the role. Director Jean-Marc Vallée says he “never met Jared Leto. I met Rayon; I don’t know Leto. Jared never showed me Jared.

During our first meeting he was Rayon, and he tried to seduce me. He was so into the character and had dressed as Rayon.”

Leto stayed in character throughout the film, something that impressed his colleagues, including Woodroof portrayer Matthew McConaughey, who says, “Some people may have been put off with Jared’s ideal of being in character the entire time. Well, too bad, it was good for him and it was good for me; it would have been easy for an actor to caricaturize in this role, but Jared kept Rayon grounded in her eccentricities. Jared went for ‘human,’ and that made him so much easier to act with and more truthful.”

We met with the actor turned rock star (Thirty Seconds to Mars has sold more than 5 million albums so far) to talk about the film, watching his roommate die of AIDS, and the reaction Dallas Buyers Club is getting in theaters.

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Dallas Buyers Club is a remarkably moving film. I love the film, from beginning to end. What about this film drew you back to acting?

Well, I fell in love with the character, first off. And, you know, it was a combination of elements. It was Matthew, who’s doing some really wonderful work in his career right now, with the director, Jean-Marc, who’s terrific. And this is a really special story. I felt like there were too many things that I couldn’t say no to.

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Scenes from a life (clockwise from left): Leto (center) and bandmates at the 2010 MTV Video Music Awards; Danes and Leto from My So-Called Life; arriving for a screening of Mr. Nobody at the Venice Film Festival in 2009; with Garner and McConaughey at the L.A. premiere of Dallas Buyers Club; Leto poses with his GQ Man of the Year Award in 2011 in Berlin.

I remember living through those early days of AIDS, when people were going straight from diagnosis to death in days or weeks. You’re just a few years younger than me, so I’m wondering when you were first aware of HIV and AIDS. Actually, when I first moved to L.A., I had a roommate in his 40s who was dying of AIDS and I watched week after week as he withered away, sores started to appear on his body, as he got skin cancer. I remember walking to the grocery store with him or to get lunch, and he would get a bunch of vegetables and put them in a blender in an attempt to stay healthy. He was wonderful and charming and funny and had a lot grace in such a challenging moment. So that left a big impact on me. My first agent, actually, also passed away, died of AIDS. So yeah, it was a death sentence at the time. I do remember it very clearly.

I’ve talked with a number of leaders from organizations like Gay Men’s Health Crisis and some HIV-positive gay men who got an advance screening of the film this week, and almost everyone that I’ve talked with has just been blown away by it.

Is it more important to you to hear that kind of thing or to hear the critics talking about your possible Oscar nominations?

It’s absolutely incredible to hear that the film connects so deeply with people who have a very, very personal connection to this story, people who have had their own challenges or lost loved ones.

I mean, that’s an absolutely mind-blowing thing to hear. And as we’ve done the screenings, people sometimes stand up and they don’t even feel compelled to ask a question, they just want to share a little bit about their experience. I think that’s the power of film.

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Film can change us. It can either show us a side of life we’ve never seen before or remind us of where we’ve come from, and that’s a really beautiful thing when it happens in that way.

HIV does not have to be a death sentence anymore, but new infections are still surging in many communities, particularly among young people. Do you think films like this can help change that?

Well, I think it’s a great conversation to have. Certainly, a film isn’t going to solve things out there, but it’s a great conversation to put into the culture, and this is an interesting film because it talks about a story that is close to so many of us, that really hasn’t been told before. So I think it shines a light both for the people that were there and for the people that weren’t, and that’s a really good thing.

You and Matthew both went through huge physical transformations for this film. Was it easier that you were both dropping so much weight at the same time?

I don’t know. We didn’t talk about weight, we didn’t talk about any of that. I really just communicated with Matthew and with Jennifer through, through the character. So I wasn’t really sharing that so much, but it was wonderful to work with Matthew— he’s incredibly committed and focused, and he was just a great partner.

Jean-Marc has said that he didn’t actually meet Jared until the film was finished—at your first meeting you were in your character as Rayon already, and you stayed in character all the

way through filming. Why was it important to go that route?

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Well, I thought it was important to go that route because of the nature of the character itself. It was such a colorful and challenging role that I needed to stay as focused and committed as possible. I mean, my job was really to contribute and to be of service to the story and the other actors, and I felt in order to do that I needed to stay as close to Rayon as I could.

I love that Rayon is a woman who had clearly faced a lot of heavy issues in her life already. She remains f lawed, there’s no happy Hollywood ending, yet she’s very much the heart of the story. How did you get into the role? Were you inspired by trans women in real life? Was there method acting here?

Well, look, yeah, I mean, it’s a combination of all of that. When I read this script I thought here was an opportunity to bring to life a real person. I think, typically, this type of role is usually only treated as comedic relief, you don’t get to know a real person there. I’ve had my own experiences that I think led me to see this role as someone who wanted to live their life as a woman—as a transgender person, not as a drag queen, as a transvestite, or someone who just enjoys putting on women’s clothing. And I think it was a key distinction to make early on in the process. I think another actor may have looked at it, seen it, and saw a different character, but, you know, when I was on the road touring, about six months before the film, before I read the script, I had an interesting experience and met some transgender people on the road, and it left a mark.

We had really interesting interactions and conversation, and you know, that was a really important thing to have happened, to really inform, I think, my process quite a bit.

What about meeting them was so impactful for you?

Well, they were young people that were involved in, I guess they were in the midst of transitioning and discovery, and, you know, I had met this one kid named Daniel, I think it was in Kentucky. I met him and a friend of his at the mall, and I was meeting their mom too, and brought them along with 30 other people I met at the mall to the show that night. And I was doing a series of interviews at the time of people all around the world for a documentary about life on the road. But I met this kid Daniel and interviewed him and didn’t get a great interview, and as I said goodbye I went to give him a hug and felt there was a bandage wrapped around his body, his chest. So as I walked out I said to my camera guy, “Go grab the mom.” And the mom walks back in, and I said, “So, Daniel” [he pauses] and she said “Yes,” and tears were running down her face, and she said he’d been living as a boy for the past nine months. She said, “I don’t know what to do, but I want to be supportive.” And I said, “Bring Daniel back in.” And we had this incredible interview, very personal and revealing. It ended up happening again a few weeks later when I met another transgender young person.

Those experiences, I think, help me understand that Rayon was—maybe if she lived in a different time, she would have had a greater understanding of her circumstances and situation.

But I saw her clearly as a person who identified and wanted to live her life as a woman. ✜

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The Beautiful Sadness of

Dallas Buyers Club 44

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After a flurry of worthy AIDS documentaries comes this new Hollywood blockbuster

By MARK S. KING

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demons, and no one gets out unscathed. The fact that the filmmakers make you root for every one of them is a testament to terrific storytelling and a vexing main character you grow to love and admire.

These characters also live a world away from the more sophisticated New York City activists who populate the Oscar-nominated documentary from 2012, How to Survive a Plague. In fact, the AIDS battles being waged elsewhere barely register in this story about Southern vice and ingenuity. When Woodroof and his rodeo buddies first learn of the death of Rock Hudson, they dismiss him as a “cocksucker,” except for one of the guys who doesn’t even know who the actor is. His buddies scoff. “Haven’t you ever seen North by Northwest?” one asks.

Woodroof’s entrepreneurial efforts ultimately create the Dallas Buyers Club, a real business that provided unapproved medications to very desperate people with AIDS. As someone who once used a buyers’ club to purchase Compound Q and other pharmacological footnotes in HIV and AIDS history, I can attest that everything about the cheap plywood setup in the film to the customers’ anxious expressions felt tragically familiar.

The real villain in the story, other than the virus itself, would have to be the early, toxic drug AZT and its manufacturer. Although the film uses a fictional pharmaceutical name, historians note that AZT was produced by Burroughs Wellcome (eventually absorbed into GlaxoSmithKline), which downplayed side effects in a complicated rush by the Food and Drug Administration to have a drug, any drug, ready to treat the growing pandemic.

Matthew McConaughey is a revelation. His physical transformation alone would be Oscar bait were it not for his ability to gain our affections for such a self-serving swindler.

Calling the performance free of vanity is an understatement. His harrowing depiction of living with AIDS makes the award-winning Philadelphia look about as realistic as Dark Victory. It reminds me of when we settled for scraps in Hollywood’s depiction of AIDS, when any major actor “brave enough” to play a gay man won an Oscar.

There is a moment late in the story during which Woodroof checks himself in the mirror before an evening out. Suddenly he finds himself staring, and in the dim bathroom light he sees the undamaged face of the man he might have been. He allows the slightest expression of pride, for the things he has accomplished, for those he has helped. And then, as those of us who lived through the 1980s know so well, the face returns to a look of both hope and despair, of the beautiful sadness that always brought too many questions about the fate that was barreling toward us.

It is that face in Dallas Buyers Club, the one free of blood and injury, that is the most haunting of all.

Activist and author Mark S. King is the journalist behind the blog My Fabulous Disease (MarkSKing.com).

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n the first minutes of Dallas Buyers Club, the astounding new film about the darkest years of the AIDS crisis, rodeo cowboy Ron Woodroof (a gaunt and barely recognizable Matthew McConaughey) is punched in the face. He has it coming. The selfserving crook has a lot of enemies.

The blood spills from his mouth and glows a bright crimson, an almost clownish contrast to his drained, ghostly pallor, which itself is evidence of a raging HIV infection he has yet to discover. Another gash on his forehead is a shocking distillation of red, and unlike in most movies, in which injuries disappear by the next scene, the wound remains. And remains. For many scenes thereafter, the blood on Woodroof’s forehead is in full view, a disconcerting reminder of what lies beneath, until you wish he would just put on a bandage already.

But Dallas Buyers Club isn’t interested in making the truth very pretty. A river of infected blood runs through it. So too does practically every other bodily fluid, along with bruises that won’t heal and purple skin lesions and flakes of dry, reddened skin. And that’s kind of beautiful. Because that’s what AIDS looked like in 1985, and it’s been ages since we have fully remembered it. (This movie doesn’t concern itself with the modern-day notion of “living with HIV,” since having the virus in those days typically meant an AIDS diagnosis and fast and efficient death.)

I have never seen AIDS shown this way in a film. And of all the movie portrayals of the disease, from Parting Glances to I Love You Phillip Morris, nothing else has captured the ugly physicality of AIDS like Dallas Buyers Club. Even the tearful hospital-bed goodbyes in Longtime Companion seem overly romanticized by comparison.

The based-on-a-true-story film concerns Woodroof, a hard-living cowboy and drug addict who must face certain death and the cruelty of his redneck buddies when he tests HIV-positive. Woodroof also lives the sheltered life of a Southern homophobe, so watching him negotiate the AIDS community terrain of queers, transgender women, and drag queens is fascinating viewing and provides some of the surprisingly plentiful humor in the film.

But Woodroof hasn’t successfully dodged the consequences of his petty crimes for nothing. He quickly cheats the system to acquire the poisonous medication AZT, and after an eye-opening trip to Mexico, he figures out how to profit from the sale of unapproved drugs to the throngs of support group members back home. Along the way, he allows himself a guarded friendship with a drug-addicted transgender woman, Rayon, who becomes his business partner (Jared Leto in an effective and quietly humble performance) and eventually accepts, to some degree, the gratitude and generosity of the many gay and trans people around him.

Nearly everyone in the story, patients and physicians alike, is a wretched outcast, damaged by drug addiction or homophobia or loneliness or their own destructive behaviors. No one is healed, no one fully conquers his or her

the hiv-positive man

courtesy bluewater produc tions

behind the comics

Fourteen years after his diagnosis, Darren Davis is getting the attention of Hollywood and perhaps the White House with his comic books filled with powerful women By jacob anderson-minshall

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hen darren g. davis was first

diagnosed with HIV in 1999, his biggest fear was becoming pigeonholed as “the HIV-positive person in comic books.” But he’s established a much broader identity than that.

The founder of Bluewater Productions, Davis is behind the celebrity-centric biographical comic series Fame, Female Force, and 15 Minutes, which collectively have featured a diverse range of notables, including Anderson Cooper, Lady Gaga, Jackie Robinson, Michelle Obama, Ellen DeGeneres, Lou Ferrigno, and the Kardashians.

Although he’s long been an avid comic book collector, Davis didn’t initially plan to work in the industry. Immediately after college, he began working with E! Entertainment Television, then moved on to USA Network and Lionsgate before he was recruited by DC Comics.

Shortly thereafter, he created his first comic book, 10th Muse, and hired iconic writer Marv Wolfman to script it. 10th Muse, about a modernday daughter of the Greek god Zeus, was originally released by Image Comics and became the sixth highest selling comic book in November 2001.

“We are in some record book for it somewhere,” Davis says. “I was hooked and started my own imprint.” In 2007, Davis launched Bluewater Productions, which today is the largest gay-owned publishing and production company specializing in comic books, graphic novels, and multimedia and the only with an out HIV-positive person at the helm. A year after founding the company, Davis saw a comic by another company that featured presidential candidates Barack Obama and John McCain. Since many of the fictional works Bluewater produces, including The Legend of Isis and 10th Muse, are driven by strong female leads, Davis thought that creating a similar book around Hillary Clinton and Sarah Palin would be a perfect fit.

When that comic took off, Bluewater began to produce more biographical titles, including Political Power, Fame, 15 Minutes, and Orbit, and many of these have featured powerful women. Bluewater’s other comics include sci-fi tales, superhero titles, and fictional adventures of Hollywood legends such as William Shatner, Roger Corman, Adam

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West, Julie Newmar, and Vincent Price. Davis has also reimagined classic stories like Logan’s Run and S.E. Hinton’s The Puppy Sister. But it is the femalecentric bio titles that have moved him and the company to a place of prominence in the industry.

“Our comic books are now taught in schools, which I love,” Davis says. “I have learned more about politics from doing these. I find them fascinating.” Of course, not all of the biographical comics are entirely educational.

“Sometimes we do ones just for fun,” Davis admits. “We did a Honey Boo Boo comic book and we found out she loved it.”

Davis says he’s just applying what he learned about the power of celebrities from his time in the entertainment industry.

“Bottom line, we have taken a lot of criticism for them,” he says of Bluewater’s biographical lines, which remain outnumbered by the publisher’s traditional titles. “But I am proud and stand by them.

It is funny, because we still do 60% of our books that are fiction. We work with William Shatner, Julie Newmar, Adam West, S.E. Hinton—all on fiction books.”

Davis met his partner, Jason Schultz, at a (non– comic book) trade show in Portland, Ore., in 2003, and the two hit it off immediately.

“I told him that night I was HIV-positive, and he said, ‘I like you better now.’ It was because I was so up front and honest with him. He’s HIVnegative. Within six months, I was moved up to Bellingham, Wash., with him.”

Four years into their relationship, the couple decided to make Bluewater a “family business.”

Schultz took over the sales and administrative side of the business while Davis continued to focus on the creative aspects. “I’m not the easiest person to work with,” Davis acknowledges. “I’m a workaholic, and he has balance. So he pulls me away from my computer to go for a walk with the dogs or eat. There are the days I’m sure he wants to smother me with a pillow. It’s a challenge, because we’ll be in bed reading and I’ll say, ‘Remember to tweet something tomorrow.’ I haven’t gotten the balance thing down that he has.”

Six years later, the challenge facing the couple now is Schultz turning some of his attention else-

where, cooking school at Le Cordon Bleu. “So we’ll be eating well,” Davis says. “He has finally found his passion, and I’ll be supporting him in this as he has done for me with mine.”

Davis admits that being gay (and HIV-positive) has sometimes been difficult in a field dominated by straight white guys. “I’ve been called some pretty nasty things in the industry regarding my sexual [orientation]. One by a huge artist that I worked with. I was shocked. It was along the lines that I should get AIDS and die.”

Davis recalls when a friend of his avoided drinking from the same glass because he was worried about catching HIV. “I am still shocked that people think they can get it from an iced tea,” Davis muses.

“Tiny things like that hurt my feelings.”

But the worst response was from a onetime employer. Davis was working in the advertising department for Wizard magazine when he was diagnosed with HIV. A few months later, Davis was struggling with the side effects of his medication.

“I remember being at a trade show in August, faking it through the day. I was a zombie, but did my job. I [had] become friends with my supervisor, so I thought it was safe to tell him about the problem. He told me he wouldn’t say anything.

Two days later, his boss fired me.”

That boss was always “a little homophobic” and Davis thinks the man was afraid he would contract HIV if they continued working together.

“My lawyer wanted me to make a statement by suing…but I wasn’t ready to be known as the HIV-positive person in comic books,” he says. “I was scared about the stigma in a male-driven marketplace. I needed time to process my diagnosis, and a lawsuit was the last thing I needed.”

Instead, Davis channeled his frustration into a journal he began keeping after he was diagnosed.

“In those years of writing, I learned a lot about myself and who I became because of this disease,” he says. At first, Davis admits, “I was so bitter and wished I had someone to talk to about it.” Although he went to support groups, Davis was frustrated that so many of the participants talked about “how they were shocked they were still alive.” Most were dealing with survivor guilt and sharing stories about friends dying. “Don’t get me wrong,” Davis

courtesy bluewater produc tions

says. “I felt for them. But, being just diagnosed, the last thing I wanted to hear was talk about dying. I wanted to live! Each time I’d leave the support group I got more depressed and lonely.”

Davis turned to comics, looking for anything about HIV-positive people. One of the few he found was 7 Miles a Second, the brutally frank autobiographical comic by gay artist David Wojnarowicz, which was published four years after his AIDSrelated death. “7 Miles a Second and all the movies I’ve seen with HIV characters, most of them are dying or dealing with death,” Davis says, so he set out to create Lost Raven, a passion project that grew out of his journal entries.

“I wanted to tell the story from the perspective of people living with the disease,” he says. “I made a point to make sure that the character [was] healthy living with it. I have never had a physical problem—so I wanted to show that person.”

In the comic, former lawyer Zak Raven is shipwrecked on a deserted island and attacked by strange creatures. “During the day he is running around fighting monsters, and at night he is writing about what it’s like to be HIV-positive,” Davis explains. “He questions everything from having kids, relationships, to when it’s OK to tell people. These were the issues I had a problem with.… I took my raw journal entries and put them into an action-adventure story.”

Davis says he has also had struggles concerning his HIV medication. On one hand, he says, it “changed my life. I had a doctor who put me on the cocktail right away. It was ‘Hit it hard, before there are any problems.’ My T cells have been over 1,200 for 10 years. My doctor loves me: I do what I am supposed to do. I get a checkup every three months and take my pills as directed.”

However, Davis says there are still “HIV days,” when he’s tired and sluggish.

“So I crawl into bed and have my partner wait on me. The medication, even after 12 years, has huge effects on my system.”

Still, he insists, “Stress from work for me will be the death of me, not HIV.” He says he’s “driven to make a difference in this world. If I can do it, there is no reason others can’t have the same success. I became a stronger person after my diagnosis. I learned that I wasn’t invulnerable. I learned to forgive the person that gave it to me.” He also wants to share that knowledge with others.

Lost Raven, which has been named best graphic novel of the year by the Independent Book Publishers Association and has been turned into a four-part comic book series, closes with a page of up-to-date statistics and information about HIV. Even better, a portion of the proceeds from Lost Raven, which is drawn

by Renato Arlem, Keu Cha, and Sean Murphy, is donated to Washington State’s Evergreen AIDS Foundation. Bluewater has also recently released a biography of famed HIV-positive artist Keith Haring titled Milestones of Art: Keith Haring: Next Stop: Art. But don’t think Davis has forgotten his first love: strong female characters. The Female Force series has been used to talk about health issues as well—in Female Force: Carrie Fisher the former Star Wars actress bravely shares her lifelong struggle with bipolar disorder, and Grease star Olivia Newton-John uses her Female Force issue as a platform to discuss her fight against breast cancer. So there’s hope that the series, which has captured the attention of the Today show and Time magazine, will keep doing the same. Next up, says Davis, are books on feminist icon Gloria Steinem, Queen Elizabeth II, Helen Gurley Brown, Melinda Gates, and Mary Pickford.◆

The Invisible Ones A graphic novel from the AIDS decade reminds us of our history 7 Miles a Second (Fantagraphics, 2013) is an autobiographical comic written by the late gay artist and AIDS activist David Wojnarowicz and illustrated by his friends James Romberger and Marguerite Van Cook, a married couple who are both living with HIV. Originally released in 1996 by DC Comics’ Vertigo imprint, it has been reissued by Fantagraphics. The illustrations are an oversaturated brew of synthetic colors and fully exploit the queer potential of comic books, juxtaposing different styles and mashing avant-garde, impressionist, and watercolor art with porn, horror, and monster movie imagery.

But 7 Miles a Second captures the rage and impotence felt by thousands of young gay men who were suddenly faced with the brutal finality of death. In one stream-of-consciousness rant (illustrated by a Godzilla-size Wojnarowicz smashing a church), Wojnarowicz writes of trying to funnel his rage into nonviolent resistance but finding it more and more difficult. “There’s religious leaders and health care officials that had better get bigger fucking dogs and higher fucking fences,” he threatens.

In real life, AIDS activists never became giants or unleashed widespread violence, and the haters never paid for their indifference. But the work of Wojnarowicz and thousands like him eventually moved individuals, institutions, and entire nations to care.

In one of the book’s final narratives, Wojnarowicz writes, “I am a glass human disappearing in rain. I am standing among all of you waving invisible arms and hands. I am shouting my invisible words.… I am disappearing.”

Wojnarowicz may have indeed disappeared. But he was never as invisible as he feared. And he lives on in 7 Miles a Second as well as in the numerous artists already influenced by his work. —Jacob Anderson-Minshall

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DA ILY DO SE

HIV stigma and the logical dissonance between “it’s not a death sentence” and “if you have sex without a condom, you will die” By josh kruger

I

’ll admit it: Untreated HIV is, in fact, a death sentence. But because American society and in particular the LGBT community built industries, both for- and not-for-profit, surrounding HIV and AIDS treatment and prevention, HIV-positive individuals now have access to the same longevity and quality of life as their HIV-negative counterparts. Still, AIDS service organizations and government groups continue to trumpet the party line that tells young people, especially, that if you have sex without a condom, you will die.

In fact, the familiar refrain that HIV is not the same as a passive, yearslong form of capital punishment is mealy-mouthed or, in its more stigmatic sense, completely devoid of any attempt at true understanding. After all, physicians, researchers, sensible outreach workers, and HIV-positive individuals themselves now adopt, thankfully, forward-thinking approaches toward HIV, including treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) as well as early use of antiretrovirals. These approaches and medicines now take early death and poor quality of life completely off the table for most HIV-positive folks.

Despite the scientifically proven efficacy of these models and the complete practical dearth of side effects from medications like Complera or Truvada, the drumbeat telling us “HIV equals death” continues like internalized stigma masquerading as spooky gimmickry.

In particular, the naysayers and the sex-negative organizations and activists in the HIV and AIDS treatment and prevention industry have a serious unease with PrEP, TasP, and almost anything that doesn’t involve condoms. Indeed, the AIDS Healthcare Foundation leads the charge in its shrill obsession with everything not latex-based and, most dangerously, internalizes stigma by acting like bareback sex is the same thing as Russian roulette. It is not.

Curiously, these same activists and organizations are willing to “empathetically” hold hands during diagnosis, force the image of an unwilling victim down the throats of the newly HIV-positive, and take personal responsibility and adult decision-making completely off the table. For example, the hack-

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• j a n u a r y/ f e b r u a r y 2 0 1 4

Josh Kruger is a writer and editor in Philadelphia. His regular column, The Uncomfortable Whole, explores what, if anything, is normal today in America and runs in Philadelphia Weekly, that city’s largest alternative weekly newspaper.

photos.com

It’s Not About Condoms

neyed spirit of “it’s not a death sentence” logically supposes that HIV is a dangerous, spooky thing that somehow just happens by someone’s life. And while the notion itself is quaint, it creates logical and cognitive dissonance.

More specifically, condom-based campaigns using sex-negative imagery (remember the man in a diaper on a billboard or the scorpion raping a woman, all campaigns trumpeted by outdated condom-obsessed AIDS organizations) imply that HIV and, subsequently, its treatment will both give you explosive diarrhea (nowadays this does not occur, thankfully) and the same moral cover as a poisonous arachnid. Logically, then, society must feel that HIV and by extension the HIV-positive are deserving of sanitation, neutralization, and eradication.

If this were not true, then we would not be willing to scare the hell out of every young thing walking around with a mucous membrane. Yet because this is in fact the approach of a widespread HIV infrastructure more identifiable as something from the age of Clinton instead of Obama, we must confront the problematic nature of some approaches in HIV prevention.

Now, thankfully, such a thing as treatment as prevention exists. That is, because I take one pill, once a day, with no side effects whatsoever personally, and I maintain an undetectable viral load (less than 20 copies of HIV RNA in every milliliter of my blood), I am statistically and practically prevented from transmitting HIV even to men with whom I have bareback sex. In addition to this, my body now enjoys the trauma of only cigarettes and too much caffeine rather than the inevitable tragedies of Kaposi’s sarcoma, bird flu, shingles, and every other malady common in those at AIDS levels or those who, for whatever reason, do not treat their HIV. Basically, HIV has had a more profound social and cultural effect on me than it has in the biological sense because I adhere to my medication precisely as described. Obviously, then, even the whisper of a death sentence is ridiculous and unnecessary. Yet this “it’s not a death sentence” is the exact refrain newly diagnosed folks hear from their compassionate friends and, in the worst cases, misguided so-called HIV experts, typically now-reformed former partiers who are nothing but envious of those HIV-positive folks still living and having a good time. This is patently obvious in the sneering concern-trolling these alleged professionals maintain whenever their colleagues mention the efficacy of the TasP model, which, at least according to The New England Journal of Medicine, has the same efficacy surrounding HIV prevention as condom use.

Curiously, I rarely if ever hear mention of peer-reviewed scientific academic articles in the arguments against PrEP and TasP. Instead, I hear (or see) nothing more than incessant personal anecdotes, moralism, and finger-wagging.

The fact of the matter is that we cannot prevent HIV by implying it is a spooky, scary, fatal, abstract thing and then, out of the other side of our mouth, pat the hands of the newly HIV-positive by telling them “it’s not a death sentence.” No wonder the newly diagnosed are terrified, after years of hearing it is.

We can, however, apply a multipronged, sex-positive, personal decision– based model of TasP, PrEP, condoms for those who wish to use them, and health services targeting the whole well-being of individuals living with or statistically likely to seroconvert to HIV. More to the point, the finger-wagging going on right now in the HIV treatment and prevention industry toward TasP and PrEP should be directed, rather, at the more dated and sex-negative onetrick-pony approach that simultaneously and paradoxically couples “it’s not a death sentence” with “if you have sex without a condom, you will die.”

Until we scrap both of these pernicious approaches and phrases, we’re going to sustain a cycle of fear and inevitable self-harm; and until we embrace the totality and naturalness of human behavior—even drug and sex behaviors— we will see HIV infections stubbornly rise across key demographics.

Dating Continued from page 30

resource guide, “Research of this nature tends to measure the most negative aspects of positive/negative couplings, telling us primarily how HIV complicates our lives. It tells us very little about the rewards, the discovery of inner strengths, the emotional ties, the opportunities for developing better communication skills, or the joy generated when a mixed-status couple does create a happy, strong, fulfilling relationship.” What you need to know if you’re part of a mixed couple is that you can have a happy and healthy relationship, but like all relationships, it requires work and commitment, because love does not conquer all. Many HIV-positive people fear spreading the virus to their partners, making sex fraught with tension. Think about PreP, about condoms, about ways to be safe sexually so this isn’t your issue too. Talk about living with a person with a disability, which HIV is. Couples might also want to see a couples counselor who specializes in coping with HIV. Many HIV-negative partners encounter disrespect from friends and family members when the other partner’s status

is revealed, which is sort of an unexpected diss for many men. A counselor can help you work through those kinds of issues and communicate to each other your anxieties, fears, and needs.

Can we have kids if one of us has HIV? Yes.

Read our article on page 31.

My new partner has kids. How do we tell them I have HIV? Many parents worry that

telling their kids might place a burden on the children. Mental health professionals say the decision about whether to tell your kids depends on many factors, including how perceptive they are (if there are medicine containers all around, kids will ask about them), how discreet you need to be (asking kids to keep your status a secret is a heavy burden), and how strong you can be for them (at first some kids will be angry or overly clingy, worried you’ll be dying). For most people, telling the children is the right thing to do. Before you do, learn everything you can about HIV. Your kids have been perfecting the “why” questions since they were 2 years old; this is a moment when there will

be a lot of “whys” and “hows.” Your doctor or counselor might have ideas about groups or advocates for children, who can also talk to the kids or be a support team for you and the offspring as you go through the coming-out process. Then talk in a quiet space, be honest, trust your kids to handle it, and let them express their emotions fully (remember, kids can experience a range of feelings, including guilt, fear, rage, and rejection). This process may take more than one day—it’s the beginning of a conversation in which you should be honest, age-appropriate, and willing to offer both answers and assurances. Kids can impress us with their ability to understand and assimilate information; you just need to have it ready for them. It’s important to remind them that HIV isn’t AIDS but that it is a chronic condition like asthma and a disability; use examples of their friends, classmates, or family members to show that many of us have disabilities and that’s just a normal part of life’s diversity. After the crying and talking is done, take them out for ice cream so they remember that this is just another thing that your family will tackle together. ✜

“A stunning memoir—candid, courageous, and humane.”

—John Berendt

“This is the compelling life and near-death story of Sean Strub, of thousands lost to HIV-AIDS, and thousands more living with it whom his activism helped save. Wow.” —Andrew Tobias, author of The Best Little Boy in the World World

“Sean Strub gives us ideas, strength, and heart.”

—Gloria Steinem

“The most personally powerful and authentic portrayal of our collective history that I have read since Paul Monette’s Borrowed Time.”

—Judith Light

“A powerful account...A page turner with moving insight.”

—Lily Tomlin Tomlin Ebook also available

|

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j a n u a r y/ f e b r u a r y 2 0 1 4 •

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The

one

for me

Patient model. Pill shown is not actual size.

What is COMPLERA? COMPLERA is a prescription HIV medicine that is used as a complete regimen to treat HIV-1 in adults who have never taken HIV medicines before and who have an amount of HIV in their blood (this is called “viral load”) that is no more than 100,000 copies/mL. COMPLERA contains 3 medicines – rilpivirine, emtricitabine and tenofovir disoproxil fumarate. It is not known if COMPLERA is safe and effective in children under the age of 18 years. ®

COMPLERA® does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Avoid doing things that can spread 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, do not share personal items that may contain bodily fluids. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others.

IMPORTANT SAFETY INFORMATION What is the most important information you should know about COMPLERA? COMPLERA® can cause serious side effects: • 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.

• 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.

• 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.

• 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 have ever taken other anti-HIV medicines.

COMPLERA may change the effect of other medicines and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses.

Do not take COMPLERA if you also take these medicines: • anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek) • anti-tuberculosis medicines: rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin) and rifapentine (Priftin) • proton pump inhibitors for stomach or intestinal problems: esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), dexlansoprazole (Dexilant), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate • St. John’s wort (Hypericum perforatum) If you are taking COMPLERA you should not take other HIV medicines or other medicines containing tenofovir (Viread, Truvada, Stribild or Atripla); other medicines containing emtricitabine or lamivudine (Emtriva, Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir, Atripla, Stribild or Truvada); rilpivirine (Edurant) or adefovir (Hepsera).

In addition, tell your healthcare provider if you are taking the following medications because they may interfere with how COMPLERA works and may cause side effects: • certain antacid medicines containing aluminum, magnesium hydroxide, or calcium carbonate (examples: Rolaids, TUMS). These medicines must be taken at least 2 hours before or 4 hours after COMPLERA. • medicines to block stomach acid including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine HCL (Zantac). These medicines must be taken at least 12 hours before or 4 hours after COMPLERA. • any of these medicines: clarithromycin (Biaxin); erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) methadone (Dolophine); posaconazole (Noxafil), telithromycin (Ketek) or voriconazole (Vfend).

• medicines that are eliminated by the kidneys like acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex) and valganciclovir (Valcyte).

COMPLERA.

A complete HIV treatment in only 1 pill a day.

COMPLERA is for adults who have never taken HIV-1 medicines before and have no more than 100,000 copies/mL of virus in their blood.

Ask your healthcare provider if it’s the one for you.

These are not all the medicines that may cause problems if you take COMPLERA. Tell your healthcare provider about all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

The most common side effects reported with COMPLERA are trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Some side effects also reported include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles) and pain.

Before taking COMPLERA, tell your healthcare provider if you: liver problems, including hepatitis B or C virus infection, or have abnormal liver tests • Have kidney problems • Have ever had a mental health problem • Have bone problems • Are pregnant or planning to become pregnant. It is not known if COMPLERA can harm your unborn child • Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, COMPLERA may pass through breast milk and could cause harm to the baby

This is not a complete list of side effects. Tell your healthcare provider or pharmacist if you notice any side effects while taking COMPLERA, and call your healthcare provider for medical advice about side effects.

• Have

COMPLERA can cause additional serious side effects: • New or worsening kidney problems, including kidney failure. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may need to do regular blood tests.

• 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.

• 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 need 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 additional tests to check your bones.

• Changes in body fat can happen in people taking HIV medicine.

• Changes in your immune system. 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 new symptoms after starting COMPLERA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088.

Additional Information about taking COMPLERA: • Always take COMPLERA exactly as your healthcare provider tells you to take it.

• Take COMPLERA with food. Taking COMPLERA with food is important to help get the right amount of medicine in your body. (A protein drink does not replace food. If your healthcare provider stops COMPLERA, make certain you understand how to take your new medicine and whether you need to take your new medicine with a meal.)

Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly.

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

Learn more at www.COMPLERA.com

Brief BriefSummary Summaryofoffull fullPrescribing PrescribingInformation Information COMPLERA COMPLERA (kom-PLEH-rah) (kom-PLEH-rah) (emtricitabine, (emtricitabine,rilpivirine, rilpivirine,tenofovir tenofovirdisoproxil disoproxilfumarate) fumarate)tablets tablets ®®

Brief Briefsummary summaryofoffull fullPrescribing PrescribingInformation.

Information.For Formore moreinformation, information,please pleasesee see the thefull fullPrescribing PrescribingInformation Informationincluding includingPatient PatientInformation.

Information.

What WhatisisCOMPLERA? COMPLERA? • •COMPLERA COMPLERAisisaaprescription prescriptionHIV HIV(Human (HumanImmunodefi Immunodeficiency ciencyVirus) Virus)medicine medicine

that thatisisused usedtototreat treatHIV-1 HIV-1ininadults adults

––who whohave havenever nevertaken takenHIV HIVmedicines medicinesbefore, before,and and ––who whohave haveananamount amountofofHIV HIVinintheir theirblood blood(this (thisisiscalled called‘viral ‘viralload’) load’)that that isisnonomore morethan than100,000 100,000copies/mL. copies/mL.Your Yourhealthcare healthcareprovider providerwill willmeasure measure your yourviral viralload. load.

(HIV (HIVisisthe thevirus virusthat thatcauses causesAIDS AIDS(Acquired (AcquiredImmunodefi Immunodeficiency ciencySyndrome)).

Syndrome)).

• •COMPLERA COMPLERAcontains contains33medicines medicines––rilpivirine, rilpivirine,emtricitabine, emtricitabine,tenofovir tenofovir

disoproxil disoproxilfumarate fumarate––combined combinedininone onetablet. tablet.ItItisisaacomplete completeregimen regimentoto treat treatHIV-1 HIV-1infection infectionand andshould shouldnot notbebeused usedwith withother otherHIV HIVmedicines. medicines.

• •ItItisisnot notknown knownififCOMPLERA COMPLERAisissafe safeand andeffective effectiveininchildren childrenunder underthe theage age

ofof1818years yearsold. old.

• •COMPLERA COMPLERAdoes doesnot notcure cureHIV HIVinfection infectionororAIDS. AIDS.You Youmust muststay stayononcontinuous continuous

therapy therapytotocontrol controlHIV HIVinfection infectionand anddecrease decreaseHIV-related HIV-relatedillnesses. illnesses.

• •Ask Askyour yourhealthcare healthcareprovider providerififyou youhave haveany anyquestions questionsabout abouthow howtoto

prevent preventpassing passingHIV HIVtotoother otherpeople. people.DoDonot notshare shareororre-use re-useneedles needlesororother other injection injectionequipment, equipment,and anddodonot notshare sharepersonal personalitems itemsthat thatcan canhave haveblood bloodoror body bodyfluids fluidsononthem, them,like liketoothbrushes toothbrushesand andrazor razorblades. blades.Always Alwayspractice practicesafer safer sex sexbybyusing usingaalatex latexororpolyurethane polyurethanecondom condomtotolower lowerthe thechance chanceofofsexual sexual contact contactwith withsemen, semen,vaginal vaginalfluids fluidsororblood. blood.

What Whatisisthe themost mostimportant importantinformation informationI Ishould shouldknow knowabout aboutCOMPLERA? COMPLERA? COMPLERA COMPLERAcan cancause causeserious seriousside sideeffects, effects,including: including: • •Build-up Build-upofofananacid acidininyour yourblood blood(lactic (lacticacidosis). acidosis).Lactic Lacticacidosis acidosiscan can happen happenininsome somepeople peoplewho whotake takeCOMPLERA COMPLERAororsimilar similar(nucleoside (nucleosideanalogs) analogs) medicines. medicines.Lactic Lacticacidosis acidosisisisaaserious seriousmedical medicalemergency emergencythat thatcan canlead leadtoto death. death.Lactic Lacticacidosis acidosiscan canbebehard hardtotoidentify identifyearly, early,because becausethe thesymptoms symptoms could couldseem seemlike likesymptoms symptomsofofother otherhealth healthproblems. problems.Call Callyour yourhealthcare healthcare provider providerright rightaway awayififyou youget getany anyofofthe thefollowing followingsymptoms symptomswhich whichcould could bebesigns signsofoflactic lacticacidosis: acidosis: ––feel feelvery veryweak weakorortired tired ––have haveunusual unusual(not (notnormal) normal)muscle musclepain pain

• •Worsening WorseningofofHepatitis HepatitisBBinfection. infection.IfIfyou youhave havehepatitis hepatitisBBvirus virus(HBV) (HBV)

infection infectionand andtake takeCOMPLERA, COMPLERA,your yourHBV HBVmay mayget getworse worse(fl(flare-up) are-up)ififyou youstop stop taking takingCOMPLERA. COMPLERA.AA“fl“flare-up” are-up”isiswhen whenyour yourHBV HBVinfection infectionsuddenly suddenlyreturns returns ininaaworse worseway waythan thanbefore. before.COMPLERA COMPLERAisisnot notapproved approvedforforthe thetreatment treatmentofof HBV, HBV,sosoyou youmust mustdiscuss discussyour yourHBV HBVwith withyour yourhealthcare healthcareprovider. provider.

––DoDonot notletletyour yourCOMPLERA COMPLERArun runout. out.Refi Refillllyour yourprescription prescriptionorortalk talktotoyour your healthcare healthcareprovider providerbefore beforeyour yourCOMPLERA COMPLERAisisallallgone. gone.

––DoDonot notstop stoptaking takingCOMPLERA COMPLERAwithout withoutfirst firsttalking talkingtotoyour yourhealthcare healthcare provider. provider.

––IfIfyou youstop stoptaking takingCOMPLERA, COMPLERA,your yourhealthcare healthcareprovider providerwill willneed needtotocheck check your yourhealth healthoften oftenand anddodoblood bloodtests testsregularly regularlytotocheck checkyour yourHBV HBVinfection. infection.

Tell Tellyour yourhealthcare healthcareprovider providerabout aboutany anynew newororunusual unusualsymptoms symptomsyou youmay may have haveafter afteryou youstop stoptaking takingCOMPLERA. COMPLERA.

Who Whoshould shouldnot nottake takeCOMPLERA? COMPLERA? DoDonot nottake takeCOMPLERA COMPLERAif:if: • •your yourHIV HIVinfection infectionhas hasbeen beenpreviously previouslytreated treatedwith withHIV HIVmedicines. medicines.

• •you youare aretaking takingany anyofofthe thefollowing followingmedicines: medicines:

––anti-seizure anti-seizuremedicines: medicines:carbamazepine carbamazepine(Carbatrol, (Carbatrol,Equetro, Equetro,Tegretol, Tegretol, Tegretol-XR, Tegretol-XR,Teril, Teril,Epitol); Epitol);oxcarbazepine oxcarbazepine(Trileptal); (Trileptal);phenobarbital phenobarbital (Luminal); (Luminal);phenytoin phenytoin(Dilantin, (Dilantin,Dilantin-125, Dilantin-125,Phenytek) Phenytek) ––anti-tuberculosis anti-tuberculosis(anti-TB) (anti-TB)medicines: medicines:rifabutin rifabutin(Mycobutin); (Mycobutin);rifampin rifampin (Rifater, (Rifater,Rifamate, Rifamate,Rimactane, Rimactane,Rifadin); Rifadin);rifapentine rifapentine(Priftin) (Priftin) ––proton protonpump pumpinhibitor inhibitor(PPI) (PPI)medicine medicineforforcertain certainstomach stomachororintestinal intestinal problems: problems:esomeprazole esomeprazole(Nexium, (Nexium,Vimovo); Vimovo);lansoprazole lansoprazole(Prevacid); (Prevacid); dexlansoprazole dexlansoprazole(Dexilant); (Dexilant);omeprazole omeprazole(Prilosec, (Prilosec,Zegerid); Zegerid);pantoprazole pantoprazole sodium sodium(Protonix); (Protonix);rabeprazole rabeprazole(Aciphex) (Aciphex) ––more morethan than11dose doseofofthe thesteroid steroidmedicine medicinedexamethasone dexamethasoneorordexamethasone dexamethasone sodium sodiumphosphate phosphate ––St.St.John’s John’swort wort(Hypericum (Hypericumperforatum) perforatum) • •IfIfyou youtake takeCOMPLERA, COMPLERA,you youshould shouldnot nottake: take:

––Other Othermedicines medicinesthat thatcontain containtenofovir tenofovir(Atripla, (Atripla,Stribild, Stribild,Truvada, Truvada,Viread) Viread) ––Other Othermedicines medicinesthat thatcontain containemtricitabine emtricitabineororlamivudine lamivudine(Combivir, (Combivir, Emtriva, Emtriva,Epivir EpivirororEpivir-HBV, Epivir-HBV,Epzicom, Epzicom,Trizivir, Trizivir,Atripla, Atripla,Truvada, Truvada,Stribild) Stribild) ––rilpivirine rilpivirine(Edurant) (Edurant) ––adefovir adefovir(Hepsera) (Hepsera) What Whatshould shouldI Itell tellmy myhealthcare healthcareprovider providerbefore beforetaking takingCOMPLERA? COMPLERA?

––have havestomach stomachpain painwith withnausea nausea(feeling (feelingsick sicktotoyour yourstomach) stomach)ororvomiting vomiting

Before Beforeyou youtake takeCOMPLERA, COMPLERA,tell tellyour yourhealthcare healthcareprovider providerififyou: you: • •have haveororhad hadliver liverproblems, problems,including includinghepatitis hepatitisBBororCCvirus virusinfection, infection,kidney kidney problems, problems,mental mentalhealth healthproblem problemororbone boneproblems problems

––feel feelcold, cold,especially especiallyininyour yourarms armsand andlegs legs

• •are arepregnant pregnantororplan plantotobecome becomepregnant. pregnant.ItItisisnot notknown knownififCOMPLERA COMPLERAcan can

––have havetrouble troublebreathing breathing

––feel feeldizzy dizzyororlightheaded lightheaded ––have haveaafast fastororirregular irregularheartbeat heartbeat • •Severe Severeliver liverproblems. problems.Severe Severeliver liverproblems problemscan canhappen happenininpeople peoplewho whotake take

COMPLERA. COMPLERA.InInsome somecases, cases,these theseliver liverproblems problemscan canlead leadtotodeath. death.Your Your liver livermay maybecome becomelarge large(hepatomegaly) (hepatomegaly)and andyou youmay maydevelop developfat fatininyour yourliver liver (steatosis). (steatosis).Call Callyour yourhealthcare healthcareprovider providerright rightaway awayififyou youget getany anyofofthe the following followingsymptoms symptomsofofliver liverproblems: problems:

––your yourskin skinororthe thewhite whitepart partofofyour youreyes eyesturns turnsyellow yellow(jaundice) (jaundice) ––dark dark“tea-colored” “tea-colored”urine urine ––light-colored light-coloredbowel bowelmovements movements(stools) (stools)

harm harmyour yourunborn unbornchild. child.

Pregnancy PregnancyRegistry.

Registry.There Thereisisaapregnancy pregnancyregistry registryforforwomen womenwho whotake take antiviral antiviralmedicines medicinesduring duringpregnancy. pregnancy.The Thepurpose purposeofofthis thisregistry registryisistotocollect collect information informationabout aboutthe thehealth healthofofyou youand andyour yourbaby. baby.Talk Talktotoyour yourhealthcare healthcare provider providerabout abouthow howyou youcan cantake takepart partininthis thisregistry. registry.

• •are arebreast-feeding breast-feedingororplan plantotobreast-feed. breast-feed.You Youshould shouldnot notbreastfeed breastfeedififyou you

have haveHIV HIVbecause becauseofofthe therisk riskofofpassing passingHIV HIVtotoyour yourbaby. baby.DoDonot notbreastfeed breastfeed ififyou youare aretaking takingCOMPLERA. COMPLERA.AtAtleast leasttwo twoofofthe themedicines medicinescontained containedinin COMPLERA COMPLERAcan canbebepassed passedtotoyour yourbaby babyininyour yourbreast breastmilk. milk.We Wedodonot notknow know whether whetherthis thiscould couldharm harmyour yourbaby. baby.Talk Talktotoyour yourhealthcare healthcareprovider providerabout aboutthe the best bestway waytotofeed feedyour yourbaby. baby.

––loss lossofofappetite appetiteforforseveral severaldays daysororlonger longer

Tell Tellyour yourhealthcare healthcareprovider providerabout aboutallallthe themedicines medicinesyou youtake, take,including including prescription prescriptionand andnonprescription nonprescriptionmedicines, medicines,vitamins, vitamins,and andherbal herbalsupplements. supplements.

––nausea nausea

• •COMPLERA COMPLERAmay mayaffect affectthe theway wayother othermedicines medicineswork, work,and andother othermedicines medicines

––stomach stomachpain pain • •You Youmay maybebemore morelikely likelytotoget getlactic lacticacidosis acidosisororsevere severeliver liverproblems problemsifif

you youare arefemale, female,very veryoverweight overweight(obese), (obese),ororhave havebeen beentaking takingCOMPLERA COMPLERA for foraalong longtime. time.

may mayaffect affecthow howCOMPLERA COMPLERAworks, works,and andmay maycause causeserious seriousside sideeffects. effects.IfIf you youtake takecertain certainmedicines medicineswith withCOMPLERA, COMPLERA,the theamount amountofofCOMPLERA COMPLERAininyour your body bodymay maybebetoo toolow lowand andititmay maynot notwork worktotohelp helpcontrol controlyour yourHIV HIVinfection. infection.

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problems problemsinclude includebone bonepain, pain,softening softeningororthinning thinning(which (whichmay maylead leadtoto fractures). fractures).Your Yourhealthcare healthcareprovider providermay mayneed needtotododoadditional additionaltests teststotocheck check your yourbones. bones.

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ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2013 Gilead Sciences, Inc. All rights reserved. CPAC0055 09/13

cur e wat ch

Using a Common Nail Fungus

Researchers have investigated house cats, Russian mushrooms, a nail fungus remedy, and more in their constant study of what kills HIV

Eradicating a Monkey Virus

Siberian Mushrooms To Stop It

An HIV vaccine candidate developed by the Oregon Health and Science University and tested on monkeys could hold the key to unlocking a cure for humans.

Researchers administered the experimental HIV vaccine on a population of monkeys infected with SIV, a related virus found in primates, and discovered that 50 percent of their subjects no longer tested positive.

In developing the vaccine, researchers modified cytomegalovirus, a member of the herpesvirus family, in order to reprogram the body’s immune system to find and destroy SIV. In more than half of cases, the virus was “banished from the host,” said OHSU researcher Louis Picker, MD. “Through this method we were able to teach the monkey’s body to better ‘prepare its defenses’ to combat the disease,” Picker said.

Although the results of the simian tests were promising, Picker said it is still too soon to celebrate. A version of the vaccine would have to be tested on human subjects before it could be widely available, and development of that human version could take up to three years, he said.

Funded by the Bill and Melinda Gates Foundation, the National Institutes of Health, and the International AIDS Vaccine Initiative, the study took place at the OHSU Vaccine and Gene Therapy Institute, in collaboration with the Oregon National Primate Research Center. The findings were published in September in the weekly science journal Nature.

Scientists from a research lab in Siberia believe a strain of mushroom is capable of combating HIV. Three different types of mushrooms, used as folk remedies in Russia since the 16th century, can be successfully developed into antiviral medicines, officials with the Vector State Research Center said in September.

Before the breakup of the Soviet Union, the state-funded Vector was a biological weapons facility that researched ways to produce mass genocide via deadly viruses such as smallpox.

Today, the Vector research base seeks to combat many of those same viruses.

Its tests found the Chaga mushroom, which grows on the region’s birch trees, to be most effective in protecting cellular DNA from damaging free radicals. In recent years Chaga has become a popular dietary supplement in the West; is believed to be the most potent due to its high concentration of betulinic acid. Laboratory tests show the acid is toxic to cancer cells and slows the growth of several kinds of tumor cells and HIV, according to the American Cancer Society.

According to the Memorial Sloan-Kettering Cancer Center in New York, no clinical trial has assessed Chaga’s safety or efficacy. But the Russian scientists said they intend to use the mushrooms to produce medicines and called the approach “a promising line of development.”

56

hiv plus

• j a n u a r y/ f e b r u a r y 2 0 1 4

What Your Cat Knows About HIV Humans might have something to learn from their feline friends when it comes to fighting HIV. When scientists added a protein from the cat AIDS virus to blood from HIV-infected humans, the human blood showed an immune response that could become the basis for developing a vaccine.

The feline immunodeficiency virus triggers anti-HIV T-cell activity in humans, said University of Florida researcher Janet Yamamoto.

“In humans, some peptides stimulate immune responses, which either enhance HIV infection or have no effect at all, while others may have anti-HIV activities that are lost when the virus changes or mutates to avoid such immunity,” she said. Although previous studies combined HIV proteins as vaccine components, none worked well enough, Yamamoto said.

“Surprisingly,” she said, “we have found that certain peptides of the feline AIDS virus can work exceptionally well.”

Findings from the study, a joint project of the University of Florida and the University of California, San Francisco, were published in the October issue of the Journal of Virology.

Research by Lucas Grindley, Nicholas Cimarusti, Daniel Reynolds, and Michael Regula

photos.com

New Ingredients for a Cure?

Researchers believe the antifungal drug ciclopirox has unique potential to fight HIV. A study by Rutgers New Jersey Medical School published recently in the journal PLOS One found the drug completely eradicated HIV from cell cultures.

Ciclopirox reportedly has a characteristic that prevents the virus from recovering when the drug is withheld, unlike other antiviral drugs.

Researchers say that means it could end current requirements that people with HIV be on medication for their lifetime.

The drug, which is administered topically for fungal infections, causes HIV-infected cells to “commit suicide” by interfering with a cell component called mitochondria, the researchers say.

Ciclopirox’s HIV-fighting ability has so far only been tested in cell cultures, so it will still need to go through clinical trials on humans to study its safety and efficacy as a potential HIV treatment. The fact that it is already deemed safe and approved by the Food and Drug Administration for human use to combat other infections, though, could make the regulatory process go faster than usual.

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Welcome to a pharmacy that gets to know you, not just your diagnosis. We’re not just treating HIV patients, we’re getting to know individuals.

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