HIV Plus Magazine #74 - Jan/Feb 2010

H E A L T H + S P I R I T + C U L T U R E + L I F E

THEY’RE SMOKIN’ Hydeia Broadbent All Grown Up but Still Our Poster Girl

A Philly dance troupe puts HIV center stage

BLACK AIDS CRISIS Are racial HIV disparities a U.S. indictment?

TRUTH BE TOLD JANUARY/FEBRUARY 2010 www.hivplusmag.com

Adult film legend Aiden Shaw takes us back to his start with his second autobiography, Sordid Truths

• 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

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Michael W.E. Edwards

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

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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.

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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.

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IN THIS ISSUE

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“It hurts to know that people have been [speaking up about HIV prevention] for longer than I’ve been alive, but people aren’t getting the message.”

—Hydeia Broadbent

FEATURES

24 Man of Words Aiden Shaw has completed his second set of memoirs, this time taking readers back to his earlier years, the ones that saw him move from life as college student in England to eventual adult film superstar.

31 Excerpt: In his prologue to Sordid Truths, the author recounts an encounter that made him wonder who he— who Aiden Shaw—really was.

32 As Good As It Gets Ten years ago HIV Plus first sat down with then-teenager Hydeia Broadbent, who was born with the virus. Now we revisit the bright young advocate to find out that life is better than ever, despite a few bumps along the way.

DEPARTMENTS & VOICES

8 Status Symbols Dance troupe Smoke, Lilies, and Jade has HIV at the heart of its mission. Plus: A roundup of advice and news for living your life to the fullest.

11 Nutrition+Fitness 15 Mind+Manner

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

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38 HAART Beats Researchers say racial disparities in U.S. HIV prevalence rates are an indictment of the response to the epidemic. Plus: Lots more treatment news and advice.

44 Medicine+Wellness 45 Rx+Research

46 Perfectly Flawed Corey Saucier takes the health care system in our nation to task.

48 Ask & Tell Many people say they are a survivor, but Kengi Carr is the real deal.

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ON THE COVER: AIDEN SHAW PHOTOGRAPHED BY JAMES STAFFORD.

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BE T TE R

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STATUS SYMBOLS

The Movement Has Its Moves Philadelphia dance troupe Smoke, Lilies, and Jade has HIV awareness and fund-raising at the core of its mission

COURTESY OF GABRIEL BIENCZYCKI

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AIDS has dimmed some of the brightest lights of the dance world: Rudolf Nureyev, Michael Bennett, Robert Jorey, Alvin Ailey, and tips+tools Willi Ninja, just to name a few. In the wake of such loss, how can a Watch videos of choreographer turn his own grief into inspiration and call audiences Smoke, Lilies, and into action?

Jade and see what the troupe is doing When veteran dancer and Philadelphia native Zane Booker by visiting us at returned home from a decade performing in Europe, the culture HIVPLUSmag.com shock opened his eyes to how American dance companies don’t often integrate their art with activism and politics like their European counterparts. He set out to create a tribute concert to the men from the Philadelphia Dance Company who had died of AIDS. The result was the birth of his own dance company—Smoke, Lilies, and Jade, a multimedia performing arts group whose core mission is to use artistic expression to raise awareness about HIV. Trained at Philadanco, as the Philly company is known, Booker counts classical and contemporary ballet as major inuences but also his time as a Broadway dancer, not to mention years spent dancing in the clubs. His company’s performances are thus a blend of styles, with spokenword poetry added to help get his message across. They unapologetically explore issues of race and sexuality.

HIV-negative himself, Booker says he’s moved to take action by the many people in his life who are living with the virus. Also, as a professor of dance at the University of the Arts in Philadelphia, he hopes to inspire the young people in his charge to remember the ever-present realities of the disease. “This is my way of keeping it in their minds,� he says, “and also honoring those people that passed away. Through dance, you get a visceral communication about the subject matter. Our work really instigates conversation.� “Zane does these performances that are so in-your-face,� says SLJ board member Terrence Gore, an HIV-positive former dancer. “I might see one person walk out, but I might see 10 people who are in awe: Oh, I did not know that. I did not know that one could live with the disease, that it’s not necessarily a death sentence, that one can be positive and live a healthy life.�

Booker hopes to grow his edgling company in the coming years by presenting its message at everything from health conferences to gay pride events and dance clubs. —Benjamin Ryan

Killer Sex > 10 >

Yoga Goodness > 11 >

Friend or Foe? > 19 >

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STATUS SYMBOLS

TAKE 5 Some Meds Have Wrong Target?

More than half the people who take antidepressants for depression never get relief because the cause of depression has been oversimplified and drugs designed to treat it aim at the wrong target, according to research from Northwestern University. The medications are like arrows shot at the outer rings of a bull’s eye instead of the center, experts say.

A study from laboratory of depression researcher Eva Redei appears to topple two strongly held beliefs about depression. One is that stressful life events are a major cause of depression.

The other is that an imbalance in neurotransmitters in the brain triggers depressive symptoms. Redei has found that there is almost no overlap between stress-related genes and depression-related genes.

Both findings are sign i f i c a nt b e c au s e th e s e beliefs were the basis for developing drugs currently used to treat depression. �This research opens up new routes to develop new antidepressants that may be more effective,� Redei says. “There hasn’t been an antidepressant based on a novel concept in 20 years.�

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

Sex: It Could Kill You. About a quarter of the 60 million premature deaths globally each year are due to unsafe sex, poor childhood nutrition, alcohol, inadequate sanitation and hygiene, and high blood pressure, the World Health Organization reported. In fact, global life expectancy could gain almost five years if these five problems were tackled.

HIV is the world’s sixth biggest killer. In 2004 unsafe sex was responsible for more than 99% of HIV infections in Africa, the only region where more women than men have HIV. Elsewhere, the proportion of HIV deaths due to risky sexual behaviors ranged from about 50% in low- and middle-income countries of the WHO’s Western PaciďŹ c region to 90% in nations of the Americas with similar resources.

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Drugmakers Unite to Create.

GlaxoSmithKline and Pfizer have launched a joint venture, Viiv Healthcare, to focus on the development of new antiHIV treatments. Even though health advocates welcomed the link-up, they also stress it is essential that the dilution of competition does not drive up prices and lead to less drug development overall. An earlier partnership between two different pharma companies, Bristol Myers-Squibb and Gilead, led to the creation of Atripla in 2006. Keep your ďŹ ngers crossed that this one will also be as successful.

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Hep C Being Transmitted Sexually. Researchers in New York City have reported uncovering a new epidemic of hepatitis C virus infection among men who have sex with men and who have HIV infection. Although it has long been thought that blood-borne transmission, like what happens when injection-drug users share needles, is how the virus is spread, the researchers were able to demonstrate that sexual transmission was the main route of infection in the New York cases.

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JANUARY/FEBRUARY 2010

Undaunted by Recession.

Even though the recession may be affecting the way you spend your cash, the Obama administration is to be commended for assuring the head of the President’s Emergency Plan for AIDS Relief that it is committed to the global HIV fight. In fact, Eric Goosby says, the U.S. government will increase the PEPFAR budget to ďŹ ght HIV in South Africa, which in 2009 elected a new president, who has rejected the denialist policies of the nation’s previous government.

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5 Biting Terror. A neighborhood tussle in Michigan became an issue of “terrorâ€? when an HIV-positive man was charged with attempted bioterrorism for allegedly biting his neighbor while the two were ďŹ ghting one another in the fall. But, wisely, the state’s lawmakers are critical of the charges, especially since experts stepped up to say that it is a near impossibility to spread HIV through a human bite.

NUTRITION

FITNESS

No Need to Bend Over Backward My doctor has told me that I’m at risk for high blood pressure and placed me on blood-pressure medication. What’s the best way to augment my workout routine in this situation? —Denise, Los Angeles

Sam Page

Ease Depression With a Mediterranean Diet?

Individuals who follow the Mediterranean dietary pattern— rich in vegetables, fruits, nuts, whole grains, and fish— appear less likely to develop depression, according to a report published in the journal Archives of General Psychiatry.

The specific mechanisms by which a better adherence to the Mediterranean dietary pattern could help to prevent the occurrence of depression are not well-known, the authors write. Components of the diet may improve blood vessel function, fight inf lammation, reduce risk for heart disease, and repair oxygen-related cell damage, all of which may decrease the chances of developing depression. �However, the role of the overall dietary pattern may be more important than the effect of single components,� the authors write. “It is plausible that the synergistic combination in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression.�

GE T T Y IMAGES

Focus on HIV and Aging

50%

Approximately, the proportion of HIV-positive people in the United States who will be older than 50 by 2015; currently about 15% of HIVers are over 50.

HIVers who participated in a regular ranging from “11th-step yoga� (for those yoga program experienced a natural in 12-step programs) to “hot nude yoga� drop in blood pressure, according to new for the more adventurous.

When you’re ready to find your inner research from the Washington University School of Medicine. The study, published yogi, ask friends if they know of a good in the journal HIV Medicine, followed 60 yoga studio in your neighborhood. Most HIV-positive adults over the course of gyms and studios offer beginner-level a supervised 20-week yoga program. classes, but a good instructor can adjust Resting systolic and diastolic blood even intermediate classes for the novpressures were reduced more in the yoga ice, offering helpful suggestions without group than in the control group despite making you feel awkward. no greater reduction If you’re just starting, try in body weight, fat, or Yoga has also “restorative� or “passive� overall quality of life. yoga, a class in which foam been shown The best part? Levels of blocks and other objects are T4, a thyroid hormone, used to relax the body into to improve were not adversely the yoga asanas (poses) anxiety, without undue strain or affected. depression— stress. You may be confused Pr ac tic ing yo ga is an intelligent idea even irritable or frustrated, but instead for other reasons too. of getting irked, “offer bowel Participants in other up� your yoga practice to someone or something in double-blind studies on syndrome! your life that needs your yoga have documented substantial improvements in flexibility, support, patience, or understanding. balance, and muscular endurance. Flex- This will align your focus and help you ibility and strength are two key areas for stay in the moment.

HIVers, especially as we advance into our Remember, the benefits of yoga golden years. become evident only if you do it reguYoga has also been shown to improve larly. Make an effort to practice the asaanxiety, depression—even irritable nas you have learned. Above all, listen to bowel syndrome! Best of all, yoga is your body and don’t force yourself into relatively inexpensive and accessible, any pose that causes pain. Drink water, with many community classes free of take breaks, and breathe. Namaste. charge or “pay what you can� from $5 to $20. There are yoga classes for nearly Get more tips from Page and read his blog every specific interest and demographic, at PeaceLoveLunges.com

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IMPORTANT INFORMATION ABOUT REYATAZ® (atazanavir sulfate) INDICATION: REYATAZ is a prescription medicine used in combination with other medicines to treat people who are infected with the human immunodeficiency virus (HIV). REYATAZ has been studied in a 48-week trial in patients who have taken anti-HIV medicines and a 96-week trial in patients who have never taken anti-HIV medicines.

REYATAZ does not cure HIV or lower your chance of passing HIV to others.

IMPORTANT SAFETY INFORMATION: Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

Do not take REYATAZ if you are taking the following medicines due to potential for serious, life-threatening side effects or death: Versed® (midazolam) when taken by mouth, Halcion® (triazolam), ergot medicines (dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as Cafergot®, Migranal®, D.H.E. 45®, ergotrate maleate, Methergine®, and others), Propulsid® (cisapride), or Orap® (pimozide).

Do not take REYATAZ with the following medicines due to potential for serious side effects: Camptosar® (irinotecan), Crixivan® (indinavir), Mevacor® (lovastatin), or Zocor® (simvastatin).

Do not take REYATAZ with the following medicines as they may lower the amount of REYATAZ in your blood, which may lead to increased HIV viral load and resistance to REYATAZ or other anti-HIV medicines: rifampin (also known as Rimactane®, Rifadin®, Rifater®, or Rifamate®), St. John’s wort (Hypericum perforatum)containing products, or Viramune® (nevirapine).

Do not take Vfend® (voriconazole) if you are taking REYATAZ and Norvir® (ritonavir).

The above lists of medicines are not complete. Taking REYATAZ with some other medicines may require your therapy to be monitored more closely or may require a change in dose or dose schedule of REYATAZ or the other medicine. Discuss with your healthcare provider all prescription and non-prescription medicines, vitamin and herbal supplements, or other health preparations you are taking or plan to take.

Tell your healthcare provider if you are pregnant, breast-feeding, planning to become pregnant or breast-feed, or if you have end-stage kidney disease managed with hemodialysis or severe liver dysfunction.

Tell your healthcare provider right away if you have any side effects, symptoms, or conditions, including the following: • Mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started, and usually goes away within 2 weeks with no change in treatment.

• Severe rash has occurred in a small number of patients taking REYATAZ.This type of rash is associated with other symptoms that could be serious and potentially cause death. If you develop a rash with any of the following symptoms, stop using REYATAZ and call your healthcare provider right away: – Shortness of breath – Conjunctivitis (red or inflamed – General ill-feeling or eyes, like “pink-eye”) “flu-like” symptoms – Blisters – Fever – Mouth sores – Muscle or joint aches – Swelling of your face • Yellowing of the skin and/or eyes may occur due to increases in bilirubin levels in the blood (bilirubin is made by the liver).

• A change in the way your heart beats may occur. You may feel dizzy or lightheaded.

These could be symptoms of a heart problem.

• Diabetes and high blood sugar may occur in patients taking protease inhibitor medicines like REYATAZ. Some patients may need changes in their diabetes medicine.

• If you have liver disease, including hepatitis B or C, it may get worse when you take anti-HIV medicines like REYATAZ. • Kidney stones have been reported in patients taking REYATAZ. Signs or symptoms of kidney stones include pain in your side, blood in your urine, and pain when you urinate.

• Some patients with hemophilia have increased bleeding problems with protease inhibitor medicines like REYATAZ. • Changes in body fat have been seen in some patients taking anti-HIV medicines.

The cause and long-term effects are not known at this time.

• Gallbladder disorders (including gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. Other common side effects of REYATAZ taken with other anti-HIV medicines include: nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.

You should take REYATAZ once daily with food (a meal or snack). Swallow the capsules whole; do not open the capsules. You should take REYATAZ and your other anti-HIV medicines exactly as instructed by your healthcare provider.

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.

On REYATAZ, Wedn esda y Ma ry ’s birthd ay pa rty

Thursda y 5:30 C h oi r e practic Bu y new shoes for Latish a

Fight HIV your way.

Please see Important Patient Information about REYATAZ on adjacent pages.

how you spend your time is up to you.

Individual results may vary.

Once-daily REYATAZ can fit into your schedule and help fight your HIV. REYATAZ, a protease inhibitor (PI), in HIV combination therapy: u Can

help lower your viral load and raise your T-cell (CD4+ cell) count u Has a low chance of diarrhea (shown in clinical trials)* u Is

taken once a day with a snack or meal

* REYATAZ in combination therapy had a 1%-3% rate of moderate-to-severe diarrhea.

REYATAZ is one of several treatment options your doctor may consider.

Ask your healthcare team about REYATAZ. www.REYATAZ.com REYATAZ does not cure HIV, a serious disease, and has not been shown to reduce the risk of passing HIV to others.

REYATAZ and SUSTIVA are registered trademarks of Bristol-Myers Squibb.All other trademarks are the property of their respective owners and not of Bristol-Myers Squibb. Š 2009 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US09AB22801 11/09

E.U.’s “Unaware� Rate Is Higher

1 in 3: The proportion of people in the European Union who are infected with HIV but who aren’t aware of it. In the United States, roughly one in four people who are estimated to be infected with the virus don’t know they carry it.

Sperm’s Leading Role With HIV

Want Muscle? Go Easy on the Protein For thousands of years, people have believed that eating large amounts of protein made it easier to build bigger, stronger muscles.

A study by University of Texas Medical Branch at Galveston metabolism researchers, however, provides evidence that strongly contradicts this ancient tradition. It also suggests practical ways to both improve normal American eating patterns and reduce muscle loss.

The study’s results, obtained by measuring muscle synthesis rates in volunteers who consumed dierent amounts of lean beef, have shown that only about the ďŹ rst 30 grams (just over an ounce) of dietary protein consumed in a meal actually produce muscle. â€?We saw that 12 ounces gave exactly the same increase in muscle protein synthesis as four ounces,â€? says Douglas Paddon-Jones, senior author of a paper on the study published in the Journal of the American Dietetic Association. “This suggests that at around 30 grams of protein per meal—maybe a little less—muscle protein synthesis hits an upper ceiling. I think this has a lot of application for how we design meals and make menu recommendations.â€?

The results of the study, Paddon-Jones points out, show that a more efficient eating strategy for making muscle and controlling total caloric intake would be to shift some of the extra protein consumed at dinner to lunch and breakfast. â€?Usually, we eat very little protein at breakfast, eat a bit more at lunch, and then consume a large amount at night. When was the last time you had just four ounces of anything during dinner at a restaurant?â€? Paddon-Jones asks. “So we’re not taking enough protein on board for eďŹƒcient muscle-building during the day, and at night we’re taking in more than we can use. Most of the excess is oxidized and could end up as glucose or fat.â€?

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Sperm—and not just the f luid it bathes in—can transmit HIV to macrophages, T cells, and dendritic cells, according to a research team led by Ana Ceballos at the University of Buenos Aires in Argentina. Writing in The Journal of Experimental Medicine, the team says that by infecting dendritic cells, which carry the virus and potently pass it to T cells, sperm may play a leading role in spreading HIV. During sexual intercourse, infected men transmit HIV through their semen, which carries free-oating virus as well as HIV-infected leukocytes. Traces of the virus have been detected

on sperm as well, but the role they play in viral transmission has been a matter of debate.

After all, men with vasectomies can transmit HIV. Now Ceballos’s team has shown that HIV attaches to the surface of sperm and that these carriers pass on the virus to dendritic cells and other HIV targets.

Sperm m ig ht reach dendritic cells by passing through microabrasions in the vaginal or anal lining that often form during intercourse, suggest the authors. Or they might contact the ďŹ nger-like projections of the dendritic cells that extend to the surface of mucosal linings.

STATUS SYMBOLS

Nope, the “Down Low�

Didn’t Do It Heterosexual black men with multiple sex partners—not bisexual men who secretly have sex w it h men—a re responsible for high rates of HIV among black women, according to a senior oďŹƒcial at the Centers for Disease Control a nd Prevent ion. â€?We have looked to see what proportion of infections is coming from male partners who are bisexual and found there are actually relatively few,â€? says Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “More are male partners who are having female partners and are injecting drugs or using drugs or have some other risks that may put those female partners at risk of acquiring HIV.â€?

GE T T Y IMAGES

Getting Past HIV's Social Roadblocks The feeling of stigmatization that people living with HIV often experience doesn’t exact just a psychological toll; new research suggests it can also lead to measurable negative health outcomes.

In a study published in the Journal of General Internal Medicine, researchers from the University of California, Los Angeles, found that individuals who experienced high levels of internalized stigma were four times as likely as those who didn’t to report poor access to medical care; they were three times as likely to report suboptimal adherence to anti-HIV medications. â€?We were surprised to ďŹ nd that in our models, experiencing high levels of internalized HIV stigma was one of the strongest predictors of poor access to medical care, even after controlling for social factors such as gender, race and ethnicity, income, insurance status, and clinical variables such as T-cell count and years since HIV diagnosis,â€? says lead investigator Jennifer Sayles, an assistant professor of medicine at UCLA and the medical director of the Los Angeles County OďŹƒce of AIDS Programs and Policy.

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STATUS SYMBOLS

Swine Flu May Increase MRSA As hospitals face an even tougher winter than usual managing the rise in demand for beds alongside the second wave of swine flu, a group of doctors, scientists and patient representatives has called for the early discharge of appropriate methicillin-resistant Staphylococcus aureus patients to prevent a rise in MRSA infection rates.

Lose While You Cruise Contrary to what you might believe, living near a variety of restaurants, convenience stores, supermarkets, and even fast food outlets actually lowers your risk for obesity, according to a new study.

Surprisingly, people who live more than a half mile away from any food outlets are the ones who tend to be fatter. â€?Having access to a range of food options in your neighborhood aects both your energy input and output,â€? says Cathleen Zick, coauthor of the study and professor of family and consumer studies at the University of Utah. “A healthy grocery option may influence the food you choose to buy, while having multiple food de s t i n at ion s w it h i n walking distance might encourage you to walk, rather than drive, to your next meal.â€?

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Experts are urging hospitals not to let increasing pressure on staff and rising bed occupancy rates reverse the good work they have done to date to reduce MRSA rates. Research has shown that when a hospital’s bed occupancy rate exceeds 90%, MRSA rates can be as much as 40% above average.

MIND

MANNER

Time: Is It Your Friend or Enemy?

Has the beginning of a new year got you thinking about how you spent the past one? A client I’ll call Larry has been on disability for a few years, and he’s ďŹ nding the days passing all too slowly.

Gary McClain, Ph.D.

GE T T Y IMAGES

Don’t Flag on AIDS Support The ďŹ nancial crisis is constraining aid spending among donor countries, but scaling back international AIDS eorts now would be penny-wise and pound-foolish, experts say. â€?The financial crisis is of course affecting—and clearly aecting—the capacity of donors to fund international programs on AIDS,â€? says Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Kazatchkine says he is concerned especially for the year ahead, when a three-year round of fund-raising ends. “2010 will be a key year when it comes to funding global health and funding AIDS prevention, treatment, and AIDS science,� he says. “The risk is that we lose momentum, that we lose the trust, and that we lose the hope that we have generated in an unprecedented movement in global health in the past eight years.�

Adds Peter Piot, the former chief of the Joint United Nations Programme on HIV/AIDS: “Now is not the time to decrease eorts because the bill is then going to get higher and higher.

It’s a matter of ‘pay now or pay later.’ We know that there is money. The bailout of banks has shown that there is money; there is mega-money when it is needed.�

“I get up and read the paper, I make coffee, read the paper again, and I think about what to have for lunch. Each day fades into the next,� he says.

Another client, who I’ll call Janelle, complains about the opposite problem. “I’m overcommitted,� she complains, “and it’s stressing me out. I can’t make the day any longer, and so I’m not taking care of myself.�

Now, I suspect that if Larry and Janelle were in the same room, each might look at the other with envy. Temporarily, at least.

Then they’d both realize that overwork and boredom can be two sides of the same coin.

Whether you’re sprinting or crawling, being stuck on a treadmill is still being stuck.

Here’s how to get moving again: Take a look at your “big five� life priorities. Thought about what’s important in life lately? Think immediate and long-term. Maintain a healthy lifestyle.

Keep stress to a minimum. Create new relationships. Get a better job. Challenge your mind and creativity. Help people you care about. Serve your community. Enhance your spiritual growth.

Ask yourself, How am I building my “big five� into my daily life? If you haven’t thought about this in a while, you might be on to the first clue as to why you aren’t satisfied with how you’re spending your time. One helpful—and painful— way to answer this question is to make a list of how you spend your time each day. Do this for a week. And then go back through

and see how your “big five� are reflected in what you do with your time. Where are you letting yourself down?

Take a hard look at familiar patterns. Human beings have a tendency to hold on to patterns of overcommitment and chaos—or lack of direction and boredom—because, while these patterns are unsatisfactory, they are also familiar.

Kind of like hitting your head against a wall over and over. Change means uncertainty and that can be uncomfortable. Take a deep breath and chant: “Something’s gotta give.�

New Year’s resolution: Tiptoe outside your comfort zone. Take another look at your “big five� and start introducing some of what’s missing in your life— quiet time, new people, and activities you might actually enjoy. Don’t be afraid to give yourself a push by scheduling what’s new and challenging ahead of time. This will keep you from talking yourself out of it when those old habits start whining for attention.

Warning: A little self-discipline is required. Yes, I know you don’t want to schedule anything else. But whether you are always running from one commitment to the next or feeling like each day is slower than the one before, try building in something a block of time each day that you can dedicate to your self-development.

Make 2010 the year to give yourself a push and step off the treadmill and into your life!

McClain welcomes e-mail at Gary@JustGotDiagnosed.com

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H-EYE-V

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IT STILL RINGS TRUE Ch ntiing Cha n “Ye “Y s, we can,� a slogan tied to the e campaaig gn of President Obama,, Ke K nyan n activists a march in Nai N rob bi, calling g fo for more donor sup upportt for med diccations to combat HIV V and otther diseases. The pr tester pro ters said th they would send cards d to urge dono nors, in particular Obama, to continue backing— ng g and an significantly expaand d inv invest in estmen ments ts in—the Gl G obal obal Fund Fund to Fi Fight ght AIDS, Tub ub berc erculo ulosis sis,, and and Mal Malari a a. ari

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H-EYE-V AND WHO DOESN’T?

PRIOR SPREAD: TONY KARUMBA/AFP/GE T T Y IMAGES; THIS PAGE: MARK RALSTON/AFP/GE T T Y IMAES

An A n ac activi act ivviist iv s carries a banner paast a mo mob obile ilile H HIIV testing van with h a pic-tur ure o ur off spok pokesm okke essman and ac esm acto to or Blair Blai Un U Und nderw n r ood oo o od on n tthe side du urin ng the launch nch n ch h in i Lo os Ang ng les of th nge he “Lov Love Co Con ond dom om ms� s cam c mpa pai a gn. The in nit nitiat i iativ iat ative i iv was ccrea was eat ated at ate ed b byy AI AIDS Healthc hccare Founda Fou nd nda dati tio iio on to comb o at the sp preaad o tthe of e vvirus rru us. us

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AUDE GUERRUCCI-POOL/GE T T Y IMAGES

ALWAYS A PROUD MOM U.S .SS. Hous o e spea eaker ker Nancy P Pelos oi os hol olds ol d Jea ds Je nne W White, moth other er of Rya yaa Whit yan h e, jus justt before b re Pre Presid sident en O ma sig Oba signed ned the Ryan Wh White ite HIV V/AI A DSS Tre Treatm atment en Exxten e sio sion n Act Act a the Wh at White te Ho House e on Oc Octob tober er 30. The act is the large largest st fed edera erally lly funded ded pr p ogr ogram am for or peopl peop e livi liviing wi h HIV wit V in n the U Unite ted d Stat States e and es was named med in n honor ho onor o of th he teen en,, who contr n actted nt d the he viirus in 1984 19 4 and be ecame a well-kno k wn advocate for research h and aw wareness until his death on n April Ap i 8, 1990.

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COMING TO TERMS In his seventh book—his second autobiography—Aiden Shaw takes his fans on a trip back to his early years, which saw him go from being a ďŹ nancially struggling university student in England to the adult ďŹ lm superstar people came to idolize. He took time to talk with HIV Plus about those times, his outlook on life now, his sobriety, monogamy, and sex and HIV B Y S A M PA G E | P H O T O G R A P H E D B Y J A M E S S TA F F O R D

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A

aiden shaw has been sober since June 4 and is looking for a Narcotics Anonymous meeting on Fire Island. To say that the 43-year-old Shaw is an adult ďŹ lm superstar is not an overstatement. The â€œďŹ rst manâ€? of gay porn, with more than 50 ďŹ lms to date, Shaw has just completed his seventh book: Sordid Truths, an autobiographical prequel to his autobiography My Undoing, which was published in 2006. Sordid Truths is Shaw’s story of being ďŹ nancially broke as a scholar at the University of Sussex in England, discovering prostitution after ďŹ nishing the ďŹ rst year toward his degree, and being lured by the “heady mix of sex and moneyâ€? to a career as an adult star. The second youngest from a large Irish Catholic family, he quickly established himself as one of the most popular porn personalities in the world. I Skyped with Shaw about his new memoir, his nascent commitment to the NA program, the problems of HIV and methamphetamine in the United States, and a personal realization about monogamy.

I read that you were attending school.

I undertook a master’s in creative writing a couple of years ago—is that what you’re referring to? But I am now looking at universities in America that oer Ph.D. programs.

You guest-edited an issue of Poz magazine in 1997. What was that like?

It was interesting. Sean Strub, who runs it— who used to run it—he’s an interesting and intelligent man. It gave me an idea of what it would be like to work for a magazine, and I’d never work for a magazine again in my life!

But I’m not saying that was a bad experience. I can’t imagine how people come up with something every month or every week.

We came up with good stu because there was a good team, and I was fresh at the moment, so we got a really good issue. I think it was a really successful issue.

You became HIV-positive in 1997. Has being positive changed the way you look at the world, or has it changed you as a man?

It might have before that, but I’m not sure. It feels as though it hasn’t changed me. But it’s hard to say what I would have been like without the experience of having HIV.

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Do you think that the rest of the world looks at the AIDS epidemic—speciďŹ cally in Africa and the Third World—dierently than here in the States?

I wouldn’t speak about America as having one way of thinking or feeling. America is dierent pockets of ideas and people. Also, I don’t really like to speak for anybody else—ever.

That said, I don’t see much dierence in the way people view it.

On a personal level, I’ve only dealt with patients and doctors in the States and England, and they all seem equally well-informed. I think there’s been a fetishization of HIV—with all the [attention to] barebacking and “gift giving� and all this nonsense. In England that’s way not as fashionable or culty or popular.

I’m interested to know what you think about the resurgence of barebacking and speciďŹ cally its prevalence in gay porn.

Was that a question? Yes, it has happened.

“Your 40s are all about realizing what you were and what you are now, what you’ve lost and what you’ve gained.

For these reaons, writing this book was more mindexpanding yet traumatic.�

You don’t issue a judgment about it?

Of course not. Why would I? I read somewhere that you’re a big believer in or that you want— I’m not a big believer in anything.

But I’ve read you were very interested in monogamy.

Interested in monogamy? I’ve changed my mind.

So what happened between when you made those statements about monogamy and where you are now?

The phase I’m in at the moment is that I never want a relationship again in my life. [Laughs] Call it hurt—call it anything you want—but that’s how I feel. The idea of monogamy doesn’t come into my radar. I don’t even want a boyfriend, let alone a lover or a monogamous partner. I’m really happy being single.

I’m really happy with my own company. If I meet someone I like, then I might change my mind again.

I follow you on Twitter and one of the things you tweeted was that you were going to an NA meeting. Does that mean you’re in recovery?

Yes.

Congratulations.

I’m happy to talk about that.

Do you think one can have a path of moderation about drugs and alcohol?

I went to a dinner party last night where everybody was doing cocaine and drinking, and I didn’t. And it wasn’t diďŹƒcult at all.

Tonight, the same thing: I’m expected to go to a club with them, and it’s ďŹ ne. I’ll just go home early and go to bed and feel good, you know?

And I’ve never felt better in my life. I can’t stress enough how wonderful it is.

I feel like my 20s and 30s‌ Well, what a shame, you know? Of course it’s all great material for my work. But it seems like such a shame because now I don’t feel down all the time. I feel like, “Oh! This is what people were fuckin’ meant to feel like.â€? Like, “Oh, this is it. I get it ďŹ nally.â€? Because a few months ago I wanted to kill myself, and I can’t believe this turnaround is so dierent.

Wow. Before I gave up drugs, I was on Valium and sleeping tablets all the time. Now I have a good night’s sleep, and I can’t understand how I’ve had such good sleep. It’s nuts.

Do you think there’s any drug that’s more dangerous than another? Or are they all equal?

Technically, I’m guessing alcohol causes most harm in the world.

I also read an interview where you said that crystal turns us all into teenagers.

It just turns me into a complete dick—in every sense of the word: sex and mentally‌ I used to like crystal more than other drugs because I thought that it made me better than I am. I could dance for hours and tell jokes and be really quick. But in time, I didn’t like the creature that it created. He wasn’t sexier, funnier, with a quicker wit. He was a complete freak! Needless to say, I didn’t want to be him anymore. He was embarrassing, and the memories of what he did haunted me. I can’t believe some of the things he said and did.

Anyway, no more. He’s been put to pasture.

So how do you stay on the straight and narrow when it comes to drugs and partying?

I feel solid in my sobriety. I’ve made a commitment to NA, and I’m sticking to it. I’m pretty disciplined. I made the decision. That’s it.

I’ve never been to an NA meeting, but I’ve done therapy.

Yeah, I’ve had lots of therapy, but none of it seemed to make a dent in my drug and alcohol use. But NA is dierent. They really don’t push you. But I wish they’d been more pushy— because I wish I’d stopped years ago. They don’t advertise, but I wish someone had said, “Try NA.â€? I even asked therapists if I should go, and they said, “No, don’t bother. You won’t get anything out of it.â€? But I wish someone had just said, “Try NA, for God’s sake!â€?

Do you exercise?

Currently, more than ever. There’s this book, Staying Sober, and it has some little tricks and things that help—like “get your exercise.� So I exercise more now, and I’m getting in great shape again, which is [laughs] just a bonus.

Skin’s better, cheeks are rosier, and all that.

There’s also this really nice little slogan called HALT: h stands for hungry, a stands for angry (but I use it for anxious because I don’t really get angry), l is for lonely, and t is for tired. So if you want to drink, you’re supposed to say, “Am I hungry, anxious, lonely,

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or tired?� And it tends to be one of those reasons. These tricks help; they really help.

But I’m past the ďŹ rst 30 days, so the cravings have kind of gone away. And then it’s just kind of a mental habit. A few people have said to me, “Don’t get too conďŹ dent.â€? But I feel really solid about it.

What did you hope to accomplish with Sordid Truths?

So many things. I wanted to produce something that was entertaining—with moments of genius—that was beautifully written, would stretch my artistic abilities and be wholly satisfying and moving for me and for my reader.

[Laughs] I guess when you’re starting a project you have all those hopes and dreams, some more easily achievable than others.

How long did it take you to write?

I had a very tough deadline—about three months. My last book took eight years, so it’s not as though I always write books quickly.

Still, I like what I’ve managed to come up with. I think it is my best book yet.

I was really impressed by how candid you are in the book.

I can’t imagine what else you would do. I was brought up to be honest. I wouldn’t know how you would make up a lie—or why you’d want to. I can’t comprehend any other way.

That’s really liberating.

You can thank or blame my mother for that.

She taught all her kids to be honest—also to be independent and do their own thing, their own way.

You wrote My Undoing, your ďŹ rst autobiography, as you were going through the experiences?

That’s right.

So writing Sordid Truths, looking back on those experiences—was it dierent?

Sure. I’m in my 40s now, and I’m writing about my 20s. It took a lot of sessions with my therapist just coming to terms with that. She said, “You’ve chosen a very bad time in your life to write about your 20s.� Your 40s are all about realizing what you were and what you are now, what you’ve lost and what you’ve gained. For these reasons, writing this book was more mind-expanding yet traumatic.

When I ďŹ nished it, I just looked at the computer and shuddered. I didn’t want to touch it. In the acknowledgments to the book I thanked my publisher for asking me to write it in such a short time because I think I’ve produced something I’m really happy with, but

at the same time it makes me never want to write again.

tips+tools To learn about Shaw’s book, place an order, and see video of him, visit us online at HIVPLUSmag.com

If you could give gay youth some required reading, what three books would you recommend?

Number one would be A Single Man by Christopher Isherwood. It’s, I think, his greatest book. So tight and so beautifully written. He manages to get inside a character and all the little things that go on inside a human’s mind.

And it’s unabashed, because sometimes it’s ugly and sometimes it’s just mundane. But when you’ve got that kind of skill for writing, it’s all delicious. It’s a really short book, so it’s a must, that one. And Oscar Wilde’s fairy tales, The Happy Prince, just to remind you to tap into your heart. And I really loved The Year of Magical Thinking by Joan Didion. Not that it has anything particularly to do with being gay, but it addresses feelings, pain, love—and we could all do with understanding these things a little better. Personally, I get o on her clarity and her ballsy delivery.

I want to get a little Meet the Press with you, because I’d like your reaction to a review of your last book from Publishers Weekly: “Particularly telling is his experience being struck by a car when he’s too high to do anything but lie in the road; he’s left with a brain lesion, broken bones, and paralysis on his left side. Not every life story has to have an epiphany, but readers who suer through his recovery are bound to feel cheated when he emerges from treatment completely unchanged.

When the book ends abruptly—as if he’d run out of space in his journal and couldn’t be bothered to buy a new one— he’s back with Mr. Wrong.� Do you think that’s accurate—that you emerged from treatment “completely unchanged�?

I don’t think it’s possible to go through any experience and be unchanged. It was autobiographical, not ďŹ ction. There was no punch line, and anybody who was looking for it wasn’t reading the wrong book. You don’t read autobiographies for punch lines. And if you do, then you’re stupid and you’re not actually looking for reality. Because reality doesn’t do that. Reality doesn’t have happy endings or epiphanies. And I’m sorry if the book ended abruptly, but I wrote it up to present day, and the rest of life simply hadn’t happened yet. í˛‘

EXCERPT

To Tell the Truth In his second autobiography, Sordid Truths, Aiden Shaw takes readers back to the years predating the ďŹ rst edition he wrote about his life; here is an excerpt from the book’s beginning Prologue: San Francisco, 1997 “Aiden Shaw,â€? said a voice.

I closed the door to the meeting hall on Fifteenth Street and leaned back against it. This was part weariness, due to lack of sleep. After a two-day splurge of drug “enhanced� sex with god knows who and how many men, the remnants of drugs still lingered in my system. More important, it was to ensure that the door was in fact closed behind me and the weight of my body would keep it that way. Surely, anybody in my position would have done the same thing, seeing all those heated faces.

Again and again I heard my name, the angry tones muffled by the heavy door. “Aiden Shaw. Aiden Shaw.�

Curiosity got the better of me. I turned around and opened the door a crack, so nobody would know I was there.

A surprisingly large number of people had gathered for the town meeting. The man standing at the front skimmed his notes as he spoke. He seemed very organized and his jeans looked ironed. “I’m sure you’re all aware of the events of the last few weeks, but I’ll replay them to open up the discussion.

The portrait of Mr. Shaw is art, not pornography, created by the artists Pierre and Gilles and used for a poster to advertise a gay club night.�

The people sitting to either side of the speaker all nodded, with varying degrees of speed and enthusiasm. The man’s voice

seemed to land more heavily on the word gay. Maybe he wanted to put a gay rights or prejudice slant on the debate. �The said artwork was displayed in the window of the clothes shop All American Boy on Castro, and this is when the first complaints began.�

His use of the words the said sounded like an attempt at courtroom lingo. I wondered how the complaints were worded.

Shaw’s dick is too big, too hard, and too in-your-face?

A man in the crowd stood up. “But for his cowboy boots and hat, Shaw is naked,� he said. Ironic, I thought, that a shop used a photo of somebody wearing no clothes to sell clothes. “In addition, he does have a hard-on.� The man seemed to have trouble getting the word hard-on out of his mouth. “Personally, I did not find this offensive, but I just want to be a voice of reason.� �Thank you,� said the speaker at the front, and continued without really addressing the man’s comments. “The image was also printed on flyers. Here the press reported of how these got into a children’s schoolyard.� �Yeah!� and “No!� the horrified crowd shouted.

I closed the door once more, this time out of exasperation, and let out a heavy sigh. Before anybody could spot me, I darted across the road, turned onto Castro, and walked towards Market Street.

It was all too much, ridiculous in fact.

How could they take this so seriously?

Their reaction had gone too far from a reality I could relate to. My instinct was to get away, hide, and give myself time to consider what to do. There was a bar on my left called Daddy’s. Parting the strips of rubber that kept out the weather and glances from passersby, I entered the dimly lit room.

The early evening crowd appeared to be made up of alcoholics, the frustrated on their way home from work, and anybody high enough to need their company— the ideal scenery for knocking back vodka chased with lager. The barman was a hairy clone with a V-shaped torso, completely stunning if not a bit of a caricature.

An experienced barman knows how to work a tip, and I guessed this one had

been doing the job for years. The drink he gave me looked to be about six shots.

Little did he know I only wanted to feel jaded, not really be it. I took a swig of vodka regardless, feeling masculine and cool and maybe a little self-destructive.

It was too much, and made me retch.

Attempting to settle my stomach, I took a few big gulps of lager. I still wanted to vomit, but the feeling wasn’t intense or urgent. Did I look like a seasoned drinker, like the men to my left and right and all around me?

Pondering this, I drew backwards, away from the bar into the darkness.

Feeling beer crates against the back of my thighs, I sat down. Every few minutes, silhouettes of customers moved in front of me, heading to the toilet or escaping outside to the street. My mind swung back to the grotesque spectacle at the meeting hall.

Somebody was walking towards me. “Are you‌Aiden Shaw?â€? he said.

No, I thought, at the same time nodding yes. “Cool! You don’t know how many fights you’ve caused between me and my boyfriend.� �I’m sorry,� I said, managing to construct a laugh but hoping my words would end this interaction. �Don’t be sorry. I mean, he’s just jealous.�

I guessed this meant the speaker fancied me. “That’s sweet of you to say.� “Anyway, I’ll leave you alone. I just wanted to tell you I’m your biggest fan.�

He looked embarrassed. “Shucks!�

I said, acting embarrassed myself. “I’m flattered.� �You must get that all the time.� �Enough.� �Anyway, like I said, I’ll leave you alone.�

He shook my hand and turned to go, then turned back.

He scrunched up his nose and said, “It must be kind of weird being you.� �Sometimes,� I admitted, taking his statement as a question. Not wanting to be too serious, I followed this with another laugh, wondering how believable it was.

It must have worked, because he

responded in kind. His laugh rose in pitch to a whooping sound. Shaking his head, he said, to himself it seemed, “Aiden Shaw.� Grinning widely, he slapped his thigh and added, “How cool is that!�

I thought the appropriate response this time was to smile. He went back to his buddy at the bar. Alone again and feeling the vodka, I stared at the wooden floor.

Who the fuck was Aiden Shaw? Some porn star character I’d created. This monster was in no way like Little Fella, my nickname for the inner me, my mum’s soft, shy, blushing son, the person I’d grown up with, the one I actually liked. Sometimes it felt as though the lumbering, musclebound Brit-With-The-Big-Dick (as some magazine called me) had crushed Little Fella. There had been good reason for my creating him. Aiden Shaw was a rebellion against my religious upbringing, when I believed gods existed and that the random one my parents had indoctrinated me with was actually listening and gave a damn about anything, let alone how I behaved. What kind of monstrous institution would encourage such a fantasy in a child’s innocent, trusting soul?

Somebody else was heading my way.

Panicked, I took another swig of vodka.

The figure passed me by, moved through the rubber strips, and left the bar. In a half hour or so, I’d feel more comfortable leaving myself. It would be darker then, and due to the alcohol, I’d be a little more numb.

At the beginning of my “career,� one of my clients had told me my dick would be the making of me, adding, “and maybe your ruin.� That had been years ago. What a journey it had been since then.

Sordid Truths is now available at Alyson.com and other retailers.

JANUARY/FEBRUARY 2010 í˛‘

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ALL GROWN UP Ten years ago HIV Plus ďŹ rst interviewed then-teenager Hydeia Broadbent in our “long-term survivorsâ€? package. For the 10th observance of National Black HIV/AIDS Awareness Day, we decided to catch up with her to see how, and if, life had changed for her. Well, she’s moved beyond being just a survivor to a woman who’s thriving in her role of reaching out to others B Y B E N J A M I N R YA N

P H O T O G R A P H E D E X C L U S I V E LY FOR HIV PLUS BY ROBERT JOHN KLEY

JANUARY/FEBRUARY 2010 í˛‘

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“I just want people to know that we’re just normal people,� Hydeia Broadbent pleaded to a fellow guest on an HIV-themed segment of a children’s talk show she was appearing on in 1992.

She was just 7 years old at the time, an apple-cheeked little cherub with intricate braids, hoop earrings, and an embroidered Sunday school dress, her feet dangling o the edge of her seat. When it came time for her to open up, she burst into tears. The fellow guest—none other than Magic Johnson, who at the time had only recently made public that he too was living with HIV—consoled her tenderly. “You don’t have to cry,â€? he said, while an overwhelmed Broadbent rubbed her eyes and sobbed.

The image, searchable on YouTube, is as heartwarming as it is heartbreaking— because Broadbent is now a thriving, beautiful 25-year-old. A decade after appearing in HIV Plus as the “AIDS poster girl,� we decided to check back in with her to see how it’s been since she was a child who wasn’t certain if she could plan for another birthday or would grow into womanhood.

Well, she’s still talking, spreading the word to others that, yes, she’s a normal person. But with an extraordinary life. “I plan to do as much as I can!â€? she says, revealing all her passion for her work as well as her life. “I plan to help a lot of organizations that I was involved with when I was younger. I want people to know that I’m trying to make a dierence, because I really don’t want people to deal with HIV if they don’t have to.â€?

Born in 1984, Broadbent was abandoned at a hospital in Las Vegas by her drug-addicted mother and was soon adopted by Patricia and Loren Broadbent. A tiny child prone to every little cold and u that came along, she was diagnosed with HIV at the age of 3. Doctors told her family she probably wouldn’t live more than a couple of years.

In the 2002 book that her mom cowrote with her about her struggle for survival, You Can Get Past the Tears, Patricia Broadbent says of her daughter, “Certainly being a little black girl with AIDS was not all that Hydeia was, but I knew she’d encounter people who wouldn’t look any further.�

Determined to ďŹ ght the intense stigma and shame of the Ryan White era, Hydeia Broadbent’s mom, a social worker by trade,

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launched into public speaking about pediatric AIDS. Meanwhile, through her determined eorts, she secured a place for her daughter in the National Institutes of Health’s clinical trials of pediatric treatments for HIV. Beginning in 1990, their trips to the NIH headquarters in Bethesda, Md., gave the young girl access to the up-and-coming medications that were so desperately needed in those harrowing years.

At ďŹ rst Broadbent just tagged along as her mother spoke publicly about her daughter’s condition. But by age 6, she started piping up herself. She gradually began to take the helm and soon became an accomplished speaker in her own right. And she doesn’t hold back when it comes to letting people know her viewpoint. “It hurts to know that I’m 25 and people have been [speaking up about HIV prevention] for longer than I’ve been alive, but people aren’t getting the message. It saddens me. But now people think, Well, if I get HIV, I’ll need to take medication but I’ll be OK.â€?

But her messages also carry hope and understanding—not just her thoughts on prevention. She’s spoken on Good Morning America, 20/20, and The Oprah Winfrey Show; at college campuses; and in a print ad campaign for the FUBU clothing line.

In 1996 she stood before the Republican National Convention and said, “You can’t crush my dreams. I am the future. And I have AIDS.â€? “I think—because of what she’s gone through at such a young age—it caused her to mature quicker than most people would,â€? says Cynthia Davis, who advocates for HIV-related eorts as an assistant professor and program director in the department of family medicine at Charles Drew University of Medicine and Science in Los Angeles. Davis has called on Broadbent to appear in speaking engagements since she was 13. “It’s because of that maturity, I think, that she’s so eective at what she does. She’s very, very honest, open, willing to share her life experiences. And young people tend to look up to her.â€?

In fact, Davis once ran a focus group with

BROADBENT HAIR AND MAKE-UP BY STEPHANIE PE TERSON; NUMBERS BY PHOTOS.COM

“I plan to do as much as I can! I plan to help a lot of organizations that I was involved with when I was younger. I want people to know that I’m trying to make a difference.â€? at-risk youths in the Los Angeles area in order to ďŹ nd out who they thought would be an inspirational face for an HIV campaign. To her surprise, they bypassed a certain hometown basketball star and named Hydeia Broadbent as their hero.

Today, Broadbent says her dreams include ďŹ nishing her ďŹ nal two years of college and either going into HIV advocacy work full-time or perhaps using her honed communication skills for a career in public relations. A recent downturn in her health forced her to take some time o from her studies, she reveals, and from her lifelong commitment to speaking engagements. But by this past fall she was getting back into the swing of things with a college campus tour called R.A.P. on AIDS, and she is working on her memoirs. “When I was younger there wasn’t an outlook that I would go to college,â€? she says. “There wasn’t hope that I would get married and have kids. Now that there is that hope, I’m very grateful for that!â€?

Indeed, Broadbent has been lucky.

Stigma has rarely touched her directly.

Incidents such as the time her kindergarten teacher sprayed her face with bleach after she sneezed have been few and far between, she says. Nevertheless, her high school sweetheart, Pernell, says he does have to be a buer for her. “A lot of people think I’m crazyâ€? for dating her, the 24-year-old says. “They tell me I should leave her alone and not talk to her—that there are other females out there. I’m like, ‘Yeah, there sure is, but it’s just who I love.’â€?

Going from living day to day to suddenly ďŹ nding an uncertain future before her has proved a hard transition. While adults who lived with AIDS in the era before highly active antiretroviral therapy often maxed out their credit cards and cashed in life insurance policies—

only to later ďŹ nd themselves with the sudden gift of life but a mountain of debt—Broadbent says she feels cheated that she had no money set aside from her many paid speaking engagements to help her pay for school or a car when she turned 18. “Nobody really prepared me for the future,â€? she explains. “They didn’t think I would live that long, truthfully.â€?

The conict over the ďŹ nancial side of their mutual eorts to ďŹ ght HIV has fractured Broadbent’s relationship with, in her words, “the woman who raised me.â€?

These diďŹƒculties have opened Broadbent’s eyes to what she sees as a pressing problem in African-American family life. She worries that many other black women have troubled relationships with their mothers and that this has grave implications for the spread of HIV. “So you go outside of the home looking for love,â€? she explains. “You sometimes put yourself in a position where you’re allowing a man to disrespect you, belittle you. Or you’re sleeping with man after man after man to try to ďŹ ll that void that is missing.â€?

In addition to plans to push for legislation requiring doctors to oer HIV screening to pregnant women, she hopes to ďŹ nd a way to hold forums that will open a dialogue about AfricanAmerican mothers and daughters.

But meanwhile, she’s simply grateful for the chance to have her say. “Even though it’s a struggle, my life has been a blessing,â€? Broadbent says, “because I’ve had the opportunity to work with so many dierent people and to share my story with people. I’ve never really had days where I said to myself, ‘Why me?’ Because I’m able to talk, I have a great relationship, I’m dating somebody who knows my status, who loves me. I’m not depressed about having AIDS at all.â€? í˛‘

Overwhelming Numbers Life for women—especially for that of African-American women—has changed dramatically in the nearly three decades since the AIDS virus became widely known in the United States; while HIV’s effect was initially small on these women, a lot has changed Early in the epidemic, HIV infection and AIDS were diagnosed among relatively few women and female adolescents, although many women were infected with HIV through injection-drug use but their infections were not diagnosed.

Today, women account for more than one quarter of all new HIV diagnoses, according to the Centers for Disease Control and Prevention. Women of color are especially aected by HIV infection and AIDS. In 2004 (the most recent year for which data are available), HIV infection was h the leading cause of death for black women, including African-American women, between the ages of 25 and 34 years; h the third leading cause of death for black women ages 35 to 44 years; h the fourth leading cause of death for black women ages 45 to 54 years; and h the fourth leading cause of death for Hispanic women ages 35 to 44 years.

In that same year HIV infection was the ďŹ fth leading cause of death among all women ages 35 to 44 years and the sixth leading cause of death among all women ages 25 to 34 years. The only diseases causing more deaths of women, according to the CDC, were cancer and heart disease. äŠ?

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Simply Black & White?

LAURENCE MONNERE T/IMAGE BANK/GE T T Y IMAGES

Individuals’ behavior patterns, especially sexual ones, cannot fully explain the marked racial differences in U.S. HIV infection rates Ongoing racial disparities in the nation’s HIV infection rate are an “indictmentâ€? of the U.S. response to the epidemic, according to a study published in the November 2009 issue of the American Journal of Preventive Medicine. “Continuing racial disparities in HIV infection more than two decades after the identiďŹ cation of the virus and availability of an accurate test are an indictment of the U.S. response to the epidemic,â€? says study lead author Adaora A. Adimora, MD, MPH, a professor of infectious diseases in the University of North Carolina at Chapel Hill School of Medicine. “Existing interventions have failed to control the epidemic in African-Americans in part because critical features of [socioeconomics] promote behaviors that transmit HIV and increase the risk of HIV infection, even among those who do not have high-risk behaviors.â€?

Adimora and her fellow researchers decided to examine the factors responsible for the stark racial disparities in HIV infection in the United States and the now-concentrated epidemic among black Americans. HIV prevalence among African-Americans is 10 times greater than the prevalence among their white counterparts, according to collected data. This racial disparity in HIV prevalence has persisted, Adimora points out, in the face of both governmental and private actions, involving many billions of dollars, to combat HIV. The Centers for Disease Control and Prevention estimates that 45% of new HIV infections in the United States in 2006 occurred among non-Hispan-

Funding Shortfall > 43 >

ic blacks. Among the 13,184 adolescents and young adults in the National Longitudinal Study of Adolescent Health, a nationally representative study, HIV seroprevalence was almost 0.5% among black Americans—a rate 20 times that of white Americans in the study.

While individuals’ sexual behaviors can contribute to the disparity in HIV prevalence, according to Adimora, these dierences in individual behaviors do not fully explain the marked racial dierences in HIV infection prevalence. Even when comparisons are broken down by education, poverty level, marital status, age at ďŹ rst sexual intercourse, lifetime number of sex partners, history of male homosexual activity, illicit drug use, injection-drug use, and herpes simplex virus-2 antibody positivity, HIV prevalence among African-Americans exceeds that of whites, and it does so typically substantially.

According to the team, the overall impact of these factors constitutes “structural violence,â€? a social system characterized by inequalities in power and life of suďŹƒcient magnitude to restrict a group of people from realizing their full potential and “put them in harm’s way.â€? “There is a need for research and interventions that are informed by expertise in public health, medicine, basic science, and social sciences,â€? Adimora states, “along with expertise in economics, business and ďŹ nance, education, criminal justice, political science, and other disciplines. Governments should be held accountable for progress—or lack thereof—in eliminating inequities.â€?

Forgo the IL-2? > 44 >

Vaccine Lessons > 45 >

JANUARY/FEBRUARY 2010 í˛‘

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INDICATIONS ISENTRESS is an anti-HIV medicine used for the treatment of HIV. ISENTRESS must be used with other anti-HIV medicines, which may increase the likelihood of response to treatment.

The safety and effectiveness of ISENTRESS in children has not been studied.

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

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.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat 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 immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage.

When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included nausea, headache, tiredness, weakness, and trouble sleeping.

You are special, unique, and different from anyone else.

And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle.

In clinical studies lasting 48 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — In 4% of patients taking ISENTRESS plus Truvada versus 3% taking Sustiva plus Truvada, the most commonly reported side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 6 mg/dL with ISENTRESS plus Truvada versus 16 mg/dL with Sustiva plus Truvada

Ask your doctor about ISENTRESS. isentress.com People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

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.

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

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.

For more information about ISENTRESS, please read the Patient Information on the following page.

ISENTRESS is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2010 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

20951909(14)-1/10-ISN-CON 20901234(1)-1/10-JAN Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc.

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 used for the treatment of HIV. 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. ISENTRESS will NOT cure HIV infection.

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

• Stay under the care of your doctor during treatment with ISENTRESS. • The safety and effectiveness of ISENTRESS in children has not been studied.

ISENTRESS must be used with other anti-HIV medicines.

How does ISENTRESS work?

• ISENTRESS blocks an enzyme which the virus (HIV) needs in order to make more virus. The enzyme that ISENTRESS blocks is called HIV integrase.

• When used with other anti-HIV medicines, ISENTRESS may do two things: 1. Reduce the amount of HIV in your blood. This is called your “viral load”.

2. Increase the number of white blood cells called CD4 (T) cells.

• ISENTRESS may not have these effects in all patients.

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 contact, sharing needles, or being exposed to your blood.

• Continue to practice safer sex.

• Use latex or polyurethane condoms or other barrier methods to lower the chance of sexual contact with any body fluids. This includes semen from a man, vaginal secretions from a woman, or blood.

• Never re-use or share needles.

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 that applies to you: • You have any allergies.

• You are pregnant or plan to become pregnant.

- ISENTRESS is not recommended for use during pregnancy.

ISENTRESS has not been studied in pregnant women. If you take ISENTRESS while you are pregnant, talk to your doctor about how you can be included in the Antiretroviral Pregnancy Registry.

• You are breast-feeding or plan to breast-feed.

- 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: • prescription medicines, including rifampin (a medicine used to treat some infections such as tuberculosis) • non-prescription medicines • vitamins • herbal supplements Know the medicines you take.

• Keep a list of your medicines. Show the list to your doctor and pharmacist 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: • Take only one 400-mg tablet at a time.

• Take it twice a day.

• Take it by mouth.

• Take it with or without food.

Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

1

Registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: • The amount of virus (HIV) in your blood may increase if the medicine is stopped for even a short period of time.

• The virus may develop resistance to ISENTRESS and become harder to treat.

• Your medicines may stop working to fight HIV. • The activity of ISENTRESS may be reduced (due to resistance).

If you fail to take ISENTRESS the way you should, here’s what to do: • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do NOT take two tablets of ISENTRESS at the same time. In other words, do NOT take a double dose.

• If you take too much ISENTRESS, call your doctor or local Poison Control Center.

Be sure to keep a supply of your anti-HIV medicines.

• When your ISENTRESS supply starts to run low, get more from your doctor or pharmacy.

• Do not wait until your medicine runs out to get more.

What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included: • nausea • headache • tiredness • weakness • trouble sleeping Other side effects include rash, severe skin reactions, feeling anxious, depression, suicidal thoughts and actions, paranoia, low blood platelet count.

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 treat the HIV infection and help to 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.

Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions, muscle problems can be serious and can lead to kidney damage.

Tell your doctor if you have any side effects that bother you.

These are not all the side effects of ISENTRESS. For more information, ask your doctor or pharmacist.

How should I store ISENTRESS? • Store ISENTRESS at room temperature (68 to 77°F).

• 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.

• Do not use ISENTRESS for a condition for which it was not prescribed.

• Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them.

This leaflet gives you the most important information about ISENTRESS. • If you would like to know more, talk with your doctor.

• You can ask your doctor or pharmacist for additional information about ISENTRESS that is written for health professionals.

• For more information go to www.ISENTRESS.com or call 1-800-622-4477.

What are the ingredients in ISENTRESS? Active ingredient: Each film-coated tablet contains 400 mg of raltegravir.

Inactive ingredients: Microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. In addition, the film coating contains the following inactive ingredients: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide.

Distributed by: MERCK & CO., Inc. Whitehouse Station, NJ 08889, USA Revised October 2009 9795106 U.S. Patent Nos. US 7,169,780

20951909(14)(106)-ISN-CON

Key Antibodies Aid Research A study of how the most robust antibodies work to block HIV as it seeks entry into healthy cells has revealed a new direction for researchers hoping to design an eff ective vaccine. ”Our study clearly showed that we’ve been overlooking a very important component of antibody function,” says S. Munir Alam, Ph.D., an associate professor of medicine at Duke University Medical Center and lead author of the study, which appears in the Proceedings of the National Academy of Sciences.

Alam studied two potentially powerful antibodies against HIV: 2F5 and 4E10. Both of these are rare, broadly neutralizing antibodies, meaning that they can block a number of different strains of HIV. They accomplish that by binding to the “Achilles’ heel” of the virus— a part of the outer protein coating next to the viral membrane that opens up and is exposed to the antibodies for just a few minutes during the process of cell fusion and infection. But the problem for infection control is that such powerful antibodies are rare in HIV infection, and current experimental vaccines have been unable to generate such antibodies. In addition, the window of opportunity for such antibodies to act is very narrow. ”The target region on the virus is only open for a few minutes—maybe 15 minutes or less,” says Alam. “Unless the antibody is very close by and ready to home in on it, it won’t work. That means our goal has to be the creation of a vaccine that can induce a whole lot more of these antibodies and have them ready to go at the earliest moment of infection.”

The 2F5 and 4E10 antibodies have unusually long, loopy protein segments that are hydrophobic, meaning that they are attracted to lipids. Th e researchers found that successful docking of the antibody to the HIV outer coat membrane region required antibody attachment to HIV’s membrane, which contains lipid. ”Th is two-step mechanism, not previously appreciated, might extend to antibodies that protect against other viruses,” says coauthor Stephen Harrison, Ph.D., of Harvard Medical School. Th e research team is already working on designing a vaccine that incorporates a lipid component.

DRASTIC FUNDING SHORTFALL AWAITS

The annual spending needed to fight HIV in developing countries— three times the current level—by the time the global pandemic reaches its 50th year. At the same time, more than 1 million people could be newly infected each year.

GE T T Y IMAGES

$35 billion

HAART BEATS

MEDICINE

CD4s Are Key Predictor for Cancer

WELLNESS

Holding Back the Years HIV in the United States is changing. This is some of the news we learned at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting, Antonio Urbina, MD

held in San Francisco in the fall. For exam- prevent some of these early complications? ple, by 2015 half of HIV-positive people hMake every attempt to lower your viral will be over the age of 50. Currently, only load to the lowest detectable level. Any about 20% are over 50. Further, from amount of detectable virus leads to more 2000 to 2004, people ages 40 to 49 had inflammation and greater organ and the highest rates of HIV infection over any immune-system damage. If your viral other age group. What this means is that load is detectable, talk to your primary the HIV epidemic is “graying.� care provider about maximizing your People with HIV are not only strug- antiretroviral therapy. gling with their dish Avoid habits like ease but also dealing cigarette smoking and By 2015 half of with problems associrecreational drug use.

HIV-positive ated with aging. These Both of these have people will be problems—like heart been shown to increase over the age of disease, thinning and inflammation in the 50. What this weakening of the body and increase the bones, diabetes, and risk of organ damage, means is that cancer—occur at a the HIV epidemic in particular in the younger age in people brain and lungs. is “graying.� who are HIV-positive. h Be sure that you Roughly, HIV (even in engage in some sort of people who are on their anti-HIV treat- physical activity—if possible, every day. ments and doing well) may accelerate Exercise of any kind has a great ability to aging by about 10 years. decrease inflammation in the body and The explanation for this might be might prevent some of these early aging inflammation. After infection, HIV enters complications. into the bloodstream and inserts itself into hBe sure to have your care provider moniDNA. Although starting anti-HIV meds can tor you for diseases like diabetes and heart destroy most of these cells, a “reservoir� of disease. These conditions, when present, cells remains where the virus can quietly increase your risk for accelerated aging. exist. Medications cannot destroy these hBe sure to get appropriate screenings sites. In addition to producing more virus for colon, breast, prostate, anal, and cerviparticles, these sites can also direct the cal cancers. These cancers, if caught early, body to produce inflammatory proteins have a good chance of being cured. that put stress on organs like the brain, hLastly, to keep your mind “young,� keep heart, and kidneys. Why this occurs more socially active with friends and family and in some people with HIV and not in oth- learn how to effectively deal with stress. ers is still unknown, but researchers are By following these very simple steps, actively looking into this. you can reduce your risk of accelerated So what, then, can people do to try to aging.

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ImmunodeďŹ ciency increases the risk of a handful of cancers in people with HIV, and thus, earlier diagnosis of the virus and earlier initiation of treatment with antiretrovirals could delay the onset of some cancers, say researchers who published their ďŹ ndings in The Lancet Oncology.

A team of researchers examined the incidence of three AIDS-deďŹ ning cancers (Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical cancer) and four non-AIDS-deďŹ ning cancers (Hodgkin’s lymphoma, lung cancer, liver cancer, and anal cancer) in HIVers from 1998 to 2006.

They also investigated the relationship between immunodeďŹ ciency, viral load, antiretroviral treatment, and the onset of these cancers.

Overall, immunodeďŹ ciency increased the risk of all the cancers.

CD4 count was the most predictive risk factor for all cancers except anal cancer. The level of risk associated with viral load was shown to be consistently lower than that associated with immunodeďŹ ciency.

Findings showed that CD4 count was the only risk factor for Hodgkin’s lymphoma, lung cancer, and liver cancer. But lower CD4 count, higher HIV viral load, and a lack of combinational antiretroviral therapy increased the risk of Kaposi’s sarcoma and non-Hodgkin’s lymphoma. â€?Our results suggest that combinational antiretroviral therapy would be most beneďŹ cial if it restores or maintains the CD4 count above 500, thereby indicating an earlier diagnosis of HIV infection and earlier treatment initiation,â€? say the authors.

EXPERT SAYS NO TO IL-2 An international research team has demonstrated that treating HIV with interleukin-2 is ineective, and as a result, they have recommended in an article published in The New England Journal of Medicine that clinical trials on this compound be stopped.

IL-2 is sometimes used as a complement to highly active antiretroviral therapy. Since HAART controls replication of viruses in the blood, doctors thought IL-2 would help regenerate more CD4 immune cells, which serve as an indicator of viral progression. It was thought that IL-2 increased the natural immunity of patients by helping immune cells mature and multiply. â€?Our results show that IL-2 has no eect on the development of AIDS or on patient survival,â€? says Jean-Pierre Routy of McGill University. “More precisely, while the presence of IL-2 leads to a faster increase of CD4 cells, these cells are less functional than the CD4 cells that regenerate naturally in patients who do not receive IL-2. This means IL-2 treatment provides no benefit and does not prevent AIDS-related infectious diseases.â€?

Supercomputer Creates HIV’s Evolutionary Tree Researchers are using Los Alamos National Laboratory’s Roadrunner supercomputer, the world’s fastest, to analyze vast quantities of genetic sequences from HIVers in the hope of zeroing in on possible vaccine target areas.

Physicist Tanmoy Bhattacharya and HIV researcher Bette Korber have used samples taken by the Center for HIV/AIDS Vaccine Immunology across the globe—from both chronic and acute HIV patients—and created an evolutionary genetic family tree, known as a phylogenetic tree, to look for similarities in the acute versus chronic sequences that may identify areas where vaccines would be most effective. �[This] supercomputer gives us the capacity to look for similarities across whole populations of acute patients,� says Bhattacharya. “At this scale we can begin to figure out the relationships between chronic and acute infections using statistics to determine the interconnecting branches, and it is these interconnections where a specially designed vaccine might be most effective.�

Rx

Patients who received Viread for up to 144 weeks experienced sustained suppression of hepatitis B DNA levels to below 400, according to data from two Phase III clinical trials evaluating the safety and efficacy of once-daily Viread among adult patients with chronic infection.

GE T T Y IMAGES

Ă‚

A majority of patients taking boosted Reyataz once daily, instead of a twice-daily boosted regimen, achieved an undetectable viral load, confirming success through 96 weeks in the Castle Study. In addition, subjects had lower

Further analysis has found that Merck’s failed AIDS vaccine, MRKAd5, did not actually enhance volunteers’ risk of HIV infection as was reported when the trial was halted in 2007, researchers have announced. Initial ďŹ ndings suggested that some vaccinated participants in the Step Study, such as uncircumcised men, may have been at increased risk of subsequent HIV infection. â€?With ongoing follow-up, the trend in the wrong direction is diminishing,â€? Susan Buchbinder of San Francisco’s public-health department told the AIDS Vaccine 2009 conference. “Either they were at risk—and that has gone away—or they were never at increased risk.â€?

The Step Study enrolled 3,000 people from South America, the United States, Canada, and Australia, and researchers continue to monitor its participants, Buchbinder says.

Merck’s vaccine used weakened adenovirus-5 as a vector and was designed to encourage cellmediated immunity, using T cells to stop or slow HIV infection. The Step Study continues to be important in analyzing the eect of such vectors on the immune system,

according to Buchbinder. â€?We never understood the complexity of the immune system against the vector, and we think that is a very important thing to understand,â€? she says. Animal studies can’t address that because adenovirus-5 does not normally infect nonhuman primates.â€? â€?These eďŹƒcacy trials are really moving science forward,â€? Buchbinder says. “With each step we are learning more information that we couldn’t get any other way. We don’t know what it is going to take to make a safe and effective vaccine. Each of these studies, particularly larger trials in humans, helps shine a light on issues that we didn’t know or understand before.â€?

DEVELOPMENTS IN MEDICAL STUDIES

RESEARCH

Ă‚

Lessons of Stalled AIDS Vaccine

increases in total and LDL cholesterol as well as triglyceride levels.

Ă‚

While studying an HIV protein that plays an essential role in AIDS progression, researchers at the University of Pittsburgh school of medicine have discovered compounds that show promise as novel treatments for the disease.

Anti-HIV drug discovery efforts have met with little success in finding compounds that interact with an important HIV virulence factor called Nef because it lacks biochemical activity that can be directly measured.

But the scientists bound Nef to the Hck gene

and confirm that three compounds inhibited the activity of the Nef-Hck complex and, more important, all of them also interfered with HIV replication. One compound was so effective that it suppressed HIV replication to undetectable levels in cell culture experiments.

Ă‚

A $6 million, five-year federal grant to Children’s Hospital of Philadelphia Research Institute will enable researchers to investigate a novel approach in treating HIV infection with a unique class of drugs focused on developing therapies for psychological and neurological effects in AIDS.

Ă‚

Mothers receiving highly active antiretroviral therapy to treat HIV-1 infection are less likely than untreated mothers to transmit the virus to their newborns through breastfeeding, according to a new study published in The Journal of Infectious Diseases.

Ă‚

The FDA has approved use of the vaccine Gardasil in boys and men ages 9 through 26 for the prevention of genital warts due to human papillomavirus types 6 and 11. Previously, Gardasil had only been approved for use in females of the same age group.

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B Y

CO RE Y

SAUCIE R

PERFECTLY FLAWED

THE LUCKY ONES

ISTOCKPHOTO

While taking account of his health issues, Corey decides that only in America are you lucky to be dying of AIDS

I have a hole in my tooth! Well, technically I have a hole in my metal crown, which was placed over a two-year-old infected root canal. Last month I cracked a (prematurely) hollowed-out incisor, and when the dentist tried to extract it, it shattered into like a hundred pieces. I’ve been pulling out little bloody fragments from my gum up until a couple of days ago.

Last week I went to the emergency room because I had chest pains! And after six hours of waiting and tests and abuse by the most incompetent nursing sta I’ve ever seen, they released me with a piece of paper with a diagnosis of “chest pains: uncertain cause.â€? (But I’m pretty sure that I knew that when I went in.)

Today I scheduled an appointment for my surgery on the same exact thing I’ve had surgery on before (it has to do with my butt, so don’t ask!), and tomorrow I have an optometrist appointment to replace my calciďŹ ed contact lenses. We’re gonna keep our ďŹ ngers crossed that the eye doctor doesn’t try to blind me. This is the broken, redundant, cheap, ghetto-ass health care system I get in the “greatest country in the worldâ€?! It’s kind of pathetic.

What’s worse is that I realize I’m one of the lucky ones. How ironic is that? If I wasn’t HIV-

positive, I probably wouldn’t have any of it. I mean, how many people do you know who get to visit the doctor every three months, if necessary, to see a specialist for unresolved issues that come up while getting their chronic illness medications ďŹ lled free of charge?

Well, if you lived in any other “great� nation with a comparable economic system, it would be the norm—and our health care would be free! But since we live in “good ol’ America,� that’s not the case, and our government believes that we should be run like an 18thcentury French monarchy, where the prevailing philosophy is “Let them eat cake.�

If not for the heroic and radical battles of the queer community against the government and insurance companies in the ’80s on behalf of the many infected with or dying of HIV granting me the minimal care I have now, I’d probably be dead from some benign nuisance that was never taken care of. I deďŹ nitely wouldn’t have any teeth in my mouth; my eyes would be brown (the horror!); and let’s not forget the butt thing (don’t judge me).

It should be better than this.

We should be better this! This is America, for God’s sake. No disrespect to other countries, but we are supposed to be the best. And frankly, in this regard, we suck!

From a humanistic perspective, I’m ashamed at how we treat our neighbors, at how we treat our poor, and at how we treat our sick and dying. I am horriďŹ ed to even imagine the heavy burdens that others have to bear—others without subpar, ghetto, free HIV-positive health care. I feel sorry for those who feel they have nothing—no voice, no power, no access—and who must beg for the crumbs from the master’s table. I am appalled by the many who have good jobs, great insurance, and pay their portion and yet still get their treatments rejected and their well-being negotiated. And more than anything, my heart went out to the little blue-eyed child next to me whose mother cried in the emergency room, praying for six hours that someone would see her baby.

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

Carr is the real deal.

The 41-year-old has lived through life on the streets, sickle-cell anemia, kidney cancer (now in remission), and now HIV. Through it all, Carr’s altruistic spirit remained as strong as his will to live. He’s launched two groups—Do Something Saturday and Unpluggin HIV—to help others in his situation embrace their inner Gloria Gaynor.

W I TH

K E NG I

What’s the goal of Unpluggin HIV?

I started Unpluggin HIV on April 3 of last year, which was the one-year anniversary of me testing positive for HIV. Its mission is to support people battling low-income life, homelessness, and HIV. So I do that on Los Angeles’s skid row at a site that houses 40 HIV-positive residents. It’s anything from getting them hygiene products to gently used clothes; if they need someone to talk to, they can call me.

Where does funding come from?

I have a core group of people who supported me through my 29 months of homelessness.

How did you become homeless?

I lost my job and was taking care of a family member.

What was scarier: losing your home or testing positive?

Losing my home. When HIV came, I already knew I was positive because I was sort of seeing someone who had lied about their status. For me, HIV is totally different from homelessness. I have sickle-cell anemia, so I’ve been fighting my entire life. I’d already battled cancer and was battling homelessness. I remember the first thing I said to my doctor: “How will I be able to continue my work?� I wasn’t worried I was going to die, because dying wasn’t an option for me. I was worried about the HIV because I was homeless and the services we think are there for people who are low-income or homeless are just not there.

Have we gotten to a point where people just accept HIV status as a character trait, like race or gender?

tips+tools Check out Kengi “KengiKat� Carr’s video blog by visiting us online at HIVPLUSmag.com

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CA R R

No. Most people automatically assume I was out being promiscuous. One thing I can say about being homeless and HIVpositive is that it’s forced me to always believe in myself and not give up. No matter how much I feel the world is stacked against me, if I believe in me and keep moving forward, things will move forward. That’s what I try to do with my

outreach—I remind people you may be in this situation, but you are still here, your life is still here, you are still valuable.

How diďŹƒcult is it for people on the streets to get medications and health care?

When you’re homeless, your main concern is housing. So there were times I had to make a choice: Am I going to see my cancer team, or am I going to line up for housing? You have to make those choices every day. You can’t do it all. There is nothing to help you navigate it all. There were times I made the choice to get housing, which meant I had to make the choice of which trash can I was going to eat out of. —Neal Broverman

“I wasn’t worried I was going to die, because dying wasn’t an option for me. I was worried about the HIV because I was homeless and the services we think are there for people who are low-income or homeless are just not there.�

JANUARY/FEBRUARY 2010

CAMERON JOHNSON

Many people call themselves survivors, but Kengi

Q& A

By starting HIV

treatment,

I went from being in denial to

discovering acceptance.

If you’re HIV positive, the decision to begin taking medication can be difficult. But it can be the first step toward reclaiming your life and living longer. Talking to your doctor and getting the right information on HIV treatment can help take you from being in denial to feeling in control.

Take the next step and go to hivtreatmentispower.com or call (877) Y-TREAT-HIV Š2009 Gilead Sciences, Inc. All rights reserved. PT0561A 03/09