HIV Plus Magazine - Issue 73 - October 2009 by Pride Media

H E A L T H

U L T U R E + L I F E

Honoring 25 of todayâ&#x20AC;&#x2122;s leaders working to ensure the HIV fight rages on

NOVEMBER/DECEMBER 2009 www.hivplusmag.com

• Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of INDICATION suicide and a few have actually committed suicide. ® ATRIPLA (efavirenz 600 mg/emtricitabine 200 mg/ These problems may occur more often in patients tenofovir disoproxil fumarate [DF] 300 mg) is a who have had mental illness. prescription medication used alone as a complete • Dizziness, trouble sleeping or concentrating, regimen or with other medicines to treat HIV-1 drowsiness, unusual dreams, and/or infection in adults. hallucinations are common, and tend to go away ATRIPLA does not cure HIV-1 and has not been after taking ATRIPLA (efavirenz 600 mg/ shown to prevent passing HIV-1 to others. emtricitabine 200 mg/tenofovir DF 300 mg) for See your healthcare provider regularly. a few weeks. Symptoms were severe in a few patients and some patients discontinued therapy. IMPORTANT SAFETY INFORMATION These symptoms may become more severe with Contact your healthcare provider right away if the use of alcohol and/or mood-altering (street) you experience any of the following side effects drugs. If you are dizzy, have trouble concentrating, or conditions associated with ATRIPLA: and/or are drowsy, avoid activities that may be • Nausea, vomiting, unusual muscle pain, and/ dangerous, such as driving or operating machinery. or weakness. These may be signs of a buildup • Kidney or liver problems. If you have had kidney of acid in the blood (lactic acidosis), which is or liver problems, including hepatitis infection or a serious medical condition. take other medicines that may cause kidney or • Light colored stools, dark colored urine, and/ liver problems, your healthcare provider should do or if your skin or the whites of your eyes turn regular blood tests. yellow. These may be signs of serious liver • Pregnancy: Women should not become problems. pregnant while taking ATRIPLA and for • If you have HIV-1 and hepatitis B virus (HBV), 12 weeks after stopping ATRIPLA. Serious birth your liver disease may suddenly get worse if defects have been seen in children of women you stop taking ATRIPLA. Do not stop taking treated during pregnancy with one of the ATRIPLA unless directed by your healthcare medicines in ATRIPLA. Therefore, women must use provider. a reliable form of barrier contraception, such as a Do not take ATRIPLA if you are taking the condom or diaphragm, even if they also use other following medicines because serious and methods of birth control. life-threatening side effects may occur when • Breast-Feeding: Women with HIV-1 should not taken together: breast-feed because they can pass HIV-1 through Vascor® (bepridil), Propulsid® (cisapride), their milk to the baby. Also, ATRIPLA may pass Versed® (midazolam), Orap® (pimozide), through breast milk and cause serious harm to the ® Halcion (triazolam), or ergot medications baby. ® ® (for example, Wigraine and Cafergot ). • Rash is a common side effect that usually goes In addition, ATRIPLA should not be taken away without treatment, but may be serious in a with: Combivir® (lamivudine/zidovudine), small number of patients. ® EMTRIVA (emtricitabine), • Seizures have occurred in patients taking a Epivir® or Epivir-HBV® (lamivudine), component of ATRIPLA, usually in those with Epzicom® (abacavir sulfate/lamivudine), a history of seizures. If you have ever had seizures, SUSTIVA® (efavirenz), or take medicine for seizures, your healthcare Trizivir® (abacavir sulfate/lamivudine/zidovudine), provider may want to switch you to another TRUVADA® (emtricitabine/tenofovir DF), medicine or monitor you. or VIREAD® (tenofovir DF), because they contain the same or similar active ingredients as ATRIPLA. • Bone changes. If you have had bone problems in the past, your healthcare provider may want to Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate), ® with or without Norvir (ritonavir), should not be taken check your bones. with ATRIPLA since they may lose their effect and • If you have ever had mental illness or use illegal may also increase the chance of having side effects drugs or alcohol. ® ® from ATRIPLA. Fortovase or Invirase (saquinavir) Changes in body fat have been seen in some people should not be used as the only protease inhibitor in taking anti-HIV-1 medicines. The cause and combination with ATRIPLA. long-term health effects are not known. Taking ATRIPLA with St. John’s wort or products containing St. John’s wort is not recommended as it Other common side effects of ATRIPLA include tiredness, headache, upset stomach, vomiting, gas, may cause decreased levels of ATRIPLA, increased and diarrhea. Skin discoloration (small spots or viral load, and possible resistance to ATRIPLA or freckles) may also happen. cross-resistance to other anti-HIV drugs. You should take ATRIPLA once daily on an empty This list of medicines is not complete. Discuss stomach. Taking ATRIPLA at bedtime may make with your healthcare provider all prescription some side effects less bothersome. and nonprescription medicines, vitamins, or herbal supplements you are taking or plan ATRIPLA is one of several treatment options to take. your doctor may consider. Contact your healthcare provider right away if you experience any of the following side effects or You are encouraged to report negative conditions: side effects of prescription drugs to the

Important Information

FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please see Patient Information on the following pages.

Patient model. Individual results may vary.

© 2009 Bristol-Myers Squibb & Gilead Sciences, LLC. All rights reserved. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, VIREAD, and TRUVADA are trademarks of Gilead Sciences, Inc. SUSTIVA is a registered trademark of Bristol-Myers Squibb Pharma Company. REYATAZ is a registered trademark of Bristol-Myers Squibb Company. All other trademarks are owned by third parties. 697US09AB01704/TR1492 03/09

“ATRIPLA has all my HIV meds in one pill daily, and helps me take charge of my HIV.” Steven on ATRIPLA for 2 years

ATRIPLA is the #1 prescribed HIV regimen.* • Only ATRIPLA combines 3 HIV medications in 1 pill daily. • Proven to lower viral load to undetectable† and help raise T-cell (CD4+) count to help control HIV through 3 years of a clinical study. Talk to your doctor to see if ATRIPLA is right for you. Your doctor may prescribe ATRIPLA alone or with other HIV medications.

Please see Important Safety Information, including information on lactic acidosis, serious liver problems, and flare-ups of hepatitis B virus (HBV) on adjacent page. *Synovate Healthcare Data; US HIV Monitor, Q3 2008.

†

Defined as a viral load of less than 400 copies/mL.

To learn more, visit www.ATRIPLA.com

FDA-Approved Patient Labeling Patient Information ATRIPLA® (uh TRIP luh) Tablets ALERT: Find out about medicines that should NOT be taken with ATRIPLA. Please also read the section “MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA.” Generic name: efavirenz, emtricitabine and tenofovir disoproxil fumarate (eh FAH vih renz, em tri SIT uh bean and te NOE’ fo veer dye soe PROX il FYOU mar ate) Read the Patient Information that comes with ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) before you start taking it and each time you get a refill since there may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment. You should stay under a healthcare provider’s care when taking ATRIPLA. Do not change or stop your medicine without first talking with your healthcare provider. Talk to your healthcare provider or pharmacist if you have any questions about ATRIPLA. What is the most important information I should know about ATRIPLA? • Some people who have taken medicine like ATRIPLA (which contains nucleoside analogs) have developed a serious condition called lactic acidosis (build up of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get the following signs or symptoms of lactic acidosis: • You feel very weak or tired. • You have unusual (not normal) muscle pain. • You have trouble breathing. • You have stomach pain with nausea and vomiting. • You feel cold, especially in your arms and legs. • You feel dizzy or lightheaded. • You have a fast or irregular heartbeat. • Some people who have taken medicines like ATRIPLA have developed serious liver problems called hepatotoxicity, with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get the following signs or symptoms of liver problems: • Your skin or the white part of your eyes turns yellow (jaundice). • Your urine turns dark. • Your bowel movements (stools) turn light in color. • You don’t feel like eating food for several days or longer. • You feel sick to your stomach (nausea). • You have lower stomach area (abdominal) pain. • You may be more likely to get lactic acidosis or liver problems if you are female, very overweight (obese), or have been taking nucleoside analog-containing medicines, like ATRIPLA, for a long time. • If you also have hepatitis B virus (HBV) infection and you stop taking ATRIPLA, you may get a “flare-up” of your hepatitis. A “flare-up” is when the disease suddenly returns in a worse way than before. Patients with HBV who stop taking ATRIPLA need close medical follow-up for several months, including medical exams and blood tests to check for hepatitis that could be getting worse. ATRIPLA is not approved for the treatment of HBV, so you must discuss your HBV therapy with your healthcare provider. What is ATRIPLA? ATRIPLA contains 3 medicines, SUSTIVA® (efavirenz), EMTRIVA® (emtricitabine) and VIREAD® (tenofovir disoproxil fumarate also called tenofovir DF) combined in one pill. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and SUSTIVA is an HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI). VIREAD and EMTRIVA are the components of TRUVADA®. ATRIPLA can be used alone as a complete regimen, or in combination with other antiHIV-1 medicines to treat people with HIV-1 infection. ATRIPLA is for adults age 18 and over. ATRIPLA has not been studied in children under age 18 or adults over age 65. HIV infection destroys CD4+ T cells, which are important to the immune system. The immune system helps fight infection. After a large number of T cells are destroyed, acquired immune deficiency syndrome (AIDS) develops. ATRIPLA helps block HIV-1 reverse transcriptase, a viral chemical in your body (enzyme) that is needed for HIV-1 to multiply. ATRIPLA lowers the amount of HIV-1 in the blood (viral load). ATRIPLA may also help to increase the number of T cells (CD4+ cells), allowing your immune system to improve. Lowering the amount of HIV-1 in the blood lowers the chance of death or infections that happen when your immune system is weak (opportunistic infections). Does ATRIPLA cure HIV-1 or AIDS? ATRIPLA does not cure HIV-1 infection or AIDS. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get opportunistic infections or other conditions that happen with HIV-1 infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infection. It is very important that you see your healthcare provider regularly while taking ATRIPLA.

Does ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) reduce the risk of passing HIV-1 to others? ATRIPLA has not been shown to lower your chance of passing HIV-1 to other people through sexual contact, sharing needles, or being exposed to your blood. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes or razor blades. • Do not have any kind of sex without protection. Always practice safer sex by using a latex or polyurethane condom or other barrier to reduce the chance of sexual contact with semen, vaginal secretions, or blood. Who should not take ATRIPLA? Together with your healthcare provider, you need to decide whether ATRIPLA is right for you. Do not take ATRIPLA if you are allergic to ATRIPLA or any of its ingredients. The active ingredients of ATRIPLA are efavirenz, emtricitabine, and tenofovir DF. See the end of this leaflet for a complete list of ingredients. What should I tell my healthcare provider before taking ATRIPLA? Tell your healthcare provider if you: • Are pregnant or planning to become pregnant (see “What should I avoid while taking ATRIPLA?”). • Are breast-feeding (see “What should I avoid while taking ATRIPLA?”). • Have kidney problems or are undergoing kidney dialysis treatment. • Have bone problems. • Have liver problems, including hepatitis B virus infection. Your healthcare provider may want to do tests to check your liver while you take ATRIPLA. • Have ever had mental illness or are using drugs or alcohol. • Have ever had seizures or are taking medicine for seizures. What important information should I know about taking other medicines with ATRIPLA? ATRIPLA may change the effect of other medicines, including the ones for HIV-1, and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses. Other medicines, including herbal products, may affect ATRIPLA. For this reason, it is very important to let all your healthcare providers and pharmacists know what medications, herbal supplements, or vitamins you are taking. MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA • The following medicines may cause serious and life-threatening side effects when taken with ATRIPLA. You should not take any of these medicines while taking ATRIPLA: Vascor (bepridil), Propulsid (cisapride), Versed (midazolam), Orap (pimozide), Halcion (triazolam), ergot medications (for example, Wigraine and Cafergot). • ATRIPLA also should not be used with Combivir (lamivudine/zidovudine), EMTRIVA, Epivir, Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), Trizivir (abacavir sulfate/lamivudine/zidovudine), SUSTIVA, TRUVADA, or VIREAD. • Vfend (voriconazole) should not be taken with ATRIPLA since it may lose its effect or may increase the chance of having side effects from ATRIPLA. • Do not take St. John’s wort (Hypericum perforatum), or products containing St. John’s wort with ATRIPLA. St. John’s wort is an herbal product sold as a dietary supplement. Talk with your healthcare provider if you are taking or are planning to take St. John’s wort. Taking St. John’s wort may decrease ATRIPLA levels and lead to increased viral load and possible resistance to ATRIPLA or cross-resistance to other anti-HIV-1 drugs. It is also important to tell your healthcare provider if you are taking any of the following: • Fortovase, Invirase (saquinavir), Biaxin (clarithromycin); or Sporanox (itraconazole); these medicines may need to be replaced with another medicine when taken with ATRIPLA. • Calcium channel blockers such as Cardizem or Tiazac (diltiazem), Covera HS or Isoptin (verapamil) and others; Crixivan (indinavir); Methadone; Mycobutin (rifabutin); Rifampin; cholesterol-lowering medicines such as Lipitor (atorvastatin), Pravachol (pravastatin sodium), and Zocor (simvastatin); or Zoloft (sertraline); these medicines may need to have their dose changed when taken with ATRIPLA. • Videx, Videx EC (didanosine); tenofovir DF (a component of ATRIPLA) may increase the amount of didanosine in your blood, which could result in more side effects. You may need to be monitored more carefully if you are taking ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) and didanosine together. Also, the dose of didanosine may need to be changed. • Reyataz (atazanavir sulfate) or Kaletra (lopinavir/ritonavir); these medicines may increase the amount of tenofovir DF (a component of ATRIPLA) in your blood, which could result in more side effects. Reyataz is not recommended with ATRIPLA. You may need to be monitored more carefully if you are taking ATRIPLA and Kaletra together. Also, the dose of Kaletra may need to be changed. • Medicine for seizures [for example, Dilantin (phenytoin), Tegretol (carbamazepine), or phenobarbital]; your healthcare provider may want to switch you to another medicine or check drug levels in your blood from time to time.

These are not all the medicines that may cause problems if you take ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate). Be sure to tell your healthcare provider about all medicines that you take. Keep a complete list of all the prescription and nonprescription medicines as well as any herbal remedies that you are taking, how much you take, and how often you take them. Make a new list when medicines or herbal remedies are added or stopped, or if the dose changes. Give copies of this list to all of your healthcare providers and pharmacists every time you visit your healthcare provider or fill a prescription. This will give your healthcare provider a complete picture of the medicines you use. Then he or she can decide the best approach for your situation. How should I take ATRIPLA? • Take the exact amount of ATRIPLA your healthcare provider prescribes. Never change the dose on your own. Do not stop this medicine unless your healthcare provider tells you to stop. • You should take ATRIPLA on an empty stomach. • Swallow ATRIPLA with water. • Taking ATRIPLA at bedtime may make some side effects less bothersome. • Do not miss a dose of ATRIPLA. If you forget to take ATRIPLA, take the missed dose right away, unless it is almost time for your next dose. Do not double the next dose. Carry on with your regular dosing schedule. If you need help in planning the best times to take your medicine, ask your healthcare provider or pharmacist. • If you believe you took more than the prescribed amount of ATRIPLA, contact your local poison control center or emergency room right away. • Tell your healthcare provider if you start any new medicine or change how you take old ones. Your doses may need adjustment. • When your ATRIPLA supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ATRIPLA and become harder to treat. • Your healthcare provider may want to do blood tests to check for certain side effects while you take ATRIPLA. What should I avoid while taking ATRIPLA? • Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping it. Serious birth defects have been seen in the babies of animals and women treated with efavirenz (a component of ATRIPLA) during pregnancy. It is not known whether efavirenz caused these defects. Tell your healthcare provider right away if you are pregnant. Also talk with your healthcare provider if you want to become pregnant. • Women should not rely only on hormone-based birth control, such as pills, injections, or implants, because ATRIPLA may make these contraceptives ineffective. Women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control. Efavirenz, a component of ATRIPLA, may remain in your blood for a time after therapy is stopped. Therefore, you should continue to use contraceptive measures for 12 weeks after you stop taking ATRIPLA. • Do not breast-feed if you are taking ATRIPLA. The Centers for Disease Control and Prevention recommend that mothers with HIV not breast-feed because they can pass the HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby. Talk with your healthcare provider if you are breast-feeding. You should stop breast-feeding or may need to use a different medicine. • Taking ATRIPLA with alcohol or other medicines causing similar side effects as ATRIPLA, such as drowsiness, may increase those side effects. • Do not take any other medicines, including prescription and nonprescription medicines and herbal products, without checking with your healthcare provider. • Avoid doing things that can spread HIV-1 infection since ATRIPLA does not stop you from passing the HIV-1 infection to others. What are the possible side effects of ATRIPLA? ATRIPLA may cause the following serious side effects: • Lactic acidosis (buildup of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get signs of lactic acidosis. (See “What is the most important information I should know about ATRIPLA?”) • Serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get any signs of liver problems. (See “What is the most important information I should know about ATRIPLA?”) • “Flare-ups” of hepatitis B virus (HBV) infection, in which the disease suddenly returns in a worse way than before, can occur if you have HBV and you stop taking ATRIPLA. Your healthcare provider will monitor your condition for several months after stopping ATRIPLA if you have both HIV-1 and HBV infection and may recommend treatment for your HBV. • Serious psychiatric problems. A small number of patients may experience severe depression, strange thoughts, or angry behavior while taking ATRIPLA. Some patients have thoughts of suicide and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. Contact your healthcare provider right away if you think you are having these psychiatric symptoms, so your healthcare provider can decide if you should continue to take ATRIPLA.

• Kidney problems. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider should do regular blood tests to check your kidneys. • Changes in bone mineral density (thinning bones). It is not known whether long-term use of ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) will cause damage to your bones. If you have had bone problems in the past, your healthcare provider may need to do tests to check your bone mineral density or may prescribe medicines to help your bone mineral density. Common side effects: Patients may have dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams during treatment with ATRIPLA. These side effects may be reduced if you take ATRIPLA at bedtime on an empty stomach. They also tend to go away after you have taken the medicine for a few weeks. If you have these common side effects, such as dizziness, it does not mean that you will also have serious psychiatric problems, such as severe depression, strange thoughts, or angry behavior. Tell your healthcare provider right away if any of these side effects continue or if they bother you. It is possible that these symptoms may be more severe if ATRIPLA is used with alcohol or mood altering (street) drugs. If you are dizzy, have trouble concentrating, or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery. Rash may be common. Rashes usually go away without any change in treatment. In a small number of patients, rash may be serious. If you develop a rash, call your healthcare provider right away. Other common side effects include tiredness, upset stomach, vomiting, gas, and diarrhea. Other possible side effects with ATRIPLA include: • Changes in body fat. Changes in body fat develop in some patients taking anti-HIV-1 medicine. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), in the breasts, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these fat changes are not known. • Skin discoloration (small spots or freckles) may also happen with ATRIPLA. Tell your healthcare provider or pharmacist if you notice any side effects while taking ATRIPLA. Contact your healthcare provider before stopping ATRIPLA because of side effects or for any other reason. This is not a complete list of side effects possible with ATRIPLA. Ask your healthcare provider or pharmacist for a more complete list of side effects of ATRIPLA and all the medicines you will take. How do I store ATRIPLA? • Keep ATRIPLA and all other medicines out of reach of children. • Store ATRIPLA at room temperature 77 °F (25 °C). • Keep ATRIPLA in its original container and keep the container tightly closed. • Do not keep medicine that is out of date or that you no longer need. If you throw any medicines away make sure that children will not find them. General information about ATRIPLA: Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use ATRIPLA for a condition for which it was not prescribed. Do not give ATRIPLA to other people, even if they have the same symptoms you have. It may harm them. This leaflet summarizes the most important information about ATRIPLA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ATRIPLA that is written for health professionals. Do not use ATRIPLA if the seal over bottle opening is broken or missing. What are the ingredients of ATRIPLA? Active Ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate Inactive Ingredients: croscarmellose sodium, hydroxypropyl cellulose, microcrystalline cellulose, magnesium stearate, sodium lauryl sulfate. The film coating contains black iron oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc, and titanium dioxide.

September 2008 ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, TRUVADA, and VIREAD are trademarks of Gilead Sciences, Inc. SUSTIVA is a trademark of Bristol-Myers Squibb Pharma Company. Reyataz and Videx are trademarks of Bristol-Myers Squibb Company. Pravachol is a trademark of ER Squibb & Sons, LLC. Other brands listed are the trademarks of their respective owners.

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Dan Bowers, MD, is an HIV specialist and is board-certified in family medicine. He is in private practice in New York City.

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Argus Galindo

Cade Fields-Gardner is the director of services for the HIV nutrition company Cutting Edge and is a member of the International AIDS Society and the American Dietetic Association’s Dietetic Practice Group on HIV and AIDS. She is the author of Living Well With HIV and AIDS: A Guide to Nutrition and a coauthor of HIV Medications: Food Interactions and A Clinician’s Guide to Nutrition in HIV and AIDS.

Thomas Fransen is a licensed clinical social worker who is in private therapy practice in Chicago.

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Gary McClain, Ph.D., is a licensed counselor in New York City with a speciality in coping with chronic and lifethreatening health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy, and he is a frequent contributor to health-related publications. He is also on the board of directors of Miracle House, a nonprofit that serves patients and caregivers who are visiting New York City for HIV or cancer treatment.

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Lisa Barker, Christin Dennis, John Knoebel Corey Saucier is a writer, performance artist with a focus on theatrical activism, and blogger (MySpace. com/BeautyinMyEyes) who lives in Los Angeles. Through workshops and performance, he cultivates his personal histories into a public voice that echoes themes of gay minority identity, neopositive perspective, queer faith, and the crystal meth epidemic. Antonio Urbina, MD, is an HIV specialist and the medical director of HIV education and training at St. Vincent’s Comprehensive HIV Center as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.

HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10960 Wilshire Blvd., Suite 1050, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Publishing Inc. Entire contents © 2009 by Here Publishing Inc. All rights reserved. Printed in the USA.

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23 Living Legends Ahead of the final World AIDS Day of the 2000–2009 decade, we’ve partnered with AIDS Project Los Angeles—currently celebrating its 25th anniversary—to pay homage to 25 LGBT leaders who are actively involved in making sure that the fact that HIV continues to have a disproportionate impact on gay men is not overlooked.

Even if you have the disease, you can still… do great things. — O + Men cre at or Robert Walker, who illustrated himself for our cover

36 Reel Beauty Filmmaker Andy Abrahams Wilson has created a new documentary about an HIVfocused section in San Francisco’s Golden Gate Park that’s little known—although it’s been designated as the National AIDS Memorial Grove.

D E PA R T M E N T S & V O I C E S

Symbols 6 St Status t S Sym Poet Devin Robinson is working w to take his silver screen to reach a one-man show to the silv bbroader d audience. di Plus: More Pl M news and tips. 8 Take 5 11 Nutrition+Fitness 12 Nation+Beyond 13 Mind+Manner

14 H-Eye-V Eyewitnesses deliver HIV-related events from around the globe in living color.

42 HAART Beats

Although m most HIVers regularly see a physician for their the physical care, too many fail to m bring up mental health issues. Plus: Lots more treatment treatm news. 45 Rx+ Rx+Research

46 Perfectly Flawed Corey Saucier takes a moment to contemplate the meaning of an annoying cough.

48 Ask & Tell Dab “AIDS Bear” Garner is delivering teddy bears to people to help hug out their fears. ON THE COVER: ROBERT WALKER IS SELF-

ILLUSTRATED; VALERIE SPENCER PHOTOGRAPHED FOR ILLUSTRATED HIV PLUS BY BRADFORD ROGNE; JACK MACKENROTH PHOTOGRAPH PHOTOGRAPHED FOR HIV PLUS BY PETER ROSS.

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Renowned for his fiery stage shows promoting HIV awareness and safer sex, one advocate is expanding his reach on World AIDS Day by taking his oneman show to the silver screen 6

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Want to learn more about Robinson’s World AIDS Day screening of God, Me…HIV? and his other HIV-related projects? Visit us at HIVPLUSmag.com

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Being in the public eye is nothing new for Devin Robinson, a passionate 26-year-old Florida activist better known by the monikers “Egypt” and “Devin T. Robinson X.” Robinson regularly takes the stage in front of hundreds of young people to perform his oneman confessional narrative “God Did Not Give Me HIV” to help spread HIV awareness among at-risk African-Americans. He’s performed all or parts of the show more than 1,000 times in 26 U.S. states and as far away as Barbados, Trinidad, Tobago, and South Africa. But for World AIDS Day, on December 1, Robinson will step up to a whole new level—the silver screen. He will premiere a film version of his one-man show that he has redubbed God, Me…HIV? at the Cinema Paradiso movie theater in Broward County, the region of South Florida with the second highest number of HIV cases per capita. “I want to reach as many people as I can with these powerful stories and messages,” says Robinson, who also founded the group AIDS Awareness Poets and publishes his original poetry on HIVPLUSmag.com. “I can do that live in only so many places; I’m just one man. But a movie? That’s going to reach such a bigger audience.” To encourage attendance at the film’s four World AIDS Day screenings, cable TV giant Comcast helped Robinson tape several ad spots and donated local commercial air time on CNN, MSNBC, Fox News, BET, MTV, Spike TV, and many other channels. All told, the ads will air more than 5,000 times in the weeks leading up to December 1. Filmgoers at the Florida screenings will be offered free HIV testing at each theater as well as free condoms provided by LifeStyles

Take 5 > 8 >

and information about safer sex and HIV prevention from the state health department and other area AIDS service organizations. “This is the first movie ever screened in the United States where HIV tests will be available on site,” Robinson notes. “I usually have local organizations offer tests outside my stage performances and get as many as 100 to be inspired enough to get tested on the spot. The movie is taking it to the next step; hopefully, we’ll get more than a thousand people to learn their HIV status that day.” A video crew also will be on hand to tape the reaction of audience members during the screenings. That new footage will be added to the film, which Robinson hopes to take to theaters nationwide for World AIDS Day, 2010, and to make available for purchase online and through movie-rental services. “It’s going to be huge!” Robinson says enthusiastically. “This is just the beginning. I’m not going to stop until every single person at risk for HIV sees this, gets tested, and becomes a soldier in the fight against AIDS. We can do it! We have the power to end it!” —Bob Adams

Stress & the City > 11 >

Is Your Food Safe? > 13 >

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Introducing the Patient Savings Coupon Program for ISENTRESS Merck now offers a co-pay assistance program for ISENTRESS.

STATUS SYMBOLS THE TOP STORIES THAT HAD US SPENDING A LITTLE EXTRA TIME AT THE WATER COOLER

Sex Causes Cancer? Quite possibly, according to two new studies. Scientists from the American Association for Cancer Research say that at least half of all throat cancers are linked to oral transmission of HPV, one of the most common sexually transmitted diseases. A separate study in the Journal of Clinical Pathology links two particular human papillomavirus strains to half of all penile cancer cases. These studies suggest that more education needs to be done to encourage greater use of both male and female condoms, particularly for oral sex.

Eligibility restrictions, a

apply. To find out more, call 1-866-350-9232 or visit isentress.com. 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. a For

eligible privately insured patients.

Not valid for residents of Colorado and Massachusetts. Restrictions apply. Please see full terms and conditions on isentress.com.

You Booze, You Lose. AIDS experts have long warned that alcohol use affects adherence to antiretroviral therapy, and now researchers at the University of Washington have discovered just how strong a role booze plays in sticking to a medication regimen. Their analysis of studies of more than 25,000 HIVers has shown that people who drink are 50% less likely to be adherent, which the researchers quantify as taking medications as directed 90% to 100% of the time. Poor adherence can lead to the development of drug-resistant virus and, ultimately, faster disease progression.

Yeah! Take That, HIV! Researchers have isolated two new antibodies that in lab tests not only completely cripple HIV’s ability to infect human cells but also target a portion of the virus that scientists say may be its Achilles’ heel. The newly discovered broadly neutralizing antibodies, called PG9 and PG16, disable a key HIV protein that—unlike the rest of the virus—is unable to mutate to develop defenses against immune system attacks. Researchers hope their findings lead to a preventive vaccine that stimulates bNAb development. ISENTRESS is a registered trademark of Merck & Co.,Inc. Copyright © 2009 Merck & Co., Inc. All rights reserved. 20952392(1)-09/09-ISN-CON

Half a Bandwagon? While developing nations implement sweeping male-circumcision programs based on data showing the procedure cuts a heterosexual man’s HIV risk by 60% or more, U.S. health officials are only now starting to recognize its potential as a prevention method. The Centers for Disease Control and Prevention announced in August that it may for the first time recommend circumcision for all newborn boys in the United States to lower their HIV risks later in life. But there is a significant caveat. Circumcision doesn’t help the most-affected group of Americans—gay and bisexual men— primarily because most men who have sex with men engage in multiple high-risk sexual activities.

Gay Dudes Get It Bad. It’s long been known that gay and bisexual men bear the brunt of the U.S. AIDS epidemic, but researchers now know how disproportionately hardhit they are. Data from the National HIV Prevention Conference indicate that men who have sex with men contract HIV at a rate 50 times higher than women and hetero men. Worse yet, MSM of color, particularly black men, have even higher rates.

PHOTOS.COM

terms, and conditions

Presenting ISENTRESS. A different way to treat HIV when used as part of HIV combination therapy. The first drug in a class of HIV medications called integrase inhibitors. Based upon studies of up to 48-weeks: ISENTRESS when taken in combination with other anti-HIV medications may reduce viral load to undetectable (less than 400 copies/mL, or less than 50 copies/mL)a and may increase CD4 (T) cell counts. ISENTRESS may not have these effects in all patients. (adepending upon the test used)

Talk to your doctor about ISENTRESS.

Visit isentress.com for more information. Need help paying for ISENTRESS? Call the patient SUPPORT™ program at 1-800-850-3430.

INDICATIONS ISENTRESS is an anti-HIV medicine that helps control HIV infection. ISENTRESS is used along with other anti-HIV medicines in patients who are already taking or have taken anti-HIV medicines that are not controlling their HIV infection, such as patients with HIV resistant to more than one type of anti-HIV medication.

People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

The safety and effectiveness of ISENTRESS have not been established for the treatment of HIV infection in adult patients who have never taken HIV medications before or in patients under 16 years of age.

Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed because their babies could be infected with HIV through their breast milk.

The use of other medications active against HIV in combination with ISENTRESS may increase the likelihood of your overall response to treatment. Your doctor will work with you to find the right combination of HIV medications.

Tell your doctor about all the medicines you take, including prescription medicines such as rifampin (a medicine used to treat some infections such as tuberculosis), nonprescription medicines, vitamins, and herbal supplements.

It is important that you remain under your doctor’s care.

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.

ISENTRESS will NOT cure HIV infection or reduce your chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood. ISENTRESS must be used with other anti-HIV medicines.

For additional information about ISENTRESS, please read the information on the following page.

IMPORTANT RISK INFORMATION Immune reconstitution syndrome can happen in some patients with advanced HIV infection (AIDS) when antiHIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to control the HIV infection and strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included nausea, headache, tiredness, and weakness.

Patient Information ISENTRESS® (eye sen tris) (raltegravir) Tablets Read the patient information that comes with ISENTRESS1 before you start taking it and each time you get a refill. There may be new information. This leaflet is a summary of the information for patients. Your doctor or pharmacist can give you additional information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment. What is ISENTRESS? ฀ ฀ ISENTRESS is an anti-HIV (antiretroviral) medicine that helps to control HIV infection. The term HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). ISENTRESS is used along with other anti-HIV medicines in patients who are already taking or have taken anti-HIV medicines and the medicines are not controlling their HIV infection. ISENTRESS will NOT cure HIV infection. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ infections or other conditions that happen with HIV infection. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ age has not been studied. ISENTRESS must be used with other anti-HIV medicines. How does ISENTRESS work? ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ 1. It may reduce the amount of HIV in your blood. This is called your “viral load”. 2. It may also increase the number of white blood cells called CD4 (T) cells that help fight off other infections. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Does ISENTRESS lower the chance of passing HIV to other people? No. ISENTRESS does not reduce the chance of passing HIV to others through sexual ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ chance of sexual contact with any body fluids. This includes semen from a ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Ask your doctor if you have any questions about safer sex or how to prevent passing HIV to other people. What should I tell my doctor before and during treatment with ISENTRESS? Tell your doctor about all of your medical conditions. Include any of the following ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ - ISENTRESS is not recommended for use during pregnancy. ISENTRESS has not been studied in pregnant women. If you take ISENTRESS while ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ - It is recommended that HIV-infected women should not breast-feed their infants. This is because their babies could be infected with HIV through their breast milk. - Talk with your doctor about the best way to feed your baby. Tell your doctor about all the medicines you take. Include the following: ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ infections such as tuberculosis) ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Know the medicines you take. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ when you get a new medicine. How should I take ISENTRESS? Take ISENTRESS exactly as your doctor has prescribed. The recommended dose is as follows: ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

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IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ stopped for even a short period of time. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ If you fail to take ISENTRESS the way you should, here’s what to do: ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ regular schedule. Do NOT take two tablets of ISENTRESS at the same time. ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Center. Be sure to keep a supply of your anti-HIV medicines. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ pharmacy. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included: ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Other side effects ฀ ฀ ฀ ฀ ฀ ฀ ฀ thoughts and actions. A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when combination antiretroviral treatment is started. Signs and symptoms of inflammation from opportunistic infections that a person has or had may occur as the medicines work to control the HIV infection and strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS with other anti-HIV medicines. ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Tell your doctor if you have any side effect that bothers you or that does not go away. ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ doctor or pharmacist. How should I store ISENTRESS? ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀Keep ISENTRESS and all medicines out of the reach of children. General information about the use of ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ you have. It may harm them. This leaflet gives you the most important information about ISENTRESS. ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ISENTRESS that is written for health professionals. ฀ ฀฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ What are the ingredients in ISENTRESS? Active ingredient:฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ Inactive ingredients:฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ and black iron oxide. ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀

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Gloomy? Try the Sunshine Vitamin As the winter closes in, the issue of vitamin D takes on extra importance, especially for people in more northern climes. Vitamin D acts as a prohormone in the body to regulate many normal body functions and tissues. We think of it mostly for its role in maintaining good bone and cardiovascular health. Cade Fields-Gardner, RD

CHICAGO AND BICYCLE BY PHOTOS.COM; SANDWICH BY ISTOCKPHOTO.COM; MILK BY ISTOCKPHOTO.COM

Stress and the City Feeling more stressed-out these days? Part of the reason could be where you live, according to a study reported by Forbes.com. A review of stress factors—including unemployment rates, costof-living estimates, median home prices, population density, and weather data for the 40 largest U.S. metro areas—has shown that, unfortunately, cities home to large numbers of HIVers also rank high for stress. Here’s how the top 10 stack up: a Chicago b Los Angeles c New York City d Cleveland e Providence, R.I.

f San Francisco g Detroit h Boston i Washington, D.C. j San Jose, Calif.

And that reputation of California being stress-free? Forget it, according to the study. In addition to placing three cities in the top 10, San Diego, Sacramento, and Riverside help to round out the top 16.

Vitamin D is a fat-soluble vitamin that can be made by your own body through exposure of your skin to sunlight. The fat underneath the skin forms vitamin D3 (cholecalciferol), which is further processed to become the active form (calcitriol) by the liver and kidney. If there is not enough exposure to UVB light, or if there are impairments in liver, kidney, or hormonal functions, vitamin D levels and function can become imbalanced. You can have your vitamin D levels tested. A serum level of 25-hydroxy vitamin D—25(OH) D—reflects both dietary and body synthesis of the vitamin. Other conditions that interfere with effective vitamin D functions include lack of physical activity, smoking, heavy drinking, and some medications. Even inflammatory conditions, such as chronic HIV infection, may change how well vitamin D works in the body. Food sources of vitamin D tend to be somewhat limited, so some foods (like milk) are fortified with vitamin D. There have been several reports of benefit for moderate vitamin D supplementation in

its active form (calcitriol): 1,25 dihydroxy vitamin D3—also called 1,25-dihydroxycholecalciferol or 1,25(OH)2D3. These benefits include improved bone health and better survival with cardiovascular disease. Supplemental levels are best individualized according to each person’s risk factors, but care should be taken to make sure that nutritional balance is maintained and that a person doesn’t consume too much. The adequate intake of vitamin D is set at around 200 IU (five micrograms) per day. However, general recommendations for vitamin D supplementation for people at risk for bone loss might hover around 1,000 IU per day. There is a lot of debate about vitamin D, and the Institute of Medicine is now revisiting the recommendations for vitamin D; a new report of their review is expected next year.

How Safe Is the Food You Eat? Before you scarf down that bologna sandwich, you might want to quickly review food-safety rules for HIVers. Not sure what those are? You’re not alone, say researchers at the University of Illinois at Chicago School

of Public Health. They’ve received a three-year, $600,000 federal grant to improve foodsafety awareness and will get under way this fall with surveys of HIVers in Chicago, New Orleans, and Puerto Rico. Food safety is especially important for HIVers, who

may have lower levels of stomach acid—one of the body’s primary defenses against consumed pathogens. Oh, and that sandwich? Cold cuts can harbor listeria, and should be heated before eating, says lead researcher Mark Dworkin.

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Stronger Immune Response = Faster HIV Progression? One of the more puzzling clinical aspects of HIV is that women tend to experience more rapid disease progression than men. And now researchers at the Ragon Institute might know why. Ironically, it could be because of more robust immune responses to the virus. Lab tests have shown that women’s immune systems more quickly recognize invading virus and ramp up production of a chemical to activate CD8-cell defenses. But that robust immune

response may be detrimental later; studies have shown that chronic, ongoing immune activation leads to faster progression of HIV. So while HIV levels are generally lower in women immediately after infection, they tend to fall further and faster than men’s in the long run. The researchers hope their findings lead to new therapeutic approaches to regulate initial immune system responses to the virus—and to a better understanding of gender differences in responses to the virus and the drugs used to suppress it.

WHAT’S GOING ON ACROSS THE GLOBE

EUROPE Researchers in France say risqué online conversations between gay men seeking sex partners on the Internet may be fueling later decisions to avoid condom use. A survey of more than 2,600 users of a website showed that 96% of the men intended to use a condom with a partner they met on the site but that after chatting about sexual fantasies 32% ultimately engaged in unprotected sex. An HIV organization in Germany created controversy this fall with a safer-sex campaign

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that included images of a nude Adolf Hitler having sex with a woman under the tagline “AIDS Is a Mass Murderer.” The campaign upset Jewish and Holocaust remembrance groups, which objected to the use of Hitler’s image, and AIDS advocates, who said the ad equated HIV-positive people with killers. HIVers in the United Kingdom report widespread acceptance in the workplace, according to a survey. More than half said HIV had no effect on their working life, and 75% reported that disclosing their serostatus in the workplace had been generally positive. AFRICA Malawi is reporting soaring HIV rates among men who have sex with men. A survey has found that more than half of men who selfidentify as gay are HIV-positive, as are nearly 48% of those self-identified as bisexual. Steps taken in Mozambique to shift HIV care away from specialized clinics to the nation’s larger health care system have caused a dramatic decline in the number of HIVers seeking treatment. Activists say the drop-off is due in part to fear of being publicly identified as being HIV-positive at general health care centers. Mining firm Anglo American, the largest employer in South Africa with more than 80,000 workers, reports that about 14,500 employees—18% of its workforce—are HIV-positive. About half of the infected workers are receiving anti-HIV treatment through the company.

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Government officials in Zambia have halted sales of Evolution and Hot brands of condoms after tests showed the rubbers, produced by a U.K. firm, had holes in them. Consumers who purchased the condoms before the recall were urged not to use them, since they wouldn’t protect against pregnancy, HIV, or other STDs. ASIA Government officials in Cambodia have created a de facto “AIDS colony,” activists say, by forcibly relocating 40 families affected by HIV from Phnom Penh to a substandard housing facility 25 kilometers away, far from medical facilities and support services. Nearly half of the HIVers receiving firstline anti-HIV medications in China experience treatment failure within five years, according to a new study, and are forced to cease antiretroviral therapy because second-line medications are not widely available in the nation. A 9-year-old HIV-positive boy in Allahabad, India, was expelled from his primary school because the school’s principal deemed him to pose an infection risk to other students. Activists say the case illustrates widespread ignorance about the disease and how it is spread, even among well-educated groups. About 4,000 women migrant workers are infected with HIV while abroad each year and return home to Indonesia, where they spread the virus to local sex partners, according to the Bali Health Foundation. The nation is home to an estimated 270,000 HIV-positive adults.

Health officials in Iran report discovering a strain of tuberculosis entirely resistant to all of the medications used in first- and second-line therapy. The strain may pose a severe threat to the region’s HIVers, who are more prone to contracting TB and dying from the infection. Young people ages 20 to 30 now account for most new HIV diagnoses in Lebanon, leading health officials there to call for renewed HIV education and prevention programs targeting young men who have sex with men and heterosexual couples. Health officials in the Philippines are focusing new HIV prevention efforts on men who have sex with men but who do not identify as being gay or bisexual—a group that health officials say is particularly hard to reach because they are secretive about their sexual activity and shun prevention programs targeting openly gay men. AIDS activists in Thailand say that despite being banned, sex between male prisoners and illegal drug use are fueling an explosion of HIV transmissions in the nation’s prisons. The activists are urging government officials to make condoms, personal lubricants, and sterile syringes available to all prisoners. OCEANIA New HIV infections in Australia appear to have plateaued at about 1,000 cases per year, according to government figures from 2007 and 2008. Gay and bisexual men continue to bear the brunt of the disease, accounting for 64% of all new diagnoses in 2008.

PHOTOS.COM

AMERICAS Government officials in Brazil report that since 1996 the nation has saved $1 billion by producing generic versions of patented antiHIV medications and more than $2 billion in AIDS-related hospital costs by providing free antiretroviral treatment to its HIVers. Health officials in Toronto and Ottawa, Canada, are assessing whether to establish supervised injection facilities for heroin users in an effort to stop the sharing of drug paraphernalia and the subsequent spread of blood-borne diseases, like HIV and hepatitis. A facility in Vancouver has been credited with preventing numerous HIV infections. HIV cases are rising sharply among young people in Cuba, according to local health experts. The nation is expected to record more than 1,400 new HIV cases this year, the highest percentage being among people ages 19 to 24. Cuba offers free antiretroviral treatment to its HIV-positive citizens.

Can Oral Sex Cause Cancer?

Losing Your Lover, Reclaiming Your Power

Infection with the sexually transmitted human papillomavirus is responsible for at least one third of all new oral and throat cancer cases, according to a leading cancer institute. “In the past oral cancers were almost always associated with smok-

Love hurts. Aren’t there a few songs about that? Losing it hurts even more. Clients whom I’ll call Juan, who was recently diagnosed HIV-positive, and Christy, who has been living with HIV for over 10 years, both had their partners break up with them. Gary McClain, Ph.D.

ing and alcohol abuse,” says Solomon Hamburg, president of the Tower Cancer Research Foundation. Not anymore. Today, HPV is found in about one third of all oral cancer tumors. While HPV can be transmitted through a number of sexual practices, researchers believe infections via oral sex are closely linked with head, neck, and throat cancers. And unfortunately, male and female condoms are not 100% effective in preventing HPV.

PHOTOS.COM

Oh, Naturale! Although it may be tempting for HIVers to turn to bodybuilding supplements to fight HIV-related wasting and lipoatrophy, doing so risks serious side eﬀects, including liver injury, strokes, kidney failure, and artery blockages in the lungs, the Food and Drug Administration warns. This summer the agency issued a public-health advisory stating that many bodybuilding products marketed as dietary supplements actually contain steroids or synthetic steroid-like substances, which are unregulated

tips+tools For a list of some of the products included in the FDA warning, visit us online at HIVPLUSmag.com

drugs. The advisory warns consumers to stop taking products that outwardly claim to contain steroid-like substances or claim to enhance or diminish androgen-, estrogen-, or progestin-like eﬀects in the body.

“When I started the meds, it was like the whole thing suddenly became too real,” Juan says. “When I got home from work last night, my partner told me things had gotten too complicated and he was moving out.” Christy had a similar story: “We have a son together. We are a family—or at least he said we were. All of a sudden he needs what he calls ‘my space.’ I love it! I’m holding our home together, and he’s the one who needs space?” Sure, it hurts. Whether it’s a lover or a friend, when somebody who we thought could really be there for us suddenly heads for the exit, we are left with a big gap that, at that moment, feels like it might not ever be filled. It’s about you, and it’s not about you. A medical diagnosis of any kind creates new responsibilities, new concerns. The party isn’t over, but some modifications are in order. Life just isn’t going to be the same. People are human, and that means they have limitations that, unfortunately, aren’t always overcome by their best intentions. Maybe promises won’t be honored after all. So he/she changed. Maybe you did too. Maybe you even changed first. My newly diagnosed clients consistently tell me that their diagnosis has brought about a change in how they view life. They often tell me that they are taking life more seriously, and that means taking a closer

look at what they want in a relationship. They talk about wanting closer connections with the people they care about, being able to talk about what’s really on their minds, being giving to others, and expecting the same in return. Essentially, to make each moment count. Ask yourself, Are you expecting more from the people in your life? You may be communicating your needs and emotions in a way you haven’t in the past. Directly or indirectly, your expectations may be clear. That can be a scary change and some of the people in your life—lovers, family, and friends—are going to be up to the challenge and be willing to work to achieve a deeper relationship with you. Others are going to bump up against their own limitations and bolt. But that doesn’t mean you have to settle for less. Your power works from the inside out, not outside in. Yes, you’re human, and you need other people in your life. Sit with the pain of losing someone and let yourself grieve over the loss. There’s not much in life that aches any harder. But let’s face it, we all have to be able to count on ourselves first. Being centered in who you are, knowing how to meet your own needs—and knowing what you can give to others as well as what you expect in return—creates a whole new energy that radiates outward and attracts new energy. And, in turn, new people. So get ready for the next chapter of your life!

McClain welcomes e-mail at Gary@JustGotDiagnosed.com

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SOME JAIL TIME OFF

PRIOR SPREAD: SONNY TUMBELAK A/AFP/GE T T Y IMAGES; THIS PAGE: LAKRUWAN WANNIARACHCHI/AFP/GE T T Y IMAES

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THIS PAGE: ALEX WONG/GE T T Y IMAGES; NEXT SPREAD: PORNCHAI KIT TIWONGSAKUL/AFP/GE T T Y IMAGES

OK WITH SOME JAIL TIME Pro r tesste errs are e are e ar arrrre re est es s ed st ed in in the he r und rot undaa of the U U.S .SS. Caapi piito oll. TThe o he acc iv act iviist sts ts we were r sstttaagin giin g i gad diirectt action n ca campaign mpaiign mpa mp gn to g to ccallll o on n the Oba bama maa adm a ini inistr strati str a on to ati o kee eep p itss promis pro mises ess abo ab boutt fig ghti hting hti ht ng AID AID IDS. DS. S

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BOLD AND BEAUTIFUL Touris Tou rists ts che heck he ck out ut ma m nne nnequi quins ns deco d ecorated orated wi with th h con co dom ms for an an ntiiAIDS camp AID camp m aign aig gn at a the he e Cab abbag bag a ess & Condom Con doms rest e aur aurant ant in Ba Bang ngko okk.

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• EPZICOM, in combination with other antiretroviral agents, is indicated for the treatment of HIV-1 infection in adults. • EPZICOM is one of 3 medicines containing abacavir. Before starting EPZICOM, your healthcare provider will review your medical history in order to avoid the use of abacavir if you have experienced an allergic reaction to abacavir in the past. • In one study, more patients had a severe hypersensitivity reaction in the abacavir once-daily group than in the abacavir twice-daily group. • EPZICOM should not be used as part of a triple-nucleoside regimen. • EPZICOM does not cure HIV infection/AIDS or prevent passing HIV to others. By prescription only. 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 additional important information about EPZICOM, including boxed warnings, on the adjacent pages.

Save on your medication! Ask your doctor about the Patient Savings Card or visit www.mysupportcard.com to learn how to save on your out-of-pocket expenses. Subject to eligibility. Restrictions apply.

Important Safety Information EPZICOM contains abacavir, which is also contained in ZIAGEN® (abacavir sulfate) and TRIZIVIR® (abacavir sulfate, lamivudine, and zidovudine). Patients taking abacavir may have a serious allergic reaction (hypersensitivity reaction) that can cause death. Your risk of this allergic reaction is much higher if you have a gene variation called HLA-B*5701 than if you do not. Your healthcare provider can determine with a blood test if you have this gene variation. If you get a symptom from 2 or more of the following groups while taking EPZICOM, call your doctor right away to determine if you should stop taking this medicine. 1. Fever 2. Rash 3. Nausea, vomiting, diarrhea, or abdominal (stomach area) pain 4. Generally ill feeling, extreme tiredness, or achiness 5. Shortness of breath, cough, or sore throat Carefully read the Warning Card that your pharmacist gives you and carry it with you at all times. If you stop EPZICOM because of an allergic reaction, NEVER take EPZICOM or any other abacavir-containing medicine (ZIAGEN, TRIZIVIR) again. If you take EPZICOM or any other abacavir-containing medicine again after you have had an allergic reaction, WITHIN HOURS you may get life-threatening symptoms that may include very low blood pressure or death. If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your healthcare provider before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction,

“ I AM A

EVEN WITH HIV, “All my life, I’ve powered through any problem that came up. But when I was diagnosed with HIV, it stopped me in my tracks. It took a while, but now I realize I have to keep going. And the more I use my mind, my body, and my strength against HIV, the more I learn how powerful I really am.

DRIVING FORCE.”

“My meds are a big help. When I asked my doctor about my options, he told me about EPZICOM. “Turns out that, in combination with other medications, it’s clinically proven to help keep HIV from making copies and infecting healthy cells. And, 68% of patients taking a regimen with EPZICOM had their viral load become undetectable in less than one year. On top of that, they saw a 93% increase in their T-cell counts.* “Less than a year later, I’ve reached another milestone—my HIV is undetectable.” †

Ask your doctor if EPZICOM is right for you. Learn more at www.EpzicomInfo.com

*HEAT study of 688 patients defines undetectable as a viral load less than 50 copies/mL. Baseline median T-cell count for patients receiving EPZICOM was 214 cells/mm3 and at the 48-week mark, patients saw a median increase of 201 cells/mm3 in their T-cell count. † Not an actual patient testimonial. Based on collection of real patient experiences. Individual results may vary.

even if you never had an allergic reaction to it before. If your healthcare provider tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a healthcare provider if you need one. A buildup of lactic acid in the blood and an enlarged liver, including fatal cases, have been reported. Do not take EPZICOM if your liver does not function normally. Some patients infected with both hepatitis B virus (HBV) and HIV have worsening of hepatitis after stopping lamivudine (a component of EPZICOM). Discuss any change in treatment with your healthcare provider. If you have both HBV and HIV and stop treatment with EPZICOM, you should be closely monitored by your healthcare provider for at least several months. Worsening of liver disease (sometimes resulting in death) has occurred in patients infected with both HIV and hepatitis C virus who are taking anti-HIV medicines and are also being treated for hepatitis C with interferon with or without ribavirin. If you are taking EPZICOM as well as interferon with or without ribavirin and you experience side effects, be sure to tell your healthcare provider. When you start taking HIV medicines, your immune system may get stronger and could begin to fight infections that have been hidden in your body, such as pneumonia, herpes virus, or tuberculosis. If you have new symptoms after starting your HIV medicines, be sure to tell your healthcare provider. Changes in body fat may occur in some patients taking antiretroviral therapy. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms, and face may also occur. The cause and long-term health effects of these conditions are not known at this time.

Some HIV medicines, including those containing abacavir (ZIAGEN, EPZICOM, and TRIZIVIR), may increase your risk of heart attack. If you have heart problems, smoke, or suffer from diseases that increase your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes, tell your healthcare provider. The most common side effects seen with the drugs in EPZICOM dosed once daily were allergic reaction, trouble sleeping, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever, stomach pain, abnormal dreams, and anxiety. Most of the side effects do not cause people to stop taking EPZICOM.

I’ve got the fight in me.

EPZICOM® (abacavir sulfate and lamivudine) Tablets MEDICATION GUIDE EPZICOM® (ep′ zih com) Tablets Generic name: abacavir (uH-BACK-ah-veer) sulfate and lamivudine (la-MIV-yoo-deen) Read the Medication Guide that comes with EPZICOM before you start taking it and each time you get a refill because there may be new information. This information does not take the place of talking to your doctor about your medical condition or your treatment. Be sure to carry your EPZICOM Warning Card with you at all times. What is the most important information I should know about EPZICOM? • Serious Allergic Reaction to Abacavir. EPZICOM contains abacavir (also contained in ZIAGEN® and TRIZIVIR®). Patients taking EPZICOM may have a serious allergic reaction (hypersensitivity reaction) that can cause death. Your risk of this allergic reaction is much higher if you have a gene variation called HLA-B*5701 than if you do not. Your doctor can determine with a blood test if you have this gene variation. If you get a symptom from 2 or more of the following groups while taking EPZICOM, call your doctor right away to determine if you should stop taking this medicine.

Group 1 Group 2 Group 3 Group 4 Group 5

Symptom(s) Fever Rash Nausea, vomiting, diarrhea, abdominal (stomach area) pain Generally ill feeling, extreme tiredness, or achiness Shortness of breath, cough, sore throat

A list of these symptoms is on the Warning Card your pharmacist gives you. Carry this Warning Card with you. If you stop EPZICOM because of an allergic reaction, NEVER take EPZICOM (abacavir sulfate and lamivudine) or any other abacavir-containing medicine (ZIAGEN and TRIZIVIR) again. If you take EPZICOM or any other abacavir-containing medicine again after you have had an allergic reaction, WITHIN HOURS you may get life-threatening symptoms that may include very low blood pressure or death. If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your doctor before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If your doctor tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a doctor if you need one. • Lactic Acidosis. Some human immunodeficiency virus (HIV) medicines, including EPZICOM, can cause a rare but serious condition called lactic acidosis with liver enlargement (hepatomegaly). Nausea and tiredness that don’t get better may be symptoms of lactic acidosis. In some cases this condition can cause death. Women, overweight people, and people who have taken HIV medicines like EPZICOM for a long time have a higher chance of getting lactic acidosis and liver enlargement. Lactic acidosis is a medical emergency and must be treated in the hospital. • Worsening of hepatitis B virus (HBV) infection. Patients with HBV infection, who take EPZICOM and then stop it, may get “flare-ups” of their hepatitis. “Flare-up” is when the disease suddenly returns in a worse way than before. If you have HBV infection, your doctor should closely monitor your liver function for several months after stopping EPZICOM. You may need to take anti-HBV medicines. • Use with interferon- and ribavirin-based regimens. Worsening of liver disease (sometimes resulting in death) has occurred in patients infected with both HIV and hepatitis C virus who are taking anti-HIV medicines and are also being treated for hepatitis C with interferon with or without ribavirin. If you are taking EPZICOM as well as interferon with or without ribavirin and you experience side effects, be sure to tell your doctor. EPZICOM can have other serious side effects. Be sure to read the section below entitled “What are the possible side effects of EPZICOM?” What is EPZICOM? EPZICOM is a prescription medicine used to treat HIV infection. EPZICOM includes 2 medicines: abacavir (ZIAGEN) and lamivudine or 3TC (EPIVIR®). See the end of this Medication Guide for a complete list of ingredients in EPZICOM. Both of these medicines are called nucleoside analogue reverse transcriptase inhibitors (NRTIs). When used together, they help lower the amount of HIV in your blood. This helps to keep your immune system as healthy as possible so that it can help fight infection. Different combinations of medicines are used to treat HIV infection. You and your doctor should discuss which combination of medicines is best for you. • EPZICOM does not cure HIV infection or AIDS. We do not know if EPZICOM will help you live longer or have fewer of the medical problems that people get with HIV or AIDS. It is very important that you see your doctor regularly while you are taking EPZICOM. • EPZICOM does not lower the risk of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safe sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles. Who should not take EPZICOM? Do not take EPZICOM if you: • have ever had a serious allergic reaction (a hypersensitivity reaction) to EPZICOM or any other medicine that has abacavir as one of its ingredients (TRIZIVIR and ZIAGEN). See the end of this Medication Guide for a complete list of ingredients in EPZICOM. • have a liver that does not function properly. • are less than 18 years of age. Before starting EPZICOM tell your doctor about all of your medical conditions, including if you: • have been tested and know whether or not you have a particular gene variation called HLA-B*5701. • are pregnant or planning to become pregnant. We do not know if EPZICOM will harm your unborn child. You and your doctor will need to decide if EPZICOM is right for you. If you use EPZICOM while you are pregnant, talk to your doctor about how you can be on the Antiviral Pregnancy Registry for EPZICOM. • are breastfeeding. Some of the ingredients in EPZICOM can be passed to your baby in your breast milk. It is not known if they could harm your baby. Also, mothers with HIV should not breastfeed because HIV can be passed to the baby in the breast milk. • have liver problems including hepatitis B virus infection. • have kidney problems. • have heart problems, smoke, or suffer from diseases that increase your risk of heart disease such as high blood pressure, high cholesterol, or diabetes. Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take any of the following medicines*: • methadone • HIVID® (zalcitabine, ddC) • EPIVIR or EPIVIR-HBV® (lamivudine, 3TC), ZIAGEN (abacavir sulfate), COMBIVIR® (lamivudine and zidovudine), or TRIZIVIR (abacavir sulfate, lamivudine, and zidovudine).

How should I take EPZICOM? • Take EPZICOM by mouth exactly as your doctor prescribes it. The usual dose is 1 tablet once a day. Do not skip doses. • You can take EPZICOM with or without food. • If you miss a dose of EPZICOM, take the missed dose right away. Then, take the next dose at the usual time. • Do not let your EPZICOM run out. • Starting EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If you run out of EPZICOM even for a few days, you must ask your doctor if you can start EPZICOM again. If your doctor tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a doctor if you need one. • If you stop your anti-HIV drugs, even for a short time, the amount of virus in your blood may increase and the virus may become harder to treat. • If you take too much EPZICOM, call your doctor or poison control center right away. What should I avoid while taking EPZICOM? • Do not take EPIVIR (lamivudine, 3TC), COMBIVIR (lamivudine and zidovudine), ZIAGEN (abacavir sulfate), or TRIZIVIR (abacavir sulfate, lamivudine, and zidovudine) while taking EPZICOM. Some of these medicines are already in EPZICOM. • Do not take zalcitabine (HIVID, ddC) while taking EPZICOM. Avoid doing things that can spread HIV infection, as EPZICOM does not stop you from passing the HIV infection to others. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. • Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with semen, vaginal secretions, or blood. • Do not breastfeed. EPZICOM can be passed to babies in breast milk and could harm the baby. Also, mothers with HIV should not breastfeed because HIV can be passed to the baby in the breast milk. What are the possible side effects of EPZICOM? EPZICOM can cause the following serious side effects: • Serious allergic reaction that can cause death. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.) • Lactic acidosis with liver enlargement (hepatomegaly) that can cause death. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.) • Worsening of HBV infection. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.) • Changes in immune system. When you start taking HIV medicines, your immune system may get stronger and could begin to fight infections that have been hidden in your body, such as pneumonia, herpes virus, or tuberculosis. If you have new symptoms after starting your HIV medicines, be sure to tell your doctor. • Changes in body fat. These changes have happened in patients taking antiretroviral medicines like EPZICOM. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known. Some HIV medicines including EPZICOM may increase your risk of heart attack. If you have heart problems, smoke, or suffer from diseases that increase your risk of heart disease such as high blood pressure, high cholesterol, or diabetes, tell your doctor. The most common side effects with EPZICOM are trouble sleeping, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever, stomach pain, abnormal dreams, and anxiety. Most of these side effects did not cause people to stop taking EPZICOM. This list of side effects is not complete. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store EPZICOM? • Store EPZICOM at room temperature between 59º to 86ºF (15º to 30ºC). • Keep EPZICOM and all medicines out of the reach of children. General information for safe and effective use of EPZICOM Medicines are sometimes prescribed for conditions that are not mentioned in Medication Guides. Do not use EPZICOM for a condition for which it was not prescribed. Do not give EPZICOM to other people, even if they have the same symptoms that you have. It may harm them. This Medication Guide summarizes the most important information about EPZICOM. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for the information that is written for healthcare professionals or call 1-888-825-5249. What are the ingredients in EPZICOM? Active ingredients: abacavir sulfate and lamivudine Inactive ingredients: Each film-coated EPZICOM Tablet contains the inactive ingredients magnesium stearate, microcrystalline cellulose, and sodium starch glycolate. The tablets are coated with a film (OPADRY® orange YS-1-13065-A) that is made of FD&C Yellow No. 6, hypromellose, polyethylene glycol 400, polysorbate 80, and titanium dioxide. COMBIVIR, EPIVIR, EPZICOM, TRIZIVIR, and ZIAGEN are registered trademarks of GlaxoSmithKline. *The brands listed are trademarks of their respective owners and are not trademarks of GlaxoSmithKline. The makers of these brands are not affiliated with and do not endorse GlaxoSmithKline or its products. This Medication Guide has been approved by the US Food and Drug Administration.

Lamivudine is manufactured under agreement from Shire Pharmaceuticals Group plc, Basingstoke, UK ©2009, GlaxoSmithKline. All rights reserved. March 2009 EPZ:2MG ©2009 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA.

ECM423R0

August 2009

Twenty-five at 25 Honoring 25 of today’s LGBT leaders working to ensure the HIV fight rages on BY BENJA MIN RYA N A ND B OB A DA M S IL LU S T R AT ION BY R OBER T WA L K ER

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Valerie Spencer Valerie Spencer says she’ll eagerly step

condom,’ ” she insists. “We need to help

into the national spotlight to advocate

people build self-worth and learn to love

for her transgender peers. “I have no

themselves so that they stop making

problem speaking out. Sometimes they

those kinds of harmful decisions.” —B.A.

literally have to pull me away from the microphone at conferences,” she laughs. As one of the country’s first openly transgender AIDS activists, Spencer, 42, has spent the past 20 years strivPrevention has confirmed their impressions that a “second wave” of the AIDS epidemic in gay America is under way. And now, with men of color and not just people who were once affected by what was disparagingly called the “gay, white disease” making up a majority of the newly diagnosed cases, this attention to the virus’s reach is desperately needed. We realize, of course, that by no means are there only 25 LGBT leaders who are creating the breakthroughs and the messages that are keeping the momentum of the movement going. Many are less public in their efforts; some probably don’t even themselves yet realize the mission they’ve embarked on. We salute them all just as much. And as their fight continues, or begins, we hope that you too will give a salute to these women and men who we honor here—as well as their magnificent predecessors, who set examples of almost superhuman feats.

ing to foster self-esteem among trans men and women, including through her work as founder of the Los Angeles– based Transcend Empowerment Institute, which she says is the key to stopping HIV’s relentless spread in transgender communities. “The whole conversation really needs to look at why people say, ‘Fuck it! I’m not going to use a

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SPENCER BY BRADFORD ROGNE

There are heroes—even superheroes, as you will see—in any movement. Most of the time, though, historical figures receive the accolades because, well, let’s face it, what they accomplished was so legendary. But there are heroes on the HIV front who work among us today, exerting their influence and wielding power. For this issue of HIV Plus, which closes out the “aughties,” the 2000–2009 decade, in which many of our country’s AIDS service organizations reached their 25-year service mark, we honor these modern-day wonders. We’ve partnered with AIDS Project Los Angeles, currently celebrating its 25th anniversary, to pay homage to 25 LGBT leaders who are actively involved in making sure that the fact that HIV continues to have a disproportionate impact on gay men is not overlooked. To many experts in the field, data released by the Centers for Disease Control and

Sean Strub Sean Strub’s advocacy started on day one. In 1981 he began collecting information about a mysterious, burgeoning epidemic among gay men and sharing it with friends. He eventually became one of the cornerstones of ACT UP and, along with

Bob Huff Bob Huff is the circumspect, levelheaded brainiac who works as well helping pharmaceutical companies understand the needs of patients as he does teaching HIVers about the latest cutting-edge medical research. Beginning in 1987 as a member of the Treatment and Data Committee of ACT UP, whose advocacy succeeded in speeding new therapies onto the market and promoting openness in HIV research, he went on to work for amfAR and helped found the AIDS Treatment Registry, an organization that tracked AIDS clinical trials. After editing the Gay Men’s Health Crisis “Treatment Issues” newsletter, he joined the Treatment Action Group, where he continues to fight for new developments in HIV care. “What I would really like to see is one more great breakthrough in the quality of treatment,” he says, adding jokingly, “I’m sort of getting old and winding down!” —B.R.

Peter Staley, slid the famous condom over Jesse Helms’s home. In 1994 he launched Poz magazine, a health-promoting enterprise that now includes Staley’s AIDSMeds.com. Today, he’s the chief executive of Cable Positive, which advocates for HIV education and awareness through cable

John Duran TV, and he also works with the Center for HIV Law and Policy, fighting to change the landscape of U.S. laws that criminalize HIV exposure. Those early days have left his fellow survivors with a “mass post-traumatic

STRUB BY NEAL RASMUS

stress disorder,” he says. But he hopes that

John Duran remembers exactly how he became an AIDS activist—working to defeat California’s 1986 Proposition 64 ballot initiative, which would have forced HIVers into quarantine. “It was that fight and a promise I made to a very good friend—the first person I knew to die of AIDS—that made me committed to making a difference,” says the 50-year-old attorney. Although Duran’s résumé since then is both lengthy and impressive—he’s defended members of ACT UP, was the trial attorney for the Los Angeles needle-exchange program, and won California’s first medicinal marijuana test case, among many other accomplishments—he’s perhaps best known as the nation’s first HIV-positive mayor. A West Hollywood city councilman since 2001, Duran served as mayor from 2004 to 2005 and again from 2007 to 2008. “That really allowed me to be a public voice for people with HIV,” he says. “It was very exciting. And very humbling.” —B.A.

“teaching our history will really shape our politics today in constructive ways.”—B.R.

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George Ayala George Ayala is fighting hard to reverse one of the AIDS pandemic’s most dangerous disparities. Although the group hit hardest by HIV in much of the world is men who have sex with men, less than 2% of global HIV funding is directed toward them. “In more than 90 countries there’s no data at all on gay men; it’s like they don’t exist,” says Ayala, executive officer of the Global Forum on MSM and HIV. To help establish services for MSM, the organization crafted a three-year action plan this summer to raise funds and assist groups around the world—from local programs in hard-hit towns to large-scale international outreach efforts. “The plan leverages our strengths in network development, information exchange, education, and advocacy to bolster the health and human rights of MSM globally,” he says. “It’s not going to be easy, but we’re ready to roll our sleeves up and get to work.” —B.A.

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Marjorie J. Hill, Ph.D. Marjorie J. Hill towers over those around her. A licensed clinical psychologist who served as the assistant commissioner for New York City’s HIV services bureau and who is now the first black chief executive officer of a major LGBT organization, New York City–based Gay Men’s Health Crisis, she is just shy of six feet tall. But as proud as she is of her accomplishments, she’d rather stay as down-to-earth as possible so that others might follow in her footsteps. “People think that there’s a different kind of animal that decides to assume leadership,” she says. “I think both my initial work in HIV and my continued motivation comes from the people who are living with HIV, with dignity, and with tenacity.” —B.R.

A. Cornelius Baker A. Cornelius Baker was home from college in 1981 when he heard that a young man he’d idolized in high school was very sick. “To have seen smart, talented people taken away immediately,” he recalls, “I just thought, God, you have to do what you have to do, and I have to be involved.” Beyond just involving himself, Baker relinquished his youthful ambitions to work in theater and went on to become

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executive director of the National Association of People With AIDS and, later, Washington, D.C.’s Whitman-Walker Clinic. Today, as HIV targets black gay men more prevalently than any other demographic, he is a much-needed leader at both the National Black Gay Men’s Advocacy Coalition and the Academy for Educational Development Center on AIDS and Community Health. —B.R.

When Tony Mills was diagnosed with HIV in 1987, providing medical care to other HIVers was so psychologically overwhelming that he switched to the field of anesthesiology. “Not only did I feel like I couldn’t do anything for my patients, since they were all dying,” he says, “but it also was like facing my own mortality every day. I felt there was no hope for me either.” When his own health began to fail in the mid 1990s, Mills went on disability, but like so many other HIVers he rebounded dramatically upon the arrival of highly active antiretroviral therapy. His hope renewed, Mills opened a private HIVfocused practice in Los Angeles, through which he provides, he says, not only topnotch medical care to his patients but also inspiration. “I want them to see that I am confident I will live a long and productive life, and that they will too,” says the 48-year-old. His own recovery was so encouraging that Mills even publicly talked about his experiences with HIV as a candidate in the 1998 International Mr. Leather contest, which he won. “There was still a lot of stigma in the gay community at the time,” Mills says of deciding to compete. “I wanted to show people that I’m a strong, healthy man who also happens to have HIV, and that’s OK.” —B.A.

MILLS ILLUSTRATION BY ROBERT WALKER

Tony Mills, MD

Michael Weinstein

WEINSTEIN BY BRADFORD ROGNE

Although Michael Weinstein, cofounder and president of Los Angeles–based AIDS Healthcare Foundation, says the two main pillars of the organization he leads are direct care and advocacy, it’s perhaps the latter for which the agency’s leader is best known. AHF—initially formed as an L.A. hospice in 1987—is certainly a world leader in providing HIV care, treating nearly 110,000 HIVers in 22 countries. Domestically, the organization operates 17 health care centers, including two new clinics opened this fall, one each in San Francisco and in Washington, D.C. The agency also promotes safer sex through the Love Condoms campaign and in

2008 spearheaded a project that succeeded in testing more than 1.6 million people around the world for HIV. It also operates nonprofit pharmacies that specialize in HIV treatment as well as the Out of the Closet chain of thrift stores. Despite these impressive achievements for AHF, though, Weinstein more often grabs headlines for his fierce activism and advocacy. During the past decade, he and the agency have played a key role in pressing drugmakers for triple-drug-therapy price cuts, particularly for lowincome HIVers in developing nations. For example, Weinstein says that when AHF began offering anti-

retroviral treatment in Uganda the average yearly per-person cost was more than $5,000. Today, it’s just $82. And while continuing to advocate for affordable medications, Weinstein also is championing improved access to HIV treatment. “It’s my job to fight,” he says, “for access for every one of the 33 million HIV-positive people around the world.” But some worry that the ends may not always justify the means through which AHF accomplishes its goals. For example, the organization is currently targeting Merck’s pricing of integrase inhibitor Isentress, and this fall literally brought the issue into the homes of all the company’s employees and their families with a mass mailer about the matter. AHF also routinely turns to the courts, including suing Pfizer in 2007 over its marketing campaign for Viagra, which AHF alleged encouraged risky sexual behavior. Additionally, the agency is suing to force adultfilm companies operating in Los Angeles County to require on-set condom use. These sorts of bold efforts have earned Weinstein a reputation as something of a rabble-rouser—in both the good and bad sense of the phrase. But he is decidedly unconcerned about any criticism that he or the organization receives. “When all is said and done, if the worst thing anyone can say about me is that I offended drugcompany executives, I can definitely live with that,” Weinstein insists. “I might even consider it a badge of honor. The bottom line is that, up to this point, the virus has been smarter and far more aggressive than we’ve been. If we’re going to put an end to the era of AIDS, we’re going to have to be just as aggressive and smart as the virus.” —B.A.

Jewel Thais-Williams Jewel Thais-Williams couldn’t stand idly by during the 1980s as AIDS decimated the young gay black men who patronized the Catch One dance club she owns in Los Angeles. “Kids who normally came to the club were getting sick, and then I would never see them alive again. And no one was doing anything in the black community to stop it,” the 70-year-old recalls. So she joined with other activists in 1985 to form the Minority AIDS Project and immediately began offering condoms and educational materials at Catch One, among the nation’s earliest HIV outreach efforts to African-Americans. Once mobile HIV testing became available, Thais-Williams made sure it was regularly available outside the club as well. Today, she’s still a champion of safer sex, regularly speaking about it with clubgoers—both gay and straight. “AIDS is not over,” she says. “There’s still a lot of work to do; that’s why I continue doing it.” —B.A.

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Phill Wilson country, that country would have more HIV-positive people than even such hard-hit sub-Saharan African nations as Botswana and Namibia. “One of the reasons HIV has— and in many ways continues to have—a disproportionate impact on black Americans is that AIDS was very quickly branded as a white, gay disease,” explains Wilson, 53, who has been HIVpositive for nearly 30 years. “That created a perfect storm. Black communities didn’t want to respond to the epidemic because they didn’t want to take on another stigmatizing issue, and the messages coming out were that they didn’t need to because it didn’t aﬀect them. Meanwhile, the house was on ﬁre.” Although Wilson has seen what he calls “miraculous” progress in the black population’s response to HIV during the past decade, he insists there’s still much more work to be done. “Our goal today is exactly what it was when we formed the institute—to get black folks to take ownership of the epidemic,” he says. “We believe, quite frankly, that the only way to end the AIDS epidemic in the United States is to end it in black communities. It really is as simple as that.” —B.A.

Peter Staley His activism is the stuff of legend. Direct-action events at Manhattan’s St. Patrick’s Cathedral, the New York Stock Exchange, Burroughs Wellcome headquarters, Jesse Helms’s condom-sheathed home—Peter Staley was there. Front and center. Sometimes tossed into jail. This original front man of ACT UP— HIV-positive for over a quarter century now— took on the giants of Big Pharma and the federal government and rewrote the rules of the AIDS playbook. Thanks to him, in 1989 the sky-high price of AZT fell closer to earth. After forming the Treatment Action Group in 1992, he muscled the National Institutes of Health into revamping its approach to AIDS research. Staley went on to found AIDSMeds.com and later used his own money to campaign against the dangers of crystal meth. Looking for a fourth act, he says he’s pondering his next move. —B.R.

Jennifer Flynn When Jennifer Flynn cofounded the New York City AIDS Housing Network in 1998, the group’s main target, the city’s emergency housing program for homeless HIVers, seemed broken beyond repair: a stubbornly wasteful bureaucracy that only benefited the greed of slumlords. NYCAHN was so effective at strongarming change, Flynn has essentially claimed victory and has taken her community organizing talents over to the Health Global Access Project, or Health GAP, where as managing director, she now fights for worldwide access to antiretroviral meds. “She has a particular talent for connecting and engaging individuals from challenged backgrounds in affected communities and working with them and supporting them around advocating for themselves,” says Marjorie J. Hill, chief executive officer of Gay Men’s Health Crisis. “I think that is the best advocacy one can do.” —B.R.

tips+tools See video interviews with some of our honorees at HIVPLUSmag.com

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WILSON BY BRADFORD ROGNE; STALEY BY PE TER ROSS; FLYNN ILLUSTRATION BY ROBERT WALKER

Like many other HIVers in the mid 1990s, Phill Wilson saw his health begin to fail and he found himself unable to work, causing him to leave his job as director of policy and planning at AIDS Project Los Angeles and go out on disability. But also like so many of his peers at that time, he was literally brought back from the brink of death by the arrival of protease inhibitors and triple-combination therapy. By 1999, Wilson was even feeling healthy enough to start thinking about returning to work. “I looked around to see how things had changed while I was away, and I discovered a glaring lack of progress in mobilizing the black communities hit hard by the disease,” notes Wilson, who’s also served as AIDS coordinator for the city of Los Angeles and cochair of the L.A. County Commission on HIV. “That was the genesis of the Black AIDS Institute.” The L.A.–based institute, the ﬁrst national HIV policy center focused exclusively on black people, works to end the AIDS epidemic among blacks through training and capacity building, information dissemination, policy work, and mobilization and advocacy. Under its motto, “Our People, Our Problem, Our Solution,” the institute reaches out through its Black Gay Men’s Network, Test 1 Million campaign, and highly successful African-American HIV University, which trains organizations and individuals to ﬁght HIV in their local communities. The institute also drew international attention in 2008 with its report “Left Behind,” which showed that if black Americans by themselves populated a separate

Bryan Levinson Bryan Levinson sees himself as a social matchmaker for HIV-positive gay men. “More Barbra Streisand, less Carol Channing,” chuckles the 40-year-old, who founded the social-networking association Strength in Numbers in Los Angeles seven years ago, driven largely by his own difficulties in meeting other HIVers. The organization’s activities were such an immediate hit that SIN rapidly expanded to other cities and today reaches more than 35,000 men around the world, including through a new chapter in Argentina. Now living in San Francisco, where he works as an attorney, Levinson aims to expand SIN’s reach through the new, free website SINMen.net. He devotes his free time to developing the site and planning SIN’s first Mexican cruise, scheduled for May 2010 [SINcruise.com]. “I don’t make any money off any of this; everything I do is out of my own pocket,” Levinson says of his passion for SIN. “But I like it that way because there’s never any motive other than helping out other guys living with HIV.” —B.A.

Tom Duane

COHEN BY BRADFORD ROGNE; LEVINSON ILLUSTRATION BY ROBERT WALKER

“You think you scare me? You think you can make me back off? Nothin’ scares me!” So said New York state senator Tom Duane to his colleagues in an impassioned 3 A.M. speech this summer that saved what looked like a doomed bill proposing rent caps for indigent New Yorkers with HIV. The first openly gay and openly HIVpositive New York state senator when he was elected in 1998, Duane has made it his business to protect HIVers from discriminatory legislation and cuts in services. Now, as a member of a (famously razor-thin) majority in the state senate, he’s fearlessly on the offense. “I’ve used my life experience in HIV and LGBT issues,” he says. “It really drives my view of the world and how to make the world a better place.” —B.R.

Julie Davids Unfailingly modest, Julie Davids prefers to call herself “a cog in the machine.”This particular cog has been an instrumental force behind efforts to lower antiretroviral drug prices worldwide, to get condoms in Philadelphia jails, to expand access to sterile syringes, to increase opportunities for HIV-positive women in clinical trials, and to reduce bureaucratic red tape in HIV prevention campaigns at the U.S. Centers for Disease Control and Prevention. With a résumé already weighted with acronyms—ACT UP Philadelphia, Philadelphia FIGHT, and Health GAP—in 2003 she founded the Community HIV/AIDS Mobilization Project, or CHAMP, which is busy training the next wave of HIV activist leaders. Davids, who defines herself as a “genderqueer dyke,” says she sees her role as “a facilitator and amplifier of people’s voices. I’m lucky to be a catalyst for what’s already happening.”—B.R.

Susan Cohen A premed class in organic chemistry nearly drove Susan Cohen from a career in the health arena. “I went running away,” laughs Cohen, who is director of health education and prevention at the L.A. Gay & Lesbian Center. “But eventually I found my way to public health and, in particular, issues related to sexual health.” As a college graduate in the late 1980s, Cohen also was drawn to the ﬁght against HIV as she witnessed the disease’s impact on Los Angeles’s gay community. “It was clear to me what was happening was rooted in public health and social justice issues like safer sex, access to clean needles, access to health care, homophobia, and stigma. I felt compelled to help,” she explains.

Since 2006, Cohen has spearheaded the L.A. center’s HIV prevention outreach, mobile HIV and STD testing services, substance abuse prevention programs, and numerous other health initiatives. In 2007 her department created an ongoing Internet soap opera and interactive website—called “In the Moment”—that follows a group of gay men as they deal with issues around safer sex, substance use, Internet hookups, and other timely topics. “We needed to reach guys where they are going. And today, that’s online,” Cohen says of the project. “It gives us a unique way to reignite dialogues about HIV, crystal meth, and risky behaviors among gay and bisexual men who might not otherwise be having those conversations.” —B.A.

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Todd Murray Influenced by heroes such as Pedro

were targeting youths, even though half

M.O. is to use inspirational—as opposed

Zamora and the ACT UP leaders of the

of new HIV infections are in people under

to fear-based—messages to both reduce

1980s and ’90s, Todd Murray, who was

25. So he founded a public speaking orga-

HIV stigma and prevent transmission

infected at age 20 in 2001, is the future

nization called Hope’s Voice International

among young people around the United

of AIDS activism. After attending a Ryan

and, eventually, its companion visibility

States and in several countries abroad as

White National Youth Conference in 2004,

campaign, “Does HIV Look Like Me?”

well. “My work, it celebrates the realities

he realized how few AIDS organizations

Operating out of Salem, Ore., Murray’s

of our lives,” he says. —B.R.

Antonio Urbina, MD After more than a decade in the field, Antonio Urbina has the data to prove that more-experienced HIV physicians have healthier patients. Over three quarters of the HIVers he treats have undetectable viral loads. More important than his sheer longevity in the field, though, is Urbina’s holistic approach to care. As medical director of HIV education and training at St. Vincent’s Comprehensive HIV Center in New York City, one of the oldest HIV treatment centers, he sees some 4,000 patients, including pregnant women. Backing him up is a team of nurses and social workers who make sure that virtually no one falls through the cracks. If patients fail to show up to their appointments, for example, Urbina has a program—with a 95% success rate—that tracks them down and literally guides them to his office. “Our motto is ‘Never give up,’ ” says Urbina. “By bringing them back into care, we’ve really saved their lives.” Not content to take care of just his own patients, Urbina, who was recently appointed to the Presidential Advisory Council on HIV/AIDS (as well as being a contributing editor to HIV Plus), has invented a computer “widget” to educate New York state physicians about the proper use of postexposure prophylaxis. He hopes the tool will finally move into standard practice an effective emergency prevention measure that, available since 1996, has been largely ignored in medical education. —B.R.

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One hears a lot about the role that blood plays in HIV disease: blood-based viral loads, antibodies in the blood to the virus, and so on. But Peter Anton says there’s a part of the body that’s more vulnerable to HIV’s cellular attack—the gastrointestinal tract, or gut. “The intestine, which holds 60% to 80% of the body’s immune system cells, is where HIV first goes after infection. Studies have shown that within seven to 21 days after infection, HIV has depleted the CD4 cells in the gut while the same cells in the blood and lymph nodes are still not affected,” explains Anton, who is director of the University of California, Los Angeles, Center for HIV Prevention Research. In addition to working to better understand HIV’s impact on the GI tract to uncover avenues toward new vaccines or treatments, Anton also is focusing on the role of the gut in direct HIV prevention, which is where infections occur through anal sex. “This is important not only for men but for women too. Studies have shown women worldwide have a lot of rectal sex,” he says. “So you can do all the HIV outreach possible about using condoms for vaginal sex, but if we don’t start making people more aware that the rectum is the number 1 compartment in the body for HIV infection, we’ll still be seeing high infection rates.” —B.A.

MURRAY BY BRANDYLAND PHOTOGRAPHY; ANTON ILLUSTRATION BY ROBERT WALKER

Peter Anton, MD

Jack Mackenroth

Brandon M. Macsata As a “limousine Republican” who believes in both social and fiscal responsibility in government, Macsata has used his political consulting firm, the Macsata-Kornegay Group, to establish himself in Washington, D.C., as an advocate of both disability and HIV rights. Right-wing politics may seem an odd match for the chief executive officer of the ADAP Advocacy Association, but he says that Newt Gingrich, of all people, agrees that championing for the long-term cost savings provided by the AIDS Drug Assistance Programs makes for sound fiscal policy. “I think there’s so much need out there,” says Macsata, who was infected with HIV in 2002. “And so often it’s an issue that can be overshadowed by big government bailouts and other big issues of the day.” —B.R.

MACKENROTH BY PE TER ROSS; BREINING ILLUSTRATION BY ROBERT WALKER

W. David Hardy, MD W. David Hardy knew he had found his career path when HIV began its onslaught among his gay male peers just as he was graduating from medical school. “Really, what we were doing at the time was helping people die with dignity. But then in 1996 and 1997 people stopped dying and everything about HIV care changed,” says Hardy, who now serves as director of the division of infectious diseases at Los Angeles’s Cedars-Sinai Medical Center. Patient care has evolved so rapidly throughout the pandemic that Hardy cofounded the Los Angeles Physicians AIDS Forum to help local doctors educate each other about the disease and its treatment. He shoots for a similar goal on a national level as director of education for the American Academy of HIV Medicine. “There’s still a great need for HIV caregivers to get together, share information, network with each other, and advocate locally and at the state and national levels,” he says. “It makes us better doctors.” —B.A.

Robert Breining It’s hard to imagine that Philadelphian Robert Breining, founder of the “POZIAM” Internet radio show and related website, was once apprehensive about disclosing his serostatus—or even acknowledging his HIV infection to himself. “Since I wasn’t on meds, it just didn’t sink in,” says the 30-year-old, who was diagnosed in 2001. “It took me five years to accept it and to be able to talk about it.” Today, Breining is unabashedly candid about having HIV and all the other intimate details of his life, as are the guests on his radio show. “I want to show everyone that there’s so much more to living with HIV than just sickness and death,” he says of the weekly broadcasts, which are cohosted by fellow HIVers Jack Mackenroth and Jeromy Dunn. “POZIAM” airs Sundays at 9 P.M. Eastern on BlogTalkRadio.com/POZIAM. The socialnetworking website is found online at POZIAM.com. —B.A.

Jack Mackenroth could’ve kept quiet. He could’ve told the Project Runway producers that his living with HIV was not to become another morsel of gossip for reality TV–obsessed couch potatoes to munch on. Once his season hit the air, two years ago, and he was thrust into the spotlight, he could’ve turned down the requests that he become a poster boy for HIV advocacy work. He could’ve ignored the avalanche of heartfelt e-mails from fans thrilled to see a robustly healthy role model fulﬁlling his own dreams. With his superhero build and square-jawed good looks, Mackenroth, 40, never really saw any other option than to stay true to his own personal philosophy: to be out and proud about his HIV status, the red cape waving behind his neck.

(Or perhaps he’d sport a simple pair of Speedos, since he has a side gig as a competitive swimmer.) HIV-positive for nearly 20 years, the University of California, Berkeley, grad and former model-turnedParsons alum and fashion slave has parlayed his appearance on the popular reality show into not just a television and design career but an opportunity to become a very public face of HIV—including gracing the cover of HIV Plus in January/ February 2008…naked! Merck & Co., a major antiretroviral pharmaceutical company, hired him to work both as a public speaker and as a liaison to AIDS service organizations around the country. And on Sundays at 9 .. Eastern, he cohosts the HIV-focused Internet radio show “POZIAM.” “I think—in the grand scheme of life—what do I want to be remembered for?” Mackenroth says. “Making pretty clothes is nice, and being on TV or whatever, but if you really make a diﬀerence in someone’s life, that’s a lot more important.” Called Living Positive by Design, his speaking tour aims to reduce stigma for HIVers, encourage them to take good care of their health, and provide them a sense of hope that they too can live out their ambitions. He has also started posting newsmagazine-style webisodes on the program’s website, LivingPositivebyDesign.com. “There’s still a huge stigma wrapped around being HIV-positive,” he says. “The more you talk about it and the more people see me, and see me doing good, and living a “normal life,” then it normalizes HIV. I think anyone who’s HIV-positive can do their part just by being open.” —B.R.

[   ]

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“October 25, 2002. It’s the day I learned I have HIV. It’s also the day I learned I have the most amazing friends and family. I wanted to hide away from the world—but they wouldn’t let me. They helped keep me going. Keep me moving. And keep me living. These days, I’m feeling good. And to make sure it stays that way, I’m always reading up on treatment options. When I learned that LEXIVA could reduce the amount of HIV in my blood, I asked my doctor about it.

LEXIVA has been part of my combination therapy for just over a year. And while I can’t speak for everyone who uses it, I know LEXIVA is working great for me. My viral load is down and my T-cell counts are up. My friends, family, and I couldn’t be happier with my results.”* *Not actual patient testimonial. Based on compilation of stories. Individual results may vary. By prescription only.

I have HIV.

I am cherished. Models used for illustrative purposes only. • High blood sugar, diabetes or worsening of diabetes, and bleeding in hemophiliacs have occurred in some patients antiretroviral agents for the treatment of HIV taking protease inhibitors. infection. • When you start taking HIV medicines, your immune system may get stronger and could begin to fight infections that • The PI-experienced–patient study was not large have been hidden in your body, such as pneumonia, herpes enough to reach a definitive conclusion that virus, or tuberculosis. If you have new symptoms aZer LEXIVA/ritonavir and lopinavir/ritonavir are starting your HIV medicines, be sure to tell your doctor. clinically equivalent • Changes in body fat may occur in some patients taking • Once-daily administration of LEXIVA plus ritonavir antiretroviral therapy. The cause and long-term health is not recommended for PI-experienced patients effects of these conditions are not known at this time. or any pediatric patients • Skin rashes can occur in patients taking LEXIVA. Rarely, LEXIVA does not cure HIV or prevent passing HIV rashes were severe or life threatening. to others. • Opportunistic infections can develop when you have HIV and your immune system is weak. It is very important that Please see Important Patient Information below and on you see your healthcare provider regularly while you are taking LEXIVA to discuss any side effects or concerns. the following page. You are encouraged to report negative side effects of • Most common side effects in clinical studies were diarrhea, prescription drugs to the FDA. Visit fda.gov/medwatch, headache, nausea, rash, and vomiting. In most cases, these side effects did not cause people to stop taking their medicine. or call 1-800-FDA-1088. Models for illustrative purposes only.with other LEXIVAused is indicated in combination

IMPORTANTRSAFETYRINFORMATION DRUGRINTERACTIONS • You should not take LEXIVA if you have had an allergic • LEXIVA should not be taken with: AGENERASE® reaction to LEXIVA or AGENERASE® (amprenavir). (amprenavir), Halcion® (triazolam), ergot medications

Ask your doctor if LEXIVA is right for you. Learn more at www.LexivaHelp.com

BY9YOUR9SIDEA (Cafergot®, Migranal®, D.H.E. 45®, and others), Propulsid® (cisapride), Versed® (midazolam), Orap® (pimozide), Zocor® (simvastatin), Mevacor® (lovastatin), Rifadin® (rifampin), Rescriptor® (delavirdine mesylate), or St. John’s wort (Hypericum perforatum). If you are taking Norvir® taking or plan to take, including over-the-counter drugs, (ritonavir), you should not take Tambocor® (flecainide) or vitamins, and herbals. Rythmol® (propafenone hydrochloride). • Serious and/or life-threatening events could occur between RRESISTANCE LEXIVA and other medications, including Cordarone® • Missing or skipping doses of your medicine may make it (amiodarone), lidocaine (intravenous only), Elavil® easier for the virus to mutate and multiply. Your medicines (amitriptyline HCl), and Tofranil® (imipramine pamoate), may not work as well against a mutated virus and you may become cross-resistant to other HIV medicines. It’s tricyclic antidepressants, and Quinaglute® (quinidine). important to take your medicine exactly as prescribed. • Women who use birth control pills should choose a different kind of birth control. The use of LEXIVA with Norvir (ritonavir) in combination with birth control pills may hurt SAVE$ON$YOUR$MEDICATIONS/ your liver. Also, birth control pills may not work if you take Ask your doctor about the Patient Savings Card or visit www.mysupportcard.com LEXIVA or LEXIVA with Norvir. Talk to your healthcare to learn how to save on your out-of-pocket provider about choosing the right birth control for you. expenses. Subject to eligibility. Restrictions apply. ® ® • Patients taking Viagra (sildenafil citrate) or LEVITRA (vardenafil HCl) with LEXIVA may be at increased risk of side effects. • This list of drug interactions is not complete. Be sure to tell your healthcare provider about all medicines you are

PATIENT INFORMATION LEXIVA® (lex-EE-vah) (fosamprenavir calcium) Tablets and Oral Suspension Read the Patient Information that comes with LEXIVA before you start taking it and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment. It is important to remain under a healthcare provider’s care while taking LEXIVA. Do not change or stop treatment without first talking with your healthcare provider. Talk to your healthcare provider or pharmacist if you have any questions about LEXIVA. What is the most important information I should know about LEXIVA? LEXIVA can cause dangerous and life-threatening interactions if taken with certain other medicines. Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. • Some medicines cannot be taken at all with LEXIVA. • Some medicines will require dose changes if taken with LEXIVA. • Some medicines will require close monitoring if you take them with LEXIVA. Know all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Keep a list of the medicines you take. Show this list to all your healthcare providers and pharmacists anytime you get a new medicine or refill. Your healthcare providers and pharmacists must know all the medicines you take. They will tell you if you can take other medicines with LEXIVA. Do not start any new medicines while you are taking LEXIVA without talking with your healthcare provider or pharmacist. You can ask your healthcare provider or pharmacist for a list of medicines that can interact with LEXIVA. What is LEXIVA? LEXIVA is a medicine you take by mouth to treat HIV infection. HIV is the virus that causes AIDS (acquired immune deficiency syndrome). LEXIVA belongs to a class of anti-HIV medicines called protease inhibitors. LEXIVA is always used with other anti-HIV medicines. When used in combination therapy, LEXIVA may help lower the amount of HIV found in your blood, raise CD4+ (T) cell counts, and keep your immune system as healthy as possible, so it can help fight infection. However, LEXIVA does not work in all patients with HIV. LEXIVA does not: • cure HIV infection or AIDS. We do not know if LEXIVA will help you live longer or have fewer of the medical problems (opportunistic infections) that people get with HIV or AIDS. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. It is very important that you see your healthcare provider regularly while you are taking LEXIVA. The long-term effects of LEXIVA are not known. • lower the risk of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles. LEXIVA has not been fully studied in children under the age of 2 or in adults over the age of 65. Who should not take LEXIVA? Do not take LEXIVA if you: • are taking certain other medicines. Read the section “What is the most important information I should know about LEXIVA?” Do not take the following medicines* with LEXIVA. You could develop serious or life-threatening problems. • HALCION® (triazolam; used for insomnia) • Ergot medicines: dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as CAFERGOT®, MIGRANAL®, D.H.E. 45®, ergotrate maleate, METHERGINE®, and others (used for migraine headaches) • PROPULSID® (cisapride), used for certain stomach problems • VERSED® (midazolam), used for sedation • ORAP® (pimozide), used for Tourette’s disorder • are allergic to LEXIVA or any of its ingredients. The active ingredient is fosamprenavir calcium. See the end of this leaflet for a list of all the ingredients in LEXIVA. • are allergic to AGENERASE (amprenavir). You should not take AGENERASE (amprenavir) and LEXIVA at the same time. There are other medicines you should not take if you are taking LEXIVA and NORVIR® (ritonavir) together. You could develop serious or life-threatening problems. Tell your healthcare provider about all medicines you are taking before you begin taking LEXIVA and NORVIR (ritonavir) together.

What should I tell my healthcare provider before taking LEXIVA? Before taking LEXIVA, tell your healthcare provider about all of your medical conditions including if you: • are pregnant or planning to become pregnant. It is not known if LEXIVA can harm your unborn baby. You and your healthcare provider will need to decide if LEXIVA is right for you. If you use LEXIVA while you are pregnant, talk to your healthcare provider about how you can be on the Antiretroviral Pregnancy Registry. • are breastfeeding. You should not breastfeed if you are HIV-positive because of the chance of passing the HIV virus to your baby through your milk. Also, it is not known if LEXIVA can pass into your breast milk and if it can harm your baby. If you are a woman who has or will have a baby, talk with your healthcare provider about the best way to feed your baby. • have liver problems. You may be given a lower dose of LEXIVA or LEXIVA may not be right for you. • have kidney problems • have diabetes. You may need dose changes in your insulin or other diabetes medicines. • have hemophilia • are allergic to sulfa medicines Before taking LEXIVA, tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. LEXIVA can cause dangerous and life-threatening interactions if taken with certain other medicines. You may need dose changes in some of your medicines or closer monitoring with some medicines if you also take LEXIVA (see “What is the most important information I should know about LEXIVA.”). Know all the medicines that you take and keep a list of them with you to show healthcare providers and pharmacists. Women who use birth control pills should choose a different kind of contraception. The use of LEXIVA with NORVIR (ritonavir) in combination with birth control pills may be harmful to your liver. The use of LEXIVA with or without NORVIR may decrease the effectiveness of birth control pills. Talk to your healthcare provider about choosing an effective contraceptive. How should I take LEXIVA? • Take LEXIVA exactly as your healthcare provider prescribed. • Do not take more or less than your prescribed dose of LEXIVA at any one time. Do not change your dose or stop taking LEXIVA without talking with your healthcare provider. • You can take LEXIVA Tablets with or without food. • Adults should take LEXIVA Oral Suspension without food. • Pediatric patients should take LEXIVA Oral Suspension with food. If vomiting occurs within 30 minutes after dosing, the dose should be repeated. • Shake LEXIVA Oral Suspension vigorously before each use. • When your supply of LEXIVA or other anti-HIV medicine starts to run low, get more from your healthcare provider or pharmacy. The amount of HIV virus in your blood may increase if one or more of the medicines are stopped, even for a short time. • Stay under the care of a healthcare provider while using LEXIVA. • It is important that you do not miss any doses. If you miss a dose of LEXIVA by more than 4 hours, wait and take the next dose at the regular time. However, if you miss a dose by fewer than 4 hours, take your missed dose right away. Then take your next dose at the regular time. • If you take too much LEXIVA, call your healthcare provider or poison control center right away. What should I avoid while taking LEXIVA? • Do not use certain medicines while you are taking LEXIVA. See “What is the most important information I should know about LEXIVA” and “Who should not take LEXIVA?” • Do not breastfeed. See “Before taking LEXIVA, tell your healthcare provider”. Talk with your healthcare provider about the best way to feed your baby. • Avoid doing things that can spread HIV infection since LEXIVA doesn’t stop you from passing the HIV infection to others. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes or razor blades. • Do not have any kind of sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. What are the possible side effects of LEXIVA? LEXIVA may cause the following side effects: • skin rash. Skin rashes, some with itching, have happened in patients taking LEXIVA. Swelling of the face, lips, and tongue (angioedema) has also been reported. Tell your healthcare provider if you get a rash or develop facial swelling after starting LEXIVA.

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Robert Walker Take any superhero comic book and thereâ&#x20AC;&#x2122;s bound to be a backstory in which a hapless young soul is somehow infused with great physical powersâ&#x20AC;&#x201D;Peter Parkerâ&#x20AC;&#x2122;s fateful radioactive spider bite, for one. The transformation opens the character to fantastic new possibilities, but it may also cause him great anguish and subject him to public stigma. (Spider-Manâ&#x20AC;&#x201D;a menace!?) Robert Walker, a veteran comic book artist who earned his stripes at Marvel, saw the parallels between this common refrain and that of HIV infection. Looking to put his creative talents to a more socially conscious cause, he took it upon himself to create his own comic book, O+MEN, staffed entirely by HIV-positive superheroes who suffer at the hands of their infection but a r e also s e x y,

$PNNPO TJEF FGGFDUT PG -&9*7" BSF OBVTFB WPNJUJOH BOE EJBSSIFB 5FMM ZPVS IFBMUIDBSF QSPWJEFS BCPVU BOZ TJEF FGGFDUT UIBU CPUIFS ZPV PS UIBU XPO U HP BXBZ 5IJT MJTU PG TJEF FGGFDUT PG -&9*7" JT OPU DPNQMFUF $BMM ZPVS EPDUPS GPS NFEJDBM BEWJDF BCPVU TJEF FGGFDUT :PV NBZ SFQPSU TJEF FGGFDUT UP '%" BU '%" How should I store LEXIVA? t -&9*7" 5BCMFUT TIPVME CF TUPSFE BU SPPN UFNQFSBUVSF CFUXFFO ÂĄ BOE ÂĄ' ÂĄ UP ÂĄ$ ,FFQ UIF DPOUBJOFS PG -&9*7" 5BCMFUT UJHIUMZ DMPTFE t -&9*7" 0SBM 4VTQFOTJPO NBZ CF TUPSFE BU SPPN UFNQFSBUVSF PS SFGSJHFSBUFE 3FGSJHFSBUJPO PG -&9*7" 0SBM 4VTQFOTJPO NBZ JNQSPWF UBTUF GPS TPNF QBUJFOUT %P OPU GSFF[F t ,FFQ -&9*7" BOE BMM NFEJDJOFT PVU PG UIF SFBDI PG DIJMESFO t %P OPU LFFQ NFEJDJOF UIBU JT PVU PG EBUF PS UIBU ZPV OP MPOHFS OFFE #F TVSF UIBU JG ZPV UISPX BOZ NFEJDJOF BXBZ JU JT PVU PG UIF SFBDI PG DIJMESFO General information about LEXIVA .FEJDJOFT BSF TPNFUJNFT QSFTDSJCFE GPS DPOEJUJPOT UIBU BSF OPU NFOUJPOFE JO QBUJFOU JOGPSNBUJPO MFBGMFUT %P OPU VTF -&9*7" GPS B DPOEJUJPO GPS XIJDI JU XBT OPU QSFTDSJCFE %P OPU HJWF -&9*7" UP PUIFS QFPQMF FWFO JG UIFZ IBWF UIF TBNF TZNQUPNT ZPV IBWF *U NBZ IBSN UIFN 5IJT MFBGMFU TVNNBSJ[FT UIF NPTU JNQPSUBOU JOGPSNBUJPO BCPVU -&9*7" *G ZPV XPVME MJLF NPSF JOGPSNBUJPO UBML XJUI ZPVS IFBMUIDBSF QSPWJEFS :PV DBO BTL ZPVS QIBSNBDJTU PS IFBMUIDBSF QSPWJEFS GPS JOGPSNBUJPO BCPVU -&9*7" UIBU JT XSJUUFO GPS IFBMUI QSPGFTTJPOBMT 'PS NPSF JOGPSNBUJPO ZPV DBO DBMM UPMM GSFF PS WJTJU XXX -&9*7" DPN What are the ingredients in LEXIVA? 5BCMFUT "DUJWF *OHSFEJFOU GPTBNQSFOBWJS DBMDJVN *OBDUJWF *OHSFEJFOUT DPMMPJEBM TJMJDPO EJPYJEF DSPTDBSNFMMPTF TPEJVN NBHOFTJVN TUFBSBUF NJDSPDSZTUBMMJOF DFMMVMPTF BOE QPWJEPOF , 5IF UBCMFU GJMN DPBUJOH DPOUBJOT UIF JOBDUJWF JOHSFEJFOUT IZQSPNFMMPTF JSPO PYJEF SFE UJUBOJVN EJPYJEF BOE USJBDFUJO -&9*7" 5BCMFUT NH BSF QJOL JO DPMPS BOE BSF DBQTVMF TIBQFE XJUI UIF MFUUFST i(9 -- w QSJOUFE PO POF TJEF PG UIF U BCMFU

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confident, extraordinarily fit ass-kickers. â&#x20AC;&#x153;I used that old genre and tried to put a new spin on it and put it into a reality-type issue,â&#x20AC;? he says. Walker says HIV touched his life when he was a teenager and he watched a close family member die. After moving to New York City in 1992, he saw HIV further devastate the gay population. More recently, friends of his have participated in HIV clinical trials or vaccine trials. This gave him the idea for his book: about a nefarious government plot that, claiming to have found a cure for the virus, actually infects unwitting volunteers with a super form of HIV that is not only fast-acting but also leads to great physical powers. (Available at OMENPLUS.com.) The nine main O+MEN characters band together to enact their revenge against their tormentors. Walker is determined to show every possible race, ethnicity, and sexuality among them. The characters include a ďŹ ery Latina lesbian stripper called Hot, an African-American football star on the â&#x20AC;&#x153;down lowâ&#x20AC;? named K-oss, and the ghostly former drug user Goth. While the O+MEN were infected in many diďŹ&#x20AC;erent waysâ&#x20AC;&#x201D; drug abuse, mother to child, gay sex, straight sex, rapeâ&#x20AC;&#x201D;what they have in common is great fortitude. â&#x20AC;&#x153;I think when people ďŹ nd out they have HIV and AIDS, they feel a certain helplessness, they donâ&#x20AC;&#x2122;t feel powerful,â&#x20AC;? Walker says. â&#x20AC;&#x153;This is what I wanted to embody into the story of the O+MEN: a sense of power into their lives. Even if you have the disease, you can still move mountains and change the world and do great things.â&#x20AC;? â&#x20AC;&#x201D;B.R. g

One filmmaker is working to ensure that knowledge of the National AIDS Memorial Grove, a little-known sanctuary in San Francisco, travels far and wide through his film BY BENJA MIN RYA N

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IM AGE S C OUR T E SY A NDY A BR A H A M S W IL S ON

Dell, that the city could not aﬀord to maintain. Then a group of volunteers, looking for a place to channel their grief over the AIDS crisis that was so devastating their community, raised private A hidden sanctuary lies at the

funds, rolled up their sleeves, and

eastern end of San Francisco’s

turned the land into a memorial

Golden Gate Park, where 7½

to those lost to the disease. With

acres of meandering paths and

Rep. Nancy Pelosi as its cham-

sloping hills lead to a secluded

pion in Congress, the National

meadow. Surrounded by pine,

AIDS Memorial Grove, as it is

redwood, Monterey cypress,

now known, was recognized as a

and maple trees, this bucolic plot

national memorial in 1996, one of

holds an almost mythic, other-

only two in California.

worldly power in the minds and hearts of the people who love and care for the space. Twenty years ago it was a largely forgotten mass of dilapidated dirt and brush, known as the deLaveaga

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In an upcoming documentary about the National AIDS Memorial Grove, Pelosi reflects on how from the passion and commitment of these trailblazers “there emerged this magnificent grove. And then we had this work of nature that really resulted from the grief and sadness of many, converted into a beautiful memorial of remembrance and renewal.” Directed by Emmy-nominated filmmaker Andy Abrahams Wilson, Forget Me Not hopes to bring the national attention that is due to a memorial of the AIDS Grove’s stature. Wilson’s film, which is nearing completion as he seeks additional funding, will trace the memorial’s nascent years to its present, chronicling the stories of those whose lives cross paths in the park: friends, family, and loved ones of those who have died; people infected and affected alike by HIV.

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Wilson, who was himself unaware of the AIDS Grove before the memorial’s organizers approached him about creating the film, is enthralled by a place he said provides a poignant, Buddhist-like reflection on life, loss, and ultimate regeneration through nature. The AIDS Grove’s upkeep, he points out, largely falls to a group of volunteers who get their hands dirty and find solace through tending the earth and ultimately watching beautiful things grow. Their personal involvement with the space, he says, is unique and sets the site apart from the impassive stone of the Vietnam Veterans Memorial, Mount Rushmore, or Grant’s Tomb.

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tips+tools See a trailer for Wilson’s Forget Me Not online at HIVPLUSmag.com

“When we see that process in nature, we see the death,” says Wilson, “and we see the regeneration. It’s a healing. It’s a coming full circle.” “I’ve been scarred by AIDS, and I’m a survivor,” he continues, telling of having lost many friends and a former lover when living in San Francisco in the early 1990s. “The AIDS Grove is also a place for me.” “The ﬁlm, while it discusses how to memorialize AIDS—it’s also a discussion about memo-

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NOVEMBER/DECEMBER 2009

rial in general,” he explains. Our

grief? That’s pertinent right now,

current political climate, he adds,

with the war, with the memo-

begs for a national dialogue about

rial at Ground Zero. We’ve gone

how we cope with death: “I call it

through this period of crisis. So

a post-AIDS AIDS ﬁlm. In a time

this is a way of really ﬁnding

of loss, what do we do with our

healing.”

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CREDIT

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TREATMEN T

RES EA RCH

N EWS

HAART BEATS

Time for a Mental Health Checkup? Although most HIVers regularly see a physician to manage their physical care, too many fail to bring up mental health issues—like stress, anxiety, and depression. And even docs often fail to

JENNY SPECKELS/ISTOCKPHOTO.COM

check on such needs If you’re like most HIVers, you see your primary care doctor three or four times a year to discuss your meds, CD4-cell count, and viral load. But when was the last time you used one of these appointments to talk about your mental health? There’s little doubt that living with the tricks that HIV plays on an immune system can also aﬀect mental and spiritual wellbeing. But this side of the disease isn’t always discussed. As Steven M. Harlow, clinical director of New Leaf counseling center in San Francisco, notes, “As HIV has come to be more of a manageable illness, people have forgotten that there is still an emotional impact to having this disease.” Yet the stigma and discrimination that still accompany having HIV can take a toll. A study led by Susan Cochran, an epidemiologist at the University of California, Los Angeles’s School of Public Health, has found that gay HIVpositive men are up to eight times as likely as heterosexual men to report having mental health problems. Similar studies conducted around the world show that HIVers, regardless of gender, age, or

sexual orientation, commonly suffer from depression. The findings underscore the importance of HIVers discussing their mental heath with their doctors. “Getting mental health care is important in its own right, because it affects people’s lives,” says Brian Wells Pence, an epidemiologist at Duke University who studies mental health issues in HIVers. “But it’s also important because it can affect how well a person engages in their medical care.” There is no mental health equivalent to a CD4 count or a viral load, but there are screening tools doctors can regularly—and easily—use. Harlow says that HIV specialists and primary care docs can and should conduct mini assessments to identify problems their HIV-positive patients might be having with depression or anxiety. In addition, he says, they should be regularly assessing whether a patient is experiencing any emotional problems because of life changes or if their substance use or sexual behaviors have changed in ways that need to be addressed. And if the doctor doesn’t bring the subject up, says Harlow, then

Heart Healthy > 44 >

Bad News, Smokers > 45 >

Adding More to Life’s Stress? Lesbian, gay, and bisexual adults, including those who are HIVpositive, are more than twice as likely as their heterosexual peers to seek help for mental health issues, according to a study by researchers at the University of California, Los Angeles’s School of Public Health. The survey of nearly 2,100 adults, reported in the journal BMC Psychiatry, has shown that about 48.5% of respondents reported receiving mental health treatment within the previous year, compared to 22.5% of heterosexuals. The researchers believe that discrimination, violence, and other stressful life events may be greater among sexual minorities—and worse still among those who are also members of racial minorities—leading them to experience more obvious symptoms of anxiety or depression requiring treatment. Although the UCLA researchers didn’t specifically address the role of HIV stigma in the need for mental health care, previous research has shown that many HIVers report experiencing discrimination and prejudice due to their infections. —Bob Adams

the patient deﬁnitely should feel free to start the conversation. “Nobody,” he insists, “should suffer the impact of depression or anxiety and the loneliness and isolation that can accompany them without getting help.” —Sue Rochman

Man-Made Miracle? > 45 >

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HAART BEATS

Need another reason to pay closer attention to your heart health? A new study suggests that HIV significantly boosts one’s risks for hardening of the arteries and a buildup of arterial plaque—regardless of whether you’re taking anti-HIV drugs to treat it. Researchers at the University of California, San Francisco, compared the thickness of the carotid arteries of more than 400 HIVers with those of HIV-negative adults and found that HIV infection alone resulted in atherosclerosis incidence on a par with that associated with smoking, which is a proven risk factor for cardiovascular disease. “The effect [of HIV alone] is so big,” the researchers conclude, “that no drug or class of drugs stands out as being an effective contributor” to increased atherosclerosis risk.

Previous research has suggested the nucleoside reverse transcriptase inhibitor abacavir, found in Ziagen and the combination pills Epzicom and Trizivir, boosts risks for cardiovascular disease and heart attacks. But a new analysis of nearly 20,000 HIVers from the U.S. Veterans Health Administration’s Clinical Case Registry has raised doubts about the earlier studies’ conclusions. It found instead that many of the heart attacks reported among Ziagen users may have been caused by other common cardiac risk factors, like smoking, or by other ailments that can affect the heart, such as hepatitis C and kidney disease. “The association of abacavir use with [acute myocardial infarction] was much weaker after adjusting for traditional cardiovascular risk factors,” the researchers conclude.

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Heartaches

Synthetic Superstar? If researchers at the University of Wisconsin— Madison are right, it might be possible to devise a preventive HIV vaccine that doesn’t

SMOKERS FACE A MED RISK HIVers taking the protease inhibitor Reyataz might want to kick their smoking habit and stop using marijuana, according to a study presented at the 2009 Interscience Conference on Antimicrobial Agents and Chemotherapy. A two-year review of HIV-positive adults living in four U.S. cities found that tobacco and marijuana use resulted in significant reductions in Reyataz concentrations in the body; 50% of the tobacco

users and 36% of marijuana users had Reyataz levels below that which effectively suppresses HIV and at which drug resistance can develop. And the more one smoked or used pot, the lower the concentration of the protease inhibitor, according to the data. The researchers believe tobacco and marijuana may interfere with a key liver enzyme involved in the processing of Reyataz in the body.

rely on the body’s immune system at all. In the September 1 edition of the Proceedings of the National Academy of Sciences, the scientists reported having developed synthetic protein-like molecules that block the normal chemical communication that occurs between viral and human proteins during the infection process. Specifically, the synthetic molecules, called foldamer proteins, target HIV’s gp41 protein, which plays a crucial role in the virus’s ability to attach to and penetrate immune system cells. Lab tests showed that the molecules completely prevented HIV from infecting immune system cells.

DEVELOPMENTS IN MEDICAL STUDIES Nonnucleoside analog Viramune is as effective in lowering blood-based viral loads as the protease inhibitor Reyataz while being less likely to boost triglyceride levels, according to a comparison of the two presented at the 2009 International AIDS Society Conference.

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Treatment-naive HIVers with high baseline viral loads respond equally well to initial regimens with Ziagen or Viread as the backbone medication in triple-drug therapy, according to a report in the September 1 issue of The Journal of Infectious Diseases. A comparison of nonnuke Sustiva and integrase inhibitor Isentress, reported in the August 3 online edition of The Lancet, has shown the two drugs are similarly effective for treatment-naive HIVers. After 48 weeks of treatment, 86.1% of people taking Isentress reduced bloodbased viral loads to undetectable levels, compared to 81.9% of those taking Sustiva. HIVers coinfected with hepatitis B experience have about half as

many serious instances of flare-ups of liver inflammation and spikes in the liver enzyme ALT, which indicate liver damage, when taking anti-HIV therapy that includes the drug Epivir, according to a South African study presented at IAS 2009. A genetic test called HIV V3 Genotyping and Trofile is as effective at identifying HIVers who will respond well to Selzentry as the slower and more expensive Geno2pheno assays, according to research presented at IAS 2009. The test identifies whether one carries virus that invades CD4 cells through the CCR5 cellular portals, which Selzentry blocks. While HIVers with confirmed CCR5tropic HIV infections achieve similar reductions in HIV viral levels on regimens

containing either Selzentry or Sustiva after 96 weeks of treatment, they post about a 25% higher increase in CD4 cells with Selzentry, according to a study of more than 700 HIVers presented at IAS 2009. A once-daily, 800-milligram dosage of Kaletra is just as effective at lowering blood-based viral levels in treatment-experienced HIVers as twicedaily, 400-milligram dosing, researchers reported at IAS 2009. Reducing pill burden also improved medication adherence, according to the study. HIVers with a stable suppressed viral load may be safely switched to a monotherapy regimen consisting of only boosted Prezista, two studies presented at IAS 2009 have found. Monotherapy was as effective in suppressing blood-based viral levels while offering reduced drug-related side effects, lower chances of developing drug resistance, and significantly lower costs.

Schering-Plough has announced that it is expanding its Phase II clinical trial of the CCR5 inhibitor Vicriviroc among treatment-naive HIVers at its research sites in North America, Central America, Europe, and South Africa. The medication also is being studied in two Phase III trials of treatment-experienced HIVers. Shionogi and GlaxoSmithKline presented Phase II clinical trial data of experimental once-daily integrase inhibitor S/GSK1349572 at IAS 2009, showing the drug reduced HIV viral loads to undetectable levels in 70% of study subjects who took the medication for only 10 days. The data also showed low adverse reactions to the medication and no indication of drug resistance. Tobira Therapeutics presented data from two Phase I trials of experimental CCR5 inhibitor TAK-652 at IAS 2009, showing the drug is both safe and well tolerated and has a sufficient half-life to support once-daily dosing.

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Corey takes a moment from contemplating existence to contemplate the meaning of a cough I tend to see the world in very broad strokes. Like the pages of ancient Chinese calligraphy scrolls—where words have multiple meanings, where there are stories hidden within each diagonal slant of a line, and where each piece of the textual puzzle comes together to bring about one simple character’s ultimate, complex meaning. This is how I see life. I see conflict, hardship, joy, love, Saturday morning cartoons, and even a destiny-altering disease as pertinent portions of a perfect picture. All things are connected. And all things have deeper meaning. And even random discordant anomalies have purpose. So surely there’s a reason for this cough. For the past few months I have had a cough. Nothing of life-altering danger: no blood, no body-spasming convulsions that point to fluid in the lungs, no death bed sagas or poignant personal operas that closely reference La Bohème. This is just a cough: a constant annoyance with an underlying promise that there’s something brewing below the surface that needs to be discovered, explored, and resolved. Some would say “nothing to worry about.” But I have HIV, and I can’t afford to just let things go. So this has been my dilemma. This has been the puzzle that my doctor and I have been work-

ing on. This has been my most recent contemplation. But with all our tests, blood work, and extra medications, we just can’t seem to find the source. Now, based on the Occam’s razor principle of logic, it’s probably just a cold or maybe some allergies that I didn’t know I had or perhaps simply after eight months of successful hepatitis C treatment (hurray for me!), the dreaded flulike systems associated with this treatment have finally physically manifested and I should be lucky it’s just a cough. But that seems like such a limited awareness of the world and such a ridiculously lazy function of consciousness. Like I said: I see the world in a spectrum of far more magical complexity. To every truth, there must be levels of interconnected depth, where the duality of concepts can coexist in the same space of understanding. There must be more to it. Sure, medication works, logic is powerful, HIV and hepatitis C have unforeseen side effects, and sometimes a picture of a rose is just a picture of a rose. But sometimes it’s not. And this is when most people start to call me crazy. Gary Zukav, Eckhart Tolle, Oprah, and Jesus (obviously the last two are interchangeable) say that all physical ailments are a manifestation of spiritual, emo-

tional, or psychological dynamics at work in our lives—like rain being a result of a high or low pressure front over the Atlantic Ocean. Not good, not bad, just a pattern. Have I lost you? Basically, I believe my cough is a representation of some internal truth that the universe is trying to make known. And lately that truth is that no one ever knows what I’m talking about! No one wants to have conversations about the ethereal ideas that interest me. No one will sit over coﬀee and discuss with me ancient Chinese calligraphy, the contemporary theatrical relevance of La Bohème, Occam’s linear leaps of logic, or the philosophical possibilities of a physical component to the metaphysical. So because of that lack of personal expression…I have a cough. Yup! That’s what I think it is. Well, that or the whole hepatitis C thing.

Saucier is a writer, blogger, and performance artist based in Los Angeles. Find more of his writing online via our website.

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ASK & TELL

Q& A

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Teddy bears are iconic for longtime AIDS survivor Dab Garner. A burly, hairy man living in Jacksonville, Fla., who self-identifies as a “bear,” Garner is known for giving stuffed “AIDS bears” to ill HIVers around the globe. Today, the 47-year-old not only continues his nearly threedecades-long bear-distri-

How did your tradition of giving teddy bears to people with HIV get started?

I gave the first bear in 1981 to the ex of my first boyfriend when he was dying in the hospital in San Francisco. It broke my heart that he was—like all people with AIDS were back then—quarantined, afraid, and alone. I didn’t know what to do, so I just ran out and bought him a teddy bear to give him something to hold and hug. [Getting choked up] And maybe give him a glimmer of happiness and hope. That was how it got started; to date, I’ve given away more than 7,500 of them. But you founded your agency, Dab the AIDS Bear Project, in 2004 not only to continue that work but also in response to a lack of affordable HIV treatments?

to safeguard the health of

At the time there were several states that had started waiting lists for access to their AIDS Drug Assistance Programs, and a friend of mine actually died while on the waiting list for treatment in South Carolina. I decided I couldn’t let that ever happen again, so I made advocating for the nation’s ADAPs— and in general for affordable, quality health care—one of my priorities. We do a lot of speaking and advocacy work on those issues.

HIVers everywhere.

Another priority is helping kids affected by HIV, correct?

bution mission but also serves as founder and chief executive of his self-named organization, Dab the AIDS Bear Project, which works

Yes. We hold holiday events each year through the project’s Teddy Bear Touchdown program. They’re a vital part of our mission. Why are they so important to you?

To reach Dab the AIDS Bear Project or to donate holiday gifts to the Teddy Bear Touchdown program, which benefits children affected by HIV, visit us online at HIVPLUSmag.com

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“He was…quarantined, afraid, and alone. I didn’t know what to do, so I just ran out and bought him a teddy bear to give him something to hold and hug.”

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COURTESY OF DAB GARNER

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In the mid ’80s my partner and I were introduced to a little girl, Candace, in foster care who was born with HIV and fetal alcohol syndrome, which left her with some physical deformities. We couldn’t become her foster parents, so we became sort of godparents to her. She was the apple of my eye! But she got sick and passed away just before Christmas 1989. I had already bought gifts for her. [Starts to get choked up again] To honor her, I gave them to other kids living with HIV. I saw how those kids just had so much happiness and joy seeing that someone cared. So I’ve been doing it every year since. Now, with the donations we get, we’re able to hold holiday parties and give gifts to hundreds of kids in 10 U.S. cities and even outside the country. I made a promise to Candace while she was losing her battle with AIDS to do everything I could for children like her. [Begins to cry] And I’ve done my best to live up to that promise.

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