HIV Plus Magazine #76 - APLA by Pride Media

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

CYCLE OF LIFE

The PosPeds reap the beneﬁts of ﬁtness and camaraderie—and all for a good cause GREAT SEX: It’s more important—and better for you—than you might think MAY/JUNE 2010 www.hivplusmag.com

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 doctorâ&#x20AC;&#x2122;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 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. 21050040(7)(107)-05/10-ISN-CON 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.

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 December 2009 9795107 U.S. Patent Nos. US 7,169,780

21050040(7)(107)-05/10-ISN-CON

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IN THIS ISSUE

FEATURES

28 Chain Gang Being a member of a cycling group, like the PosPeds, can do more than just help you be physically ﬁt. A group of friends and a worthy cause are also good reasons to work up a sweat.

32 Between the Sheets Sex truly is an essential, not just pleasurable, part of life and good health. So if you’re not getting full-on satisfaction, check out our discourse on improving your intercourse.

40 A Personal Story Even sex addicts can overcome their problems and achieve sexual happiness.

DEPARTMENTS & VOICES

10 Status Symbols One man takes on a cross-country Cycle for Freedom. Plus: A roundup of advice and news for living your life to the fullest. 17 Mind+Manner 21 Nutrition+Fitness

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“All the reasons for sex being important for someone’s well-being remain true for people who are HIV-positive.” —Robert Kertzner

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

42 HAART Beats Resistant HIV could make the pandemic even worse in just ﬁve years. Plus: Lots more treatment news and advice. 44 Medicine+Wellness

46 Perfectly Flawed Despite his postsurgery pain—or maybe because of it—Corey Saucier takes stock of the blessings in his life.

48 Ask & Tell With the International Mr. Leather finals around the corner, reigning titleholder Jeffrey Payne reflects on a year of being public about life with HIV.

ON THE COVER: POSITIVE PEDALERS PHOTOGRAPHED BY ANGELA WYANT EXCLUSIVELY FOR HIV PLUS.

M AY / J U N E 2 0 1 0 H I V P L U S

ABOUT PREZISTA

you whether your symptoms can be managed IMPORTANT SAFETY INFORMATION on therapy or whether PREZISTA should PREZISTA® (darunavir) is a prescription • PREZISTA, together with Norvir ®, has be stopped medicine. It is one treatment option in the rarely been observed to cause liver • Taking PREZISTA with certain class of HIV (human immunodeficiency virus) problems which may be life-threatening. medicines could cause serious and/or medicines known as protease inhibitors. It was not always clear if PREZISTA life-threatening side effects or may caused these liver problems because PREZISTA is always taken with and at the same result in loss of its effectiveness. Do some patients had other illnesses or were time as ritonavir (Norvir ®), in combination with not take PREZISTA if you are taking taking other medicines. Your healthcare other HIV medicines for the treatment of HIV the following medicines: alfuzosin professional should do blood tests infection in adults. PREZISTA should also be (Uroxatral®), dihydroergotamine (D.H.E.45®, prior to starting combination treatment taken with food. Migranal®), ergonovine, ergotamine including PREZISTA. If you have chronic • The use of other medicines active against (Wigraine®, Ergostat ®, Cafergot ®, Ergomar ®), hepatitis B or C infection, your healthcare HIV in combination with PREZISTA/ritonavir methylergonovine, cisapride (Propulsid®), professional should check your blood tests (Norvir ®) may increase your ability to fight HIV. pimozide (Orap®), oral midazolam, triazolam more often because you have an increased Your healthcare professional will work with (Halcion®), rifampin (Rifadin®, Rifater ®, chance of developing liver problems you to find the right combination of Rifamate®), indinavir (Crixivan®), Talk to your healthcare professional about HIV medicines lopinavir/ritonavir (Kaletra®), saquinavir the signs and symptoms of liver problems. ® • It is important that you remain under the ), lovastatin (Mevacor ®, Altoprev®, (Invirase These may include yellowing of your ® care of your healthcare professional during ), pravastatin (Pravachol®), Advicor skin or whites of your eyes, dark (tea® ® treatment with PREZISTA , Simcor , Vytorin®), or simvastatin (Zocor colored) urine, pale-colored stools (bowel products containing St. John’s wort movements), nausea, vomiting, loss of PREZISTA does not cure HIV infection or • Before taking PREZISTA, tell your healthcare appetite, or pain, aching or sensitivity on AIDS, and does not prevent passing HIV professional if you are taking sildenafil your right side below your ribs to others. (Viagra®), vardenafil (Levitra®), tadalafil • Skin rashes have been reported in patients (Cialis®), atorvastatin (Lipitor ®), taking PREZISTA. Rarely, PREZISTA has atorvastatin/amlodipine (Caduet®), or been reported to cause a severe or liferosuvastatin (Crestor®). This is not a complete threatening rash. Contact your healthcare list of medicines. Be sure to tell your professional immediately if you develop a healthcare professional about all the rash. Your healthcare professional will advise

Belief {

in myself in my doctor in my meds

ONCE-DAILY PREZISTA FOR ADULTS TAKING HIV MEDS FOR THE FIRST TIME In a clinical study* of almost 2 years (96 weeks) in people who had never taken HIV meds before, ONCE-DAILY PREZISTA with low-dose ritonavir plus Truvada®… • Helped 8 out of 10 people achieve undetectable viral load (less than 50 copies/mL) • May help to increase T-cell count • Was associated with low rates of diarrhea, stomach pain, nausea, and vomiting — Diarrhea (8%), stomach pain (5%), nausea (3%), and vomiting (2%) were reported as moderate to severe PREZISTA must be taken with and at the same time as 100 mg of Norvir® (ritonavir), and with other HIV meds and with food. Once-daily PREZISTA is not recommended for adults who have taken HIV meds in the past. Please read Important Safety Information below and ask your doctor if once-daily PREZISTA is right for you. *343 adult patients (30% women) received combination therapy with PREZISTA/ritonavir. At the start of the study, the average T-cell count was 245, and 66% of patients had a viral load less than 100,000 copies/mL.

Individual results may vary.

medicines you are taking or plan to take, taking protease inhibitor medicines, including prescription and nonprescription including PREZISTA medicines, vitamins, and herbal supplements • Changes in body fat have been seen in some • Tell your healthcare professional if you patients taking HIV medicines, including are taking estrogen-based contraceptives PREZISTA. The cause and long-term health (birth control). PREZISTA might reduce effects of these conditions are not known at the effectiveness of estrogen-based this time contraceptives. You must take additional • As with other protease inhibitors, taking precautions for birth control, such as condoms PREZISTA may strengthen the body’s immune • Before taking PREZISTA, tell your healthcare response, enabling it to begin to fight infections professional if you have any medical conditions, that have been hidden. Patients may experience including allergy to sulfa medicines, diabetes, signs and symptoms of inflammation that can liver problems (including hepatitis B or C), include swelling, tenderness, or redness or hemophilia •The most common side effects related to • Tell your healthcare professional if you are taking PREZISTA include diarrhea, nausea, pregnant or planning to become pregnant, or rash, headache, stomach pain, and vomiting. are breastfeeding Uncommon but severe side effects such as – The effects of PREZISTA on pregnant women inflammation of the pancreas and increased or their unborn babies are not known. You blood fat levels have also been rarely reported. and your healthcare professional will need to This is not a complete list of all possible side decide if taking PREZISTA is right for you effects. If you experience these or other side – Do not breastfeed if you are taking PREZISTA. effects, talk to your healthcare professional. You should not breastfeed if you have HIV Do not stop taking PREZISTA or any other because of the chance of passing HIV to medicines without first talking to your your baby healthcare professional • High blood sugar, diabetes or worsening of diabetes, and increased bleeding in people with hemophilia have been reported in patients

www.PREZISTA.com/patient

• Please refer to the ritonavir (Norvir ®) Product Information (PI and PPI) for additional information on precautionary measures 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 adults taking HIV meds for the ﬁrst time: PREZISTA 800 mg (two 400-mg tablets) must be taken at the same time with 100 mg Norvir ® once daily every day. PREZISTA must be taken with food Please see Important Patient Information on the next page for more information, or visit www.PREZISTA.com. If you or someone you know needs help paying for medicine, call 1-888-4PPA-NOW (1-888-477-2669) or go to www.pparx.org.

Distributed by: Tibotec Therapeutics/Division of Centocor Ortho Biotech Products, L.P. Titusville, NJ 08560 ©2010 Tibotec Therapeutics 03/10 28PRZDTC0010R2 All trademarks are property of their respective owners.

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HIV PLUS í²&#x2018;

M AY / J U N E 2 0 1 0

FO R

BE T TE R

L IVIN G

STATUS SYMBOLS

Freedom Rider One man plans a cycling trip from the Deep South to Canada to help bring attention to the effects that HIV-related stigma is having on black Americans

PHOTOS.COM

I N T EL

hen Khafre Abif was diagnosed with HIV just over two decades ago, he was worried about how long he would live. But now that heâ&#x20AC;&#x2122;s reached 43 and his son is heading oďŹ&#x20AC; to college, Abif has decided heâ&#x20AC;&#x2122;s ready to expand on his outreach eďŹ&#x20AC;orts as an AIDS counselor and activist to something bigger. Enter the Cycle for Freedom, a 2,028-mile bike ride along the Underground Railroad, a path used by African slaves to escape to freedom out of the Deep South before the Civil War. This route was chosen for its relevance; Abif wants to raise awareness about HIV among African-Americans, who, he says, are enslaved by the stigma of the virus. â&#x20AC;&#x153;HIV is associated with promiscuity; itâ&#x20AC;&#x2122;s associated with drugs,â&#x20AC;? Abif explains. â&#x20AC;&#x153;That kind of mental slavery around the issue continues to prevent our community from discussing this openly, from being tested, from being educated, so itâ&#x20AC;&#x2122;s really symbolic to say that my ride is trying to ďŹ nd freedom from that shame, freedom from that stigma, freedom from homophobia to a place where we can openly and freely discuss the issue of HIV.â&#x20AC;? Abif plans to start his trip May 9 in Mobile, Ala., which is about 800 miles from his home in Pittsburgh. Over the course of about 75 days heâ&#x20AC;&#x2122;ll stop in cities along the biking course created by the Adventure Cycling Association, tracing its way along the Underground Railroad route through Mississippi, Tennessee, Kentucky, Ohio, Pennsylvania, and New York before ending in Owen Sound, in the Canadian province of Ontario. While on the road Abif will deliver his message to local media outlets, go to

rallies, and screen a documentary in which he was involved, Why Us: Left Behind and Dying. The 90-minute ďŹ lm focuses on why African-Americans are so disproportionately aďŹ&#x20AC;ected by the virus. His stops will also include an oďŹ&#x20AC;er of HIV testing through New Voices Pittsburgh and One Life for the Test 1 Million project, a campaign created by the Black AIDS Institute. But why go through the physical stress of a bike ride across America? In 2009, Abif was shaken by the loss of four friends to the virus. â&#x20AC;&#x153;They were considered long-term survivors,â&#x20AC;? he says, â&#x20AC;&#x153;so I had to take some time to really meditate on their loss and have conversations with God, talking about, â&#x20AC;&#x2DC;Why am I still here after 21 years of dealing with this virus?â&#x20AC;&#x2122; â&#x20AC;? Eventually, he says, he was inspired to bike across the country in the name of HIV awareness: â&#x20AC;&#x153;It might be possible to keep HIV in black America in the news for as long as Iâ&#x20AC;&#x2122;m on the bicycle and to get the community mobilized and informed and to get away from the stigma and shame that are continuing the cycle of continued infections and the rising rates among African-Americans.â&#x20AC;? During one of the harshest winters on record for Pittsburgh, Abif stuck mainly to training indoors at his local YMCA, which sponsored his membership. Heâ&#x20AC;&#x2122;s also been hitting the treadmill, lifting weights, and gathering advice from others who have done similar rides. And, of course, he adds, there are the physical, aesthetic perks that will ultimately come with enduring the course. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m going to be so ďŹ ne when I get oďŹ&#x20AC; that bike!â&#x20AC;? he says. â&#x20AC;&#x153;When I get oďŹ&#x20AC; that bike in July or August, itâ&#x20AC;&#x2122;s going to be over for everyone!â&#x20AC;? â&#x20AC;&#x201D;Michelle Garcia

M AY / J U N E 2 0 1 0 í˛&#x2018;

HIV PLUS

Important Safety Information and Indication

• Have liver problems, including hepatitis B or C virus infection. • Have ever had seizures: Seizures have occurred in patients taking a component of ATRIPLA, usually in those with a history of seizures. If you have ever had seizures, or take medicine for seizures, your healthcare provider may want to switch you to another medicine or monitor you. • Have ever had mental illness or use drugs or alcohol. Contact your healthcare provider right away if you experience any of the following serious or common side effects: Serious side effects associated with ATRIPLA: • Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of suicide and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. • Kidney problems (including decline or failure of kidney function). If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider should do regular blood tests. Symptoms that may be related to kidney problems include a high volume of urine, thirst, muscle pain, and muscle weakness. • Bone changes. Lab tests show changes in the bones of patients treated with tenofovir DF, a component of ATRIPLA. Some HIV patients treated with tenofovir DF developed thinning of the bones (osteopenia) which could lead to fractures. Also, bone pain and softening of the bone (which may lead to fractures) may occur as a consequence of kidney problems. If you have had bone problems in the past, your healthcare provider may want to check your bones. Common side effects: • Dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams. These side effects tend to go away after taking ATRIPLA for a few weeks. These symptoms may be more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery. • Rash is a common side effect that usually goes away without any change in treatment, but may be serious in a small number of patients. • Other common side effects include: tiredness, upset stomach, vomiting, gas, and diarrhea. Other possible side effects: • Changes in body fat have been seen in some people taking anti-HIV-1 medicines. The cause and long-term health effects are not known. • Skin discoloration (small spots or freckles) may also happen. • If you notice any symptoms of infection, contact your healthcare provider right away. • Additional side effects are inflammation of the pancreas, allergic reaction (including swelling of the face, lips, tongue, or throat), shortness of breath, pain, stomach pain, weakness and indigestion. You should take ATRIPLA once daily on an empty stomach. Taking ATRIPLA at bedtime may make some side effects less bothersome.

INDICATION ATRIPLA® (efavirenz 600 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate [DF] 300 mg) is a prescription medication used alone as a complete regimen or with other medicines to treat HIV-1 infection in adults. ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others. Do not stop taking ATRIPLA unless directed by your healthcare provider. See your healthcare provider regularly. IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following side effects or conditions associated with ATRIPLA: • Nausea, vomiting, unusual muscle pain, and/or weakness. These may be signs of a buildup of acid in the blood (lactic acidosis), which is a serious medical condition. • Light-colored stools, dark-colored urine, and/or if your skin or the whites of your eyes turn yellow. These may be signs of serious liver problems. • If you have HIV-1 and hepatitis B virus (HBV), your liver disease may suddenly get worse if you stop taking ATRIPLA. Do not take ATRIPLA if you are taking the following medicines because serious and life-threatening side effects may occur when taken together: Vascor® (bepridil), Propulsid® (cisapride), Versed® (midazolam), Orap® (pimozide), Halcion® (triazolam), or ergot medications (for example, Wigraine® and Cafergot®). In addition, ATRIPLA should not be taken with: Combivir® (lamivudine/zidovudine), EMTRIVA® (emtricitabine), Epivir® or Epivir-HBV® (lamivudine), Epzicom® (abacavir sulfate/lamivudine), SUSTIVA® (efavirenz), Trizivir® (abacavir sulfate/ lamivudine/zidovudine), TRUVADA® (emtricitabine/tenofovir DF), or VIREAD® (tenofovir DF), because they contain the same or similar active ingredients as ATRIPLA. ATRIPLA should not be used with HEPSERA® (adefovir dipivoxil). Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate), with or without Norvir® (ritonavir), should not be taken with ATRIPLA since they may lose their effect and may also increase the chance of having side effects from ATRIPLA. Fortovase® or Invirase® (saquinavir) should not be used as the only protease inhibitor in combination with ATRIPLA. Taking ATRIPLA with St. John’s wort or products containing St. John’s wort is not recommended as it may cause decreased levels of ATRIPLA, increased viral load, and possible resistance to ATRIPLA or cross-resistance to other anti-HIV drugs. This list of medicines is not complete. Discuss with your healthcare provider all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take. Tell your healthcare provider if you: • Are pregnant: Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects have been seen in children of women treated during ATRIPLA is one of several treatment options pregnancy with one of the medicines in ATRIPLA. your doctor may consider. Women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control You are encouraged to report negative while on ATRIPLA and for 12 weeks after stopping side effects of prescription drugs to the ATRIPLA. FDA. Visit www.fda.gov/medwatch • Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their or call 1-800-FDA-1088. milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby.

Please see Patient Information on the following pages.

Patient model. Individual results may vary.

© 2010 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 and REYATAZ are registered trademarks of Bristol-Myers Squibb. All other trademarks are owned by third parties. 697US09AB07010/TR3981 01/10

“My entire HIV regimen in one pill daily. For me, that’s great.” Phill ip

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. • ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others. • Selected Important Safety Information: Some people who have taken medicine like ATRIPLA have developed the following: a serious condition of acid buildup in the blood (lactic acidosis), and serious liver problems (hepatotoxicity). For patients with both HIV-1 and hepatitis B virus (HBV), hepatitis may worsen if ATRIPLA is discontinued.

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 bolded information, on adjacent page. *Synovate Healthcare Data; US HIV Monitor, Q2 2009.

†

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

To learn more, visit www.ATRIPLA.com

Couch Potato Meds Work Better? Buying medicine by mail may encourage patients to stick to their doctor-prescribed medication regimen, new research in The American Journal of Managed Care suggests. In whatâ&#x20AC;&#x2122;s touted as a ďŹ rstof-its-kind study, researchers from the University of California, Los Angeles, and Kaiser Permanenteâ&#x20AC;&#x2122;s Division of Research in Oakland, Calif., found that patients with chronic conditions who ordered their medications by mail were more likely to take them as prescribed than patients who obtained medications from a local pharmacy. â&#x20AC;?The ďŹ eld of medication adherence research typically focuses on patient factors for poor adherence, leading to a â&#x20AC;&#x2DC;blame the patientâ&#x20AC;&#x2122; approach for nonadherence,â&#x20AC;? says O. Kenrik Duru, the studyâ&#x20AC;&#x2122;s lead researcher and an assistant professor in the division of general internal medicine and health services research at the David GeďŹ&#x20AC;en School of Medicine at UCLA. â&#x20AC;&#x153;Our work helps to place this issue in a larger perspective. Our ďŹ ndings indicate that mail-order pharmacies streamline the medication-acquisition process, which is associated with better medication adherence.â&#x20AC;? For the 12-month study, researchers analyzed medication reďŹ ll data from 2006 and 2007 for 13,922 Kaiser Permanente members in Northern California. They defined â&#x20AC;&#x153;good adherenceâ&#x20AC;? as having medication available and on hand at least 80% of the time. The researchers found that 84.7% of patients who received their medications by mail at least two thirds of the time stuck to their physicianprescribed regimen, compared with 76.9% of those who picked up their medications at traditional â&#x20AC;&#x153;brick-and-mortarâ&#x20AC;? Kaiser Permanente pharmacies.

According to international studies, 20% to 37% of HIV-positive patients have diagnosable depression; however, this may be an underestimate, researchers report in the journal HIV Medicine. In an outpatient clinic in Denmark investigators set out to determine the prevalence of depression among patients with HIV and to identify important factors for the development of depression. The researchers observed symptoms of depression in 38% of patients, while 26% showed symptoms of major depression. Those at risk of major depression were almost six times more likely to have missed at least one dose of highly active antiretroviral therapy in the four days preceding assessment. â&#x20AC;&#x153;The study found that depression was underdiagnosed among HIV-positive patients and was associated with stress, loneliness, a diďŹ&#x192;cult ďŹ nancial situation, low adherence, and unsafe sex,â&#x20AC;? the authors concluded. â&#x20AC;&#x153;Screening for depression should be conducted regularly to provide full evaluation and relevant psychiatric treatment. This is particularly important at the time of diagnosis and before initiating HAART.â&#x20AC;?

HIV PLUS í˛&#x2018;

M AY / J U N E 2 0 1 0

Same Ole Same Ole

There is a â&#x20AC;&#x153;business-asusual mentality that has stymied the war on HIVâ&#x20AC;? in the United States. â&#x20AC;&#x201D;Shannon Hader, director of the Washington, D.C., HIV/ AIDS Administration, in an opinion piece in The Washington Post in late January, noting that the Centers for Disease Control and Prevention has not reported a decline in the number of new infections for more than a decade. Hader suggests that to overcome the domestic HIV epidemic, the U.S. Presidentâ&#x20AC;&#x2122;s Emergency Plan for AIDS Reliefâ&#x20AC;&#x201D;a program that oversees foreign effortsâ&#x20AC;&#x201D;provides a â&#x20AC;&#x153;clear modelâ&#x20AC;? for the Office of National AIDS Policy in developing the first national HIV strategy for the United States. â&#x20AC;&#x153;Launched in 2003, PEPFAR set high expectations, and it has achieved them,â&#x20AC;? Hader says, â&#x20AC;&#x153;bringing treatment to more than 2 million people in less than ďŹ ve years.â&#x20AC;Ś PEPFAR cut through the red tape and demanded government coordination and accountability.â&#x20AC;Ś If this can be done amid political turmoil overseas, imagine its potential here.â&#x20AC;?

MAILBOX BY GE T T Y IMAGES; DEPRESSION BY PHOTOS.COM

A Missed Malady?

STATUS SYMBOLS

MIND

MANNER

Time to Ask for Help? Depression can be overwhelming to your life, but its subtle onset can keep you from realizing that itâ&#x20AC;&#x2122;s affecting you Gary McClain, Ph.D.

GE T T Y IMAGES

Breast-feeding Is Important A new study suggests that halting breast-feeding early causes more harm than good for children not infected with HIV who are born to HIV-positive mothers. Stopping breast-feeding before 18 months was associated with signiďŹ cant increases in death rates among these children, according to the studyâ&#x20AC;&#x2122;s ďŹ ndings, described in the February issue of Clinical Infectious Diseases. The researchersâ&#x20AC;&#x2122; initial hypothesis, which proved to be incorrect, suggested that by 4 months of age, children would have passed the critical developmental point when breast-feeding is essential to their survival. However, stopping breast-feeding at 4 months, compared to usual breast-feeding as the child reaches 6 months to 24 months or older, did not decrease mortality or play a signiďŹ cant role in protecting the child from HIV transmission. These ďŹ ndings were consistent with those for mothers not infected with HIV; longer breast-feeding is necessary to protect children against potentially fatal infectious diseases, especially those prevalent in low-resource settings. To prevent postnatal HIV transmission, however, mothers with HIV should be on antiretroviral drugs. â&#x20AC;?Our results help support the change in World Health Organization guidelines for prevention of mother-to-child HIV transmission,â&#x20AC;? says study author Louise Kuhn, Ph.D., of Columbia University in New York City. â&#x20AC;&#x153;The new guidelines encourage postnatal use of antiretrovirals through the duration of breastfeeding to prevent vertical [mother-to-child] transmission.â&#x20AC;?

In my previous column I wrote about coping with uncertainty by maintaining a sense of optimism when the world seems to be kicking you around. But letâ&#x20AC;&#x2122;s face it, life is what it is. A client who Iâ&#x20AC;&#x2122;ll call Sean admitted that he was feeling like his life was in a tailspin: â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;ll say it straight out. I donâ&#x20AC;&#x2122;t know how I made it in here today. Iâ&#x20AC;&#x2122;m barely getting out of bed. I canâ&#x20AC;&#x2122;t shake off this feeling that I donâ&#x20AC;&#x2122;t have any hope.â&#x20AC;? How are you doing? Are you rolling with the punches? Or are you finding that those days when things feel almost unbearable are starting to outnumber the good ones? h When things fall apart. Feeling sad at times is part of being human. But people who are depressed have trouble maintaining their normal livesâ&#x20AC;&#x201D;getting up in the morning, doing work around the house, getting together with friends. Depression causes pain for the person who is depressed, and it also causes pain for the people around them who want to reach out but donâ&#x20AC;&#x2122;t know what to do. hYour life, your meds, your mood. The challenge of HIV and antiretrovirals can affect your mood. On some days you may feel like the challenges are overwhelming. Your medications can also affect your emotions; depression can be a side effect. h How do you know if you are depressed? There are different kinds of depression, which a mental health professional, working with your doctor, can help to diagnose. A diagnosis is based on symptoms that are common among people suffering from depression. Key

symptoms include overwhelming sadness, fatigue, loss of interest in things you enjoy, isolating yourself, getting irritable or angry easily, losing or gaining weight, or having difficulty sleeping. hDonâ&#x20AC;&#x2122;t diagnose yourself. Keep in mind that the presence of symptoms does not necessarily mean that you are depressed. Only a professional can make this determination for you. But if you think there is a possibility that you may be depressed, you can take the first step to find out for sure. hWhen the going gets toughâ&#x20AC;Ś Go shopping! Shrink shopping, that is. If you feel like the sadness or other symptoms that you are experiencing may be depression, you may want to first talk to your doctor. He or she may be able to help you with depression through medication or by referring you to a mental health professional. You can also find a mental health professional on your own by exploring local resources or going online. Try to find someone who not only understands depression but who also has experience in addressing the special needs of individuals living with HIV. >Build prevention into your routine. Donâ&#x20AC;&#x2122;t isolate yourself at home. Get out and do something you enjoy, even if itâ&#x20AC;&#x2122;s only to take a walk. Get together with your friends and with your family. Eat a balanced diet. Get some exercise and kick-start your good mood hormones. Who knows! You might even want to get a pet. Depression is treatable. Dial or doubleclickâ&#x20AC;&#x201D;but reach out! Donâ&#x20AC;&#x2122;t go through this alone.

McClain welcomes e-mail at Gary@JustGotDiagnosed.com

M AY / J U N E 2 0 1 0 í˛&#x2018;

HIV PLUS

• EPZICOM, in combination with other antiretroviral agents, is indicated for the treatment of HIV-1 infection in adults. • EPZICOM is one of 3 medicines containing abacavir. Before starting EPZICOM, your healthcare provider will review your medical history in order to avoid the use of abacavir if you have experienced an allergic reaction to abacavir in the past. • In one study, more patients had a severe hypersensitivity reaction in the abacavir once-daily group than in the abacavir twice-daily group. • EPZICOM should not be used as part of a triple-nucleoside regimen. • EPZICOM does not cure HIV infection/AIDS or prevent passing HIV to others. By prescription only. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see additional important information about EPZICOM, including boxed warnings, on the adjacent pages.

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

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

EVEN WITH HIV, “

I AM AN UNSTOPPABLE FORCE.”

“When I was ﬁrst diagnosed with HIV, I thought it would stop me from reaching my goals. But these days, I know better. I’ve come to realize that I am in charge of my destiny. Not HIV. “Now that I’m able to focus my mind, body, and spirit on my condition, I’m doing better every day. My meds help a lot, too. One of the drugs that’s made a real difference is EPZICOM. “At my last visit, my doctor told me that in combination with other medications, it helps keep HIV from making copies and infecting healthy cells. He also said that in less than one year, 68% of patients taking a regimen with EPZICOM had their viral load become undetectable. On top of that, patients saw a 93% increase in their T-cell counts.* I liked what I heard. So my doctor added it to my regimen.

“Making EPZICOM part of my combination therapy has proven to be a good thing. My viral load is undetectable. So, my HIV is where I want it to be.” †

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

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

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

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

I’ve got the ﬁght in me.

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

Group 1 Group 2 Group 3 Group 4 Group 5

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

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

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

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

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December 2009

STATUS SYMBOLS

NUTRITION

FITNESS

To Be or Not to Beâ&#x20AC;&#x201D;Alive You might have a handful of excuses of why you donâ&#x20AC;&#x2122;t exercise, but thereâ&#x20AC;&#x2122;s a handful of reasons you should, and theyâ&#x20AC;&#x2122;re more important

Not Out of the Woods

GE T T Y IMAGES

Sam Page

As a personal trainer, I know the antiaging benefits of fitness, and Iâ&#x20AC;&#x2122;ve experienced them firsthand. When my mom died last year I switched to a vegetarian diet and started a weekly yoga practice. So far Iâ&#x20AC;&#x2122;ve lost 25 pounds and my blood pressure has dropped 30 points without medication. I feel 10 years younger. Itâ&#x20AC;&#x2122;s just intuitive: Exercise works. Last year a highly publicized New York magazine article chronicled the stories of dementia and other signs of early aging faced by a striking number of HIV patients. Just recently, German scientists have discovered that exercise slows down aging on a cellular level inside the body. Thatâ&#x20AC;&#x2122;s rightâ&#x20AC;&#x201D;exercise helps keep our cells younger. HIV slowly erodes the immune system, and this is of major concern when it comes to aging. Chronic pathogens that â&#x20AC;&#x153;are controlled, not cleared,â&#x20AC;? such as HIV, â&#x20AC;&#x153;play an important role in accelerated aging because of their persistent drain on immune system resources,â&#x20AC;? says Richard Jefferys of Treatment Action Group. Studies have shown that over time, HIVers experience a more rapid onset of cognitive problems, such as memory loss; more susceptibility to infections; and higher incidences of cancer and

cardiovascular, kidney, and liver disease. Starting highly active antiretroviral therapy early may reduce these problems but more research is needed. Across the pond, German researchers have found that exercise actually has an antiaging effect on the molecular level. In the study middle-aged runners lost only about 10% of the length of their telomeres (the tiny end caps on DNA strands) compared to their 20-year-old counterparts. The longer your telomeres, the functionally younger and more active your cells. This means exercise keeps you internally fit: younger from the inside out. To remain healthy and active into your golden years, I strongly encourage a regular exercise program. Antiaging aside, the multiple health benefits are clear. Exercise reduces blood pressure, improves mood, lowers cholesterol, and reduces the risk of certain kinds of cancer. Any form of intense exercise done regularly over a long time will improve cell biology. Itâ&#x20AC;&#x2122;s exciting to see science confirm what weâ&#x20AC;&#x2122;ve intuited for so long. HIVers may age more rapidly than out noninfected counterparts, but we donâ&#x20AC;&#x2122;t have to accept this fact lying down. Hop on the treadmill instead.

Men who have sex with men are more than 44 times more likely than other men to contract HIV and over 40 times more likely than women to do so, according to statistics released by the Centers for Disease Control and Prevention in mid March. Furthermore, MSM are over 46 times more likely to contract syphilis than other men and over 71 times more likely than women to do the same. Men who have sex with men were 57% of people newly infected with HIV in 2006, according to the stats, even though MSM are only an estimated 2% of the adult population. However, research shows that most gay men practice safer sex, and gay male couples are twice as likely as heterosexual couples to practice safer sex. â&#x20AC;?The CDCâ&#x20AC;&#x2122;s newly released statistics highlight how HIV continues to disproportionately aďŹ&#x20AC;ect gay men more than any other group in the U.S.,â&#x20AC;? says Marjorie Hill, Ph.D., chief executive of New Yorkâ&#x20AC;&#x201C;based Gay Menâ&#x20AC;&#x2122;s Health Crisis. â&#x20AC;&#x153;Greater prevention eďŹ&#x20AC; orts targeted toward this population are clearly needed. We commend President Obama for proposing a new $28 million initiative in his 2011 budget to expand innovative HIV prevention with gay and bisexual men. It is time the CDC match the trends of the epidemic.â&#x20AC;?

GROWING GRAY?

The proportion of new HIV cases in the United States among people age 50 and olderâ&#x20AC;&#x201D;the result, experts say, both of patients living longer and of more older people being diagnosed. â&#x20AC;&#x153;Historically, when you looked at AIDS diagnoses, people 50 and older accounted for 10% of all diagnoses,â&#x20AC;? says Diane Sublets, an associate professor of sociology at the University of North Carolina in Charlotte.

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FLASH, DANCE More than 200 volunteersâ&#x20AC;&#x201D;many of them Great White Way performers, like Nick Adamsâ&#x20AC;&#x201D;will be dancing in the 20th Broadway Bares on June 20 in New York City. Themed â&#x20AC;&#x153;Stripopolyâ&#x20AC;? this year, the annual fundraiser contributes to the efforts of Broadway Cares/Equity Fights AIDS.

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STREETWISE A pair of pantomimists at an AIDS awareness rally in the streets of Istanbul, Turkey, sign the message that â&#x20AC;&#x153;HIV-positives can work.â&#x20AC;?

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THE GLAMOROUS LIFE Lady Gaga and Cyndi Lauper flank Sharon Osbourne, who was host of a MAC Viva Glam launch in London for the cosmetic brandâ&#x20AC;&#x2122;s newest products that fund AIDS charities. Gaga and Lauper have also announced that theyâ&#x20AC;&#x2122;ll campaign to help educate women about HIV.

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PREVIOUS PAGES: BROADWAY BARES BY JEMAL COUNTESS/WIREIMAGE; PANTOMIME BY REUTERS/MURAD SEZER; THIS PAGE: DAVE M. BENE T T/GE T T Y IMAGES

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FRANCK FIFE/AFP/GE T T Y IMAGES

Activists wrangle Condomfiere, a 130-foot-long condom-shaped balloon, at the Palais de la Decouverte in Paris. The advocacy group CondomFly plans to take the balloon on â&#x20AC;&#x153;flightâ&#x20AC;? over all continents to promote safer-sex practices.

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THIGH MASTERS Positive Pedalers say the physical ďŹ tness that comes with being a member of the cycling group is a bonus to the friendships they build and the stigma they help tear down 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 F O R H I V P L U S B Y A N G E L A W YA N T

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settled in San Franciscoâ&#x20AC;&#x201D;after two decades spent mostly overseas and then two years living with his parents in Florida when his father had cancerâ&#x20AC;&#x201D;he had quite a bit of adjusting to do. He was a new kid on the blockâ&#x20AC;&#x201D;but a middle-aged kid with a spare tire around his waist. â&#x20AC;&#x153;I come from a big Italian family, and my mom knows how to cook for only 100,â&#x20AC;? the 46-year-old says today, diverting responsibility for his extra weight. Ciano, who had grown used to the melting-pot social scene in London, where his friends came from a diverse cross section of backgrounds, says the Bay Area seemed to be segregated, cliquish, and overly youth-oriented. He didnâ&#x20AC;&#x2122;t want to have to go to a bar to meet people, so he joined a social group insteadâ&#x20AC;&#x201D;the local chapter of Positive Pedalers, a club for HIV-positive cycling enthusiasts. â&#x20AC;&#x153;I found a community and a group of people who I want to be around,â&#x20AC;? he says. â&#x20AC;&#x153;And getting on the bike, I got back into really good shape.â&#x20AC;? Celebrating its 15th anniversary, PosPeds, as members refer to it, has more than 800 members across the country, a ďŹ gure that has doubled in the past few years as more active HIVers like Ciano seek new ways to combine physical ďŹ tness with a social outlet involving like-minded folk. The group sponsors training rides in 20-plus U.S. and Canadian communities (and more are added regularly) and maintains a vivid, out-and-proud presence on the various AIDS rides that raise money

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HEN MARK CIANO

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for HIV treatment and other related services across the country. A sort of activist groupâ&#x20AC;&#x201D;but wielding jerseys and toned thighs instead of placards and ďŹ stsâ&#x20AC;&#x201D;PosPeds has a core mission beyond simply getting its members in shape and making sure they have fun; it helps transform them into living contradictions of HIVrelated stigma. Riders are encouraged, for example, to come out about their serostatus. To give them an edge when it comes to starting that conversation, each gets a bright red PosPeds jersey emblazoned with iâ&#x20AC;&#x2122;m positive. Michael Barron, director of AIDS/ LifeCycle, a seven-day ride from San Francisco to Los Angeles each June, says the 200 to 250 members of PosPeds who participate in every ride raise at least $750,000â&#x20AC;&#x201D;or about 7% of all donationsâ&#x20AC;&#x201D; each year. Furthermore, he says, the participants are an inspirationâ&#x20AC;&#x201D;the poster men and women for the cause. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s one thing to be in my position and to write the best marketing materials and to try to pitch the best stories to the media,â&#x20AC;? Barron says, â&#x20AC;&#x153;but itâ&#x20AC;&#x2122;s another thing to show people living with this disease and living with dignity and creating the positive role models that we need.â&#x20AC;? James Williams Jr., a 51-year-old attorney who found cycling was a much more practical ďŹ tness pursuit than horseback riding when he moved from Atlanta to New York City, says he sees it as his duty to wear the red jersey and put a healthy face on HIV. A couple of years ago he had his PosPeds shirt trimmed down so that he could wear it in the

New York City triathlon. While running through the northern end of Central Park in the ďŹ nal leg, he says, â&#x20AC;&#x153;I heard a couple say, â&#x20AC;&#x2DC;Oh, look, thereâ&#x20AC;&#x2122;s somebody thatâ&#x20AC;&#x2122;s got HIV.â&#x20AC;&#x2122; And that was the neatest feeling in the world. I thought to myself, Thatâ&#x20AC;&#x2122;s exactly why I wanted to do this as a PosPedaler. Our purpose is to say, â&#x20AC;&#x2DC;You know we have this virus and we have obstacles. Yes, we have to take medicines, and thereâ&#x20AC;&#x2122;s some times when we canâ&#x20AC;&#x2122;t do everything. But we can do a lot.â&#x20AC;&#x2122; â&#x20AC;? Perhaps more important is the way the riders inspire one another, not just to maintain physical ďŹ tness but to move outside the dark cloud of stigma. David Duncan, a 57-year-old former campus planner for the University of California, Berkeley, who lives on disability in San Francisco, says he and his riding buddies have coined the phrase circling the table for the way that other LifeCycle riders hover at a nervous distance when they see the PosPeds information table, not sure if theyâ&#x20AC;&#x2122;re ready to come out about their own serostatus. Duncan himself was once one of them. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s a whole process,â&#x20AC;? he says of disclosing he was HIV-positive by his at-ďŹ rst cautious association with the group. â&#x20AC;&#x153;Being positive in front of everybody elseâ&#x20AC;&#x201D;it was a huge thing to for me to do.â&#x20AC;? All anxieties aside, there probably isnâ&#x20AC;&#x2122;t a more receptive audience to such a personal announcement than a group of fellow cyclists pedaling (and peddling) for AIDS service organizations. For anyone who participates in the San Francisco to L.A. ride, the highlight is the end of the third dayâ&#x20AC;&#x201D;designated PosPeds Nightâ&#x20AC;&#x201D;

FOR THE CAUSE: The members of the Positive Pedalers biking groupâ&#x20AC;&#x201D;among them Bob Olszewski, Ramone Espinoza, Buzz Miller, Yasmen Mehta, Bob Katz, Mark Ciano, Stefen Burchard, Ronnie Mason, Gabriel Rocha, and Diana Cordioâ&#x20AC;&#x201D;meet up on Sundays in the Bay Area for training rides.

when the groupâ&#x20AC;&#x2122;s members share their stories at the dinner meeting and then invite anyone who is HIV-positive to stand and be recognized. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s the most empowering thing that you could do,â&#x20AC;? Williams says. â&#x20AC;&#x153;Before I left [on the ride], I had told only one person that I had the disease.â&#x20AC;? Shirley Jaglowski, a â&#x20AC;&#x153;happy 50-yearoldâ&#x20AC;? from Salt Lake City who is a location manager for a car dealership, spoke on PosPeds Night her ďŹ rst year on the ride. â&#x20AC;&#x153;I remember telling my story,â&#x20AC;? she recounts, â&#x20AC;&#x153;and afterward a woman came up to me and she was just bawling. She said, â&#x20AC;&#x2DC;Iâ&#x20AC;&#x2122;m positive too, and nobody knows it.â&#x20AC;&#x2122; And I just remember crying with her and giving her a hug. We actually rode the next 200 miles together, side by side, just sharing our stories and sharing our strength.â&#x20AC;? But the message of hope and understanding also winds its way into the far nooks and crannies of American life. PosPeds board cochair Nathan Menard, a 49-year-old architect from Orange County, Calif., who has been HIV-positive for more than half his life, says, â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m not your typical person living with HIV. Iâ&#x20AC;&#x2122;m married, heterosexual, I have a wife and child.â&#x20AC;? And doing fundraising for AIDS/LifeCycle has allowed him to talk openly for the ďŹ rst time with people in his surrounding community, which doesnâ&#x20AC;&#x2122;t exactly have HIV on its radar. â&#x20AC;&#x153;These are parents of my sonâ&#x20AC;&#x2122;s friends. Itâ&#x20AC;&#x2122;s one of those â&#x20AC;&#x2DC;Oh, my gosh! I had no ideaâ&#x20AC;&#x2122; types of things,â&#x20AC;? he says of their reactions when he goes asking for donations and discloses his status. â&#x20AC;&#x153;And

then they become avid supporters. They become spokespeople for the disease.â&#x20AC;? Participating in the rides â&#x20AC;&#x153;was the beginning of my new life, of being able to live and to understand that it wasnâ&#x20AC;&#x2122;t something that I needed to be ashamed of,â&#x20AC;? Menard says. â&#x20AC;&#x153;For 10 years I didnâ&#x20AC;&#x2122;t do anything. I wouldnâ&#x20AC;&#x2122;t even [spend time discussing my feelings about] being HIV-positive with my wife. Now I can openly talk about HIV.â&#x20AC;? Of his experiences riding with the group, he adds, â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s just nice to be able to have camaraderie with others that are positive. You always get into the conversation of what your numbers areâ&#x20AC;&#x201D;whatâ&#x20AC;&#x2122;s your viral load, whatâ&#x20AC;&#x2122;s your T-cell countâ&#x20AC;&#x201D;and how healthy you are.â&#x20AC;? Getting on the bike also just so happens to help nurture healthy bodies. â&#x20AC;&#x153;Cycling has enabled me to be in the best shape that Iâ&#x20AC;&#x2122;ve ever been in my life,â&#x20AC;? Williams says, proudly citing that at 5 feet 10 inches he weighs 165 pounds with 9% body fat. â&#x20AC;&#x153;And Iâ&#x20AC;&#x2122;m 51 years old! I donâ&#x20AC;&#x2122;t think I look it. I deďŹ nitely donâ&#x20AC;&#x2122;t feel it.â&#x20AC;? Ciano, who at the same height as Williams has dropped from 194 to 171 pounds and has watched his waist shrink from 33 to 31 inches, says looks are one thing, but the most important factor in his participation in the group is to keep HIV in the public consciousness. â&#x20AC;&#x153;Just like [what went] on with Haiti [after its devastating earthquake],â&#x20AC;? he says. â&#x20AC;&#x153;After a few months people start to forget whatâ&#x20AC;&#x2122;s really aďŹ&#x20AC;ecting all of us. And so by doing this, it helps us to remember those who unfortunately arenâ&#x20AC;&#x2122;t able to be here now.â&#x20AC;? í˛&#x2018;

A sort of activist groupâ&#x20AC;&#x201D; but wielding jerseys and toned thighs instead of placards and ďŹ stsâ&#x20AC;&#x201D;PosPeds has a core mission beyond simply getting in shape and having fun with friends.

tips+tools Find out more about Positive Pedalers or about various AIDS rides held across the country by visiting us online at HIVPLUSmag.com

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ex happens in Technicolor when a person is on crystal meth. Or so people say. Mark S. King knows the answer for sure. After an uneven five years of recovery from addiction, which only recently scored him a full year of uninterrupted sobriety, King says he finally knows now that all the wild fun he had when he was high was just a mirage: “I had this chemical, fake view that (a) this is what real sex is like and (b) it was enjoyable. It’s a lie that it’s enjoyable. And the lie is being told by this disease of addiction that I have.” King, a boyish and muscular 49-year-old blond who lives in Atlanta and blogs about HIV for TheBody.com, is now taking baby steps out of what he describes as a “sexual Peter Pan thing for most of my adult life, thinking that sex was apples being picked from a tree and that it was an inexhaustible resource.” A relationship with another HIVpositive man in Fort Lauderdale that imploded a few years back because of King’s drug use has shown promising signs of new life, though, and King is planning to move back to Florida to give it another shot—ever mindful, he says, that clean and sober sex is a strange yet potentially many-splendored thing. ”Sex is really important for a whole lot of reasons: establishing emotional intimacy with partners, experiencing physical pleasure, relieving negative feelings such as distress or loneliness, and also affirming your identity,” says Robert Kertzner, a Columbia University psychiatrist with a large number of HIV-positive clients in his private psychotherapy practice. “And all the reasons for sex being important for someone’s well-being remain true for people who are HIV-positive—and probably are even more compelling for them.” But sex is often a thorny issue for HIVers, to say the least. The reality of life with the virus rears its ugly head in the very place where most people want to let it all hang out and forget their troubles. Many, instead of experiencing orgasmic bliss, end up dealing with a laundry list of anxieties: worries about disclosure, transmitting the virus, or potential superinfection; concerns about body image caused by lipodystrophy or aging (King woefully cites his “flat butt” issues); feelings of shame over getting the virus in the first place; and for people like King, ripple effects from current or past drug use. hh

IT’S

JUST SEX? Sure, you’re HIV-positive, but that doesn’t mean you shouldn’t be having—or don’t deserve to have—the most amazing sex life possible B Y B E N J A M I N R YA N

To that list add performance anxiety or just plain disinterest in sex. Although studies vary in their ďŹ ndings, it is clear that at least half of all HIVers suďŹ&#x20AC;er some kind of sexual dysfunction, including low sex drive, problems with getting an erection or with vaginal engorgement and lubrication, or diďŹ&#x192;culty achieving orgasm. Researchers believe the psychological strain of living with HIV is largely to blame. But, particularly for men, many antiretroviral medications can also cause sexual problems. Other medical culprits, such as low testosterone, diabetes, or cardiovascular disease, can throw their wrenches into the works as well. Sometimes, though, itâ&#x20AC;&#x2122;s the place where we expect to get help that can be a problem or at least contribute to existing ones. Julianne Serovich, a professor of human development and family science at Ohio State University who studies the psychology of HIV-positive women, says medical professionals in particular tend to overlook HIVersâ&#x20AC;&#x2122; sexual needs. â&#x20AC;&#x153;I think we are more concerned about how [HIV-positive] people are having sexâ&#x20AC;&#x201D;what theyâ&#x20AC;&#x2122;re doingâ&#x20AC;&#x201D;not necessarily whether theyâ&#x20AC;&#x2122;re enjoying it, whether itâ&#x20AC;&#x2122;s healthy for them,â&#x20AC;? she says. â&#x20AC;&#x153;We all have the right to have a healthy sexual existence.â&#x20AC;? Fortunately, though, there are caregivers who specialize in helping people turn their not-so-steamy sex lives around. â&#x20AC;&#x153;HIV aďŹ&#x20AC;ects peopleâ&#x20AC;&#x2122;s sex drives for lots of reasons,â&#x20AC;? says David McDowell, a psychiatrist in private practice in Manhattan. â&#x20AC;&#x153;But there are good remedies. Itâ&#x20AC;&#x2122;s amazing. You give somebody the right amount of testosterone, they all of a sudden perk up.â&#x20AC;? Thatâ&#x20AC;&#x2122;s all the more reason to talk to your doctor or a mental health specialist about possible solutions for your problems [see accompanying article â&#x20AC;&#x153;My Life as a Sex Addictâ&#x20AC;? on page 40]. As for people recovering from addiction, like King, McDowell says thereâ&#x20AC;&#x2122;s a good deal of hopeâ&#x20AC;&#x201D;as long as recovering addicts can do the work to recalibrate their expectations of sex. â&#x20AC;&#x153;Sex then becomes a much more sensual, romantic, fun, balanced experience rather than this hyperkinetic overdrive,â&#x20AC;? he explains. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s going from an incredible, driving disco beat to a nice symphony. But itâ&#x20AC;&#x2122;s in some ways much more enjoyable because itâ&#x20AC;&#x2122;s about connection, not just in a very animalistic driving, predatory way.â&#x20AC;?

Change of Plans Rosario Melendez, a 36-year-old from San Antonio who is a self-proclaimed sexual enthusiast, tested positive in 1994 as her husband was dying of AIDS-related complications. After his death, â&#x20AC;&#x153;I thought my life was over,â&#x20AC;? she says, â&#x20AC;&#x153;because they told me that I had only a year left. So basically I gave up on love and having kids. I started having sex with random people. Kind of like, OK, this is it. Iâ&#x20AC;&#x2122;m going to die, so I might as well enjoy it, right? I enjoyed my life to the max.â&#x20AC;? While she was living it up under the maxim of â&#x20AC;&#x153;Stay up all night, enjoy, drink, have sex,â&#x20AC;? Melendez says she still longed for lasting companionship. â&#x20AC;&#x153;But having to tell somebody that youâ&#x20AC;&#x2122;re positive and facing the feelings of rejection? Thatâ&#x20AC;&#x2122;s one thing I didnâ&#x20AC;&#x2122;t want to go through again,â&#x20AC;? she reveals. â&#x20AC;&#x153;I was afraid.â&#x20AC;? Eventually, she started falling for a new man. They had some good times together, sleeping in the same bed without any sex at ďŹ rst. â&#x20AC;&#x153;I went through hell trying to decide if I wanted to tell himâ&#x20AC;? that she was HIV-positive, she says. â&#x20AC;&#x153;So ďŹ nally I did, and he said, â&#x20AC;&#x2DC;Well, I already knew.â&#x20AC;&#x2122; I wanted to kill him! Afterward, I was like, â&#x20AC;&#x2DC;OK, letâ&#x20AC;&#x2122;s just hang out and have sex!â&#x20AC;&#x2122;â&#x20AC;? The two have since married and now have nearly 4-year-old twins. Serovich, whose research has found that young HIV-positive women today have an increasing desire for motherhood, says a story like

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â&#x20AC;&#x153;People who allow their HIV status to impede them from having a fulďŹ lling sex lifeâ&#x20AC;&#x201D;itâ&#x20AC;&#x2122;s a tragedy. Because itâ&#x20AC;&#x2122;s not necessary.â&#x20AC;? Melendezâ&#x20AC;&#x2122;s proves that â&#x20AC;&#x153;HIV doesnâ&#x20AC;&#x2122;t have to stop anybodyâ&#x20AC;&#x2122;s life in any particular area, whether it be family or their sex life or their work or their recreation.â&#x20AC;? Jack Drescher, a clinical associate professor of psychiatry at New York Medical College and the author of Psychoanalytic Therapy and the Gay Man adds that often â&#x20AC;&#x153;inhibitions reside within the person, not within the environment around them. People might feel that nothing is going to work until they tell the people around them, who have completely diďŹ&#x20AC;erent ideas. One thing that inhibits peopleâ&#x20AC;&#x2122;s relationships and their sexuality is they get so self-absorbed about what they imagine the response is going to be that they stop paying attention to what their actual responses are.â&#x20AC;? Scott Brynildsen went through a trajectory similar to Melendezâ&#x20AC;&#x2122;s: diagnosis as a teenager, then a period of urgent sexual abandon fueled by thoughts of a supposedly bleak future. â&#x20AC;&#x153;Initially I said, â&#x20AC;&#x2DC;I need to get laid. A lot. And then die,â&#x20AC;&#x2122; â&#x20AC;? the 32-year-old from Seattle says in an irreverent deadpan. But while he too has since settled down with a steady partnerâ&#x20AC;&#x201D;his boyfriend, Christopher Adams, relocated from Chapel Hill, N.C., after the two of them met onlineâ&#x20AC;&#x201D;Brynildsen lacks Melendezâ&#x20AC;&#x2122;s enthusiastic lust. For the past four years an almost nonexistent sex drive has left him largely celibate. In the two months since Adams got to town, Brynildsen reports that the two of them have had sex only once. (Adams says it was twice.) â&#x20AC;&#x153;My sex drive just isnâ&#x20AC;&#x2122;t there anymore,â&#x20AC;? Brynildsen says. â&#x20AC;&#x153;It doesnâ&#x20AC;&#x2122;t really faze me anymore. Itâ&#x20AC;&#x2122;s a perk when I do get oďŹ&#x20AC;, but I donâ&#x20AC;&#x2122;t really expect anything.â&#x20AC;? In the early years, he says, fears of rejection and of possibly infecting someone dampened his sex drive. Lately, while his T-cell count and viral load are ďŹ ne since starting on combination therapy a year ago, Brynildsen has had nagging troubles with unexplained nerve damage in his left leg. Not feeling well and walking with a cane have left him depressed. Adams, who is 27, tested positive two years ago. He says he hoped joining a gym and participating in some mental health counseling would help both of them develop a more fruitful sex life. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s slowly coming together,â&#x20AC;? he says. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m trying to come to terms with his form of thinking. And Iâ&#x20AC;&#x2122;m compromising. I could have sex two or three times a day if I wanted to.â&#x20AC;? But that level of optimism isnâ&#x20AC;&#x2122;t necessarily the norm. â&#x20AC;&#x153;Before you move on, you have to acknowledge that an HIV diagnosis is traumatic, and trauma can interfere with a personâ&#x20AC;&#x2122;s sex drive,â&#x20AC;? Drescher says. â&#x20AC;&#x153;You might want to think about whether you have adequately mourned what fantasies or what dreams you had for yourself for the future. If youâ&#x20AC;&#x2122;ve

“If condoms are readily available… sex can be as spontaneous as you want and as dramatic as you want.” done that, then the question is, How would I want to be more sexual? What is it that I want? What is it I imagine my sex life looking like?”

Out of the Game? Annie Elmer, who at age 52 has been seropositive for 20 years, lacks both the sex drive and the interest in compromise. Menopause, she says, ran off with the last remnants of her libido, adding, “If I added a man to my life, I’d have to make closet space for him. And I’m really set in my ways.” David Goldmeier, a researcher at the Jane Wadsworth Sexual Function Clinic at Imperial College London, says Elmer’s point of view is common: “Lots of women find that it’s too much of a hassle, so they don’t actually go into relationships.” All joking aside, Elmer, who lives in Cottage Grove, Minn., says she’d rather not torture herself with the anxieties over dating—when to disclose, whether to disclose, will men like her, etc.—that she feels are best left to youth. She prefers, she says, to seek peace as an independent woman. Her armor, though, eventually reveals a bit of a chink. “There’s a lot of acceptance most of the time in my life,” Elmer says. “But if the right man comes along, I may open my mind and let that spark come back. But right now I’m dormant. It’s really good. [Dating] only got me in trouble because of the emotional roller coaster.” Serovich says this sort of self-preservation is a healthy measure for many: “If they feel like taking care of somebody else is going to be more burdensome than beneficial, then they’re probably making a good choice.” Robert John Weber Jr., a 51-year-old former ballet and Broadway dancer from Wanaque, N.J., has similar instincts that tell him to stay out of a rat race that comes with more baggage than he can handle. Having buried three partners and countless friends—and having survived a quarter century with HIV only to have hepatitis C and Lyme disease tacked on in recent years— he isn’t particularly sure anyone wants to accept his own hefty baggage. “Who could deal with all this shit!” he quips. “So I try to stay away from any expectations in that direction and focus more on just what is going to make my life satisfying.” As for middle-age sexual dysfunction, Weber says he can still “hoist the sails” at will. “When I want to give myself a ‘helping hand,’ there doesn’t seem to be an issue. I will generally watch some porn.” He says he has an enthusiasm for Colt products. Melendez seconds Weber’s outlook—on masturbation, that is. No word on any penchant for a specific genre of porn. “You

RISKY BUSINESS? Fears surrounding sexual acts and their level of safety abound still— almost three decades into the pandemic There are some queries that come up over and over again about what’s OK to do sexually and what’s not. So here’s the latest word on two hot-topic transmission risks: hIs oral sex safe? The question seems as old as Moses: Can HIV be transmitted through oral sex? Specific answers have long eluded researchers, in no small part because any evidence of risk behaviors leading to infection is selfreported and not necessarily reliable. The short answer is that oral sex is a relatively low-risk activity. Estimates on the percentage of HIV cases resulting from oral transmission vary greatly: from lower than 1% incidence, to as high as 7% in one study. Advice to lower the risk, outside of abstaining from oral sex or using a condom, is to avoid swallowing semen and to be careThis shows that ful not to engage with drug resistance is any oral cuts or abrasions. For example, often transmitted don’t brush or floss from person to shortly before or after and allow for healing person, which may time after dental work complicate future or a sore throat. hIs there really a treatment options. superbug? It’s been five years since an overly alarmist New York City health department announcement about a man with an exceptionally aggressive, multidrug-resistant case of HIV set off the “superbug” scare. Fears that increasing numbers of HIVers would soon crop up with untreatable, swiftly lethal strains of the virus proved unfounded. The Centers for Disease Control and Prevention presented new data at this year’s Conference on Retroviruses and Opportunistic Infections in February that indicated 15.6% of the new HIV diagnoses in 2007 were resistant to at least one class of antiretrovirals (2% were resistant to two classes of drugs; less than 1%, to three classes.) This shows that drug resistance is often transmitted from person to person, which may complicate future treatment options. Superinfection, also known as reinfection, in which a second strain of HIV is introduced after initial infection (possibly complicating drug regimens by broadening drug resistance), remains a common fear for many people. While the science has proved that this phenomenon has occurred in some people, it is rare, and it is most likely to occur only in the first year or two after the initial infection. 䊐

LETâ&#x20AC;&#x2122;S TALK ABOUT SEX Donâ&#x20AC;&#x2122;t be shy about it. A talk with your therapist or regular physician can go a long way to solve performance issues If youâ&#x20AC;&#x2122;re suďŹ&#x20AC;ering from some kind of chink in your sexual armor, you may want to consider seeking counsel from a mental health professional, since the problems HIVers may suďŹ&#x20AC;er in the bedroom are often psychologically based. See if your local AIDS service organization can refer you to someone, perhaps at low cost. On the other hand, itâ&#x20AC;&#x2122;s also important to discuss you concerns with your medical doctor to seek or rule out more physical causes. Anthony M. Mills, an HIV physician with a practice in West Hollywood, says heâ&#x20AC;&#x2122;s frequently dismayed that his colleagues across the country arenâ&#x20AC;&#x2122;t bringing up sexual function in the exam room. â&#x20AC;&#x153;I try to have an ongoing dialogue with my patients because it is something that has a life of its of its own,â&#x20AC;? he says of his birds-and-bees talk. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s not like once sexual dysfunction starts itâ&#x20AC;&#x2122;s just all downhill from there. People will go through periods where theyâ&#x20AC;&#x2122;re struggling, and theyâ&#x20AC;&#x2122;ll go through periods when everythingâ&#x20AC;&#x2122;s ďŹ ne.â&#x20AC;? When seeking to solve sexual problems in his patients, he takes a look at some common potential causes: htestosterone levels (â&#x20AC;&#x153;low Tâ&#x20AC;? can aďŹ&#x20AC;ect both womenâ&#x20AC;&#x2122;s and menâ&#x20AC;&#x2122;s libido and sexual functioning), hcardiovascular health, hdiabetes, hside eďŹ&#x20AC;ects from medications for blood pressure and depressionâ&#x20AC;&#x201D;or even antiretrovirals themselves, particularly their impact on erectile dysfunction. Aside from treating these â&#x20AC;&#x153;comorbiditiesâ&#x20AC;? or adjusting medication regimens for more favorable side eďŹ&#x20AC;ects, prescribing ED drugs, like Viagra and Cialis, is always an option, Mills says, at least for men. He counsels his male patients not to believe that erection problems are inevitably going to get progressively worse or that Viagra is an addictive crutch. On the contrary, he says, many men ďŹ nd that a series of successful experiences on an ED drug and the knowledge that the safeguard is in the medicine cabinet just in case can reduce performance anxiety to the point that future erections rise more on command. But do exercise caution. Protease inhibitors can increase the blood levels of erectile dysfunction drugs, such as Viagra or Levitra, also known as PDE5 inhibitors. So the National Institutes of Health advises halving the typical dose to start out. Nonnuke antiretrovirals have the opposite eďŹ&#x20AC;ect and can lower ED drug levels, so dose adjustment may be necessary. Be sure to consult your physician. Also, remember never to mix poppers (amyl nitrates) with Viagra; the combination can cause a dangerousâ&#x20AC;&#x201D;even lethalâ&#x20AC;&#x201D;drop in blood pressure. ä&#x160;?

donâ&#x20AC;&#x2122;t need to have a partner to enjoy sex,â&#x20AC;? she points out. â&#x20AC;&#x153;Thereâ&#x20AC;&#x2122;s the do-it-yourself kind of making loveâ&#x20AC;&#x201D;just to relax and clear your mind. Thatâ&#x20AC;&#x2122;s a good thing. Itâ&#x20AC;&#x2122;s good for me!â&#x20AC;? If her sex drive is ever waning, itâ&#x20AC;&#x2122;s for a particularly mundane reason, she saysâ&#x20AC;&#x201D;like keeping up with small children. But she and her husband work to keep things spicy. â&#x20AC;&#x153;Using toys or playing roles,â&#x20AC;? she explains. â&#x20AC;&#x153;Thatâ&#x20AC;&#x2122;s what kind of got us out of the routine. The more we worked together, the more we felt like we can do more. We always talk. Thatâ&#x20AC;&#x2122;s the main thing. It has been great.â&#x20AC;? Manhattan psychiatrist McDowell encourages HIVers to assert their right to a great sex life. â&#x20AC;&#x153;Sex is so readily available now in a way that it really wasnâ&#x20AC;&#x2122;t, even a decade ago,â&#x20AC;? he says. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s a whole smorgasbord out there of, kind of, whatever you want. Great sex is in your head; itâ&#x20AC;&#x2122;s not the body. So I think that people who allow their HIV status to impede them from having a fulďŹ lling sex lifeâ&#x20AC;&#x201D;itâ&#x20AC;&#x2122;s a tragedy. Because itâ&#x20AC;&#x2122;s not necessary. If they explore it and come up with some decent strategies, they can have a great sex life.â&#x20AC;? What about transmission and how condoms might trip up â&#x20AC;&#x153;the momentâ&#x20AC;?? â&#x20AC;&#x153;When it comes down to it,â&#x20AC;? McDowell says, â&#x20AC;&#x153;the real risk in terms of transmission is receptive anal or vaginal intercourse without a condom. So if you take that out of the picture, almost anything else goes. When everybody gets hung up on how sex canâ&#x20AC;&#x2122;t be spontaneousâ&#x20AC;Ś If condoms are readily available, it can be pretty spontaneous. Every other kind of sex can be as spontaneous as you want and as dramatic as you want.â&#x20AC;?

Fix Whatâ&#x20AC;&#x2122;s Broken Glenn Treisman, director of the AIDS Psychiatry Service at Johns Hopkins Hospital, takes a bit more of a measured approach and encourages HIVers to see any sexual problem they may experience not as an isolated symptom but as an indicator that they may need to take a step back and make more global changes in their lives. â&#x20AC;&#x153;Great sex isnâ&#x20AC;&#x2122;t something that you can just pull out of a Cracker Jack box,â&#x20AC;? he says. â&#x20AC;&#x153;A lot of people come to me with a variety of problems: sexual mistreatment, unreasonable expectations of what the world owes them or should give them, paraphiliias, addictions, and in order to get great sex they have to get that kind of stuďŹ&#x20AC; ďŹ xed ďŹ rst. Itâ&#x20AC;&#x2122;s not just a matter of going to counseling; itâ&#x20AC;&#x2122;s a matter of getting serious about changing the whole course of your life. When the whole course of your life has changed, you can have great sex.â&#x20AC;? Thatâ&#x20AC;&#x2122;s a tall order that Mark King hasnâ&#x20AC;&#x2122;t shied away from, especially when he considers the beneďŹ ts. Today, heâ&#x20AC;&#x2122;s busy rediscovering his own sexualityâ&#x20AC;&#x201D;ďŹ nally growing up in middle age. And how is the sex? â&#x20AC;?Better,â&#x20AC;? he says. â&#x20AC;&#x153;Better and promising,â&#x20AC;? he adds with a laugh. His boyfriend has been patient during the recent times theyâ&#x20AC;&#x2122;ve spent together in preparation for Kingâ&#x20AC;&#x2122;s return to Florida, he says. Once torn with anxiety over how he could enjoy another man without the added charge of methamphetamineâ&#x20AC;&#x201D;and whether sex would trigger him to use drugs againâ&#x20AC;&#x201D;King has been delighted to discover that sexuality can gradually evolve in ways he hadnâ&#x20AC;&#x2122;t even allowed himself to believe. â&#x20AC;?Much to my surprise, itâ&#x20AC;&#x2122;s the emotional component that is the driving force,â&#x20AC;? he says. â&#x20AC;&#x153;And that has never been the driving force before. The driving force was something chemical or it was pure lust. Sex keeps improving as I pull further away from drug addiction, as I relearn things. And you know what? He doesnâ&#x20AC;&#x2122;t mind my ďŹ&#x201A;at butt.â&#x20AC;? í˛&#x2018;

MY LIFE AS A SEX ADDICT One manâ&#x20AC;&#x2122;s journey from the need to have sex all the time to still having a fulďŹ lling sex lifeâ&#x20AC;&#x201D;but with intimacy and monogamy added to the mix B Y B E N J A M I N R YA N

ĂŠgo Luv never had a proper male role model, he says, until he was a teenager and his mother brought home a new boyfriend, whom Luv aďŹ&#x20AC;ectionately called his â&#x20AC;&#x153;play dad.â&#x20AC;? â&#x20AC;&#x153;My play dad told me, â&#x20AC;&#x2DC;Whatever you do in lifeâ&#x20AC;&#x201D;even if youâ&#x20AC;&#x2122;re a dick sucker, as long as youâ&#x20AC;&#x2122;re the best dick suckerâ&#x20AC;&#x201D;Iâ&#x20AC;&#x2122;m proud of you,â&#x20AC;&#x2122; â&#x20AC;? Luv recalls. â&#x20AC;&#x153;That blew my mind. I was 14. I was an honor roll student. I brought home all Aâ&#x20AC;&#x2122;s, maybe one B, and I never got recognized for that.â&#x20AC;? Coincidentally, sexual exploration had already been a part of Luvâ&#x20AC;&#x2122;s home lifeâ&#x20AC;&#x201D;ever since he was a little boy. On roughly a weekly basis starting when he was 5 and continuing into his adolescence, he used to sneak into his parentsâ&#x20AC;&#x2122; bedroom and examine his thenstepfatherâ&#x20AC;&#x2122;s penis while the man was sleeping. â&#x20AC;&#x153;I would look at it, feel it, get aroused,â&#x20AC;? Luv says. â&#x20AC;&#x153;That was very, very exciting to me.â&#x20AC;? Later, in his teen years, his grandmother told him sheâ&#x20AC;&#x2122;d pay half his tuition if he could get into an Ivy League university. But Luv had plans to become a famous entertainer. Furthermore, his grandmotherâ&#x20AC;&#x2122;s encouragement came as a bitter pillâ&#x20AC;&#x201D;she has never accepted that heâ&#x20AC;&#x2122;s gay. â&#x20AC;&#x153;My grandmother recognized me, but for me, it was for the wrong reasons,â&#x20AC;? he says. â&#x20AC;&#x153;I didnâ&#x20AC;&#x2122;t want to be conformed to her way of thinking.â&#x20AC;? So he declined her oďŹ&#x20AC;er and took his play dadâ&#x20AC;&#x2122;s encouragement to heart. At 16, not long after contracting HIV, he enrolled at Michigan State University and signed on with an escort agency to help pay his way. â&#x20AC;&#x153;I was very proud of what I accomplished,â&#x20AC;? he says. â&#x20AC;&#x153;I was at the top of my game as an erotic masseur. All the clients wanted me.â&#x20AC;? So he shared the news of his achievement with his mother. â&#x20AC;&#x153;My mother was very proud of me,â&#x20AC;? he says. â&#x20AC;&#x153;To her, I was succeeding beyond what she could

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even conceive of achieving.â&#x20AC;? But outside of a need for accomplishment and recognition, Luv had another piper to payâ&#x20AC;&#x201D;a sex drive so rampant, he explains, that he couldnâ&#x20AC;&#x2122;t get through the day without multiple sexual encounters. Escorting became not only a source of abundant cash but a practical way to satisfy this insatiable urge. After receiving his bachelorâ&#x20AC;&#x2122;s degree in business at 20 and then training as a nurseâ&#x20AC;&#x2122;s assistant, he ditched nursing and went into the escorting life full-time. Over the course of a decade, he says, he typically had about three johns a day and would also have sex with ongoing partners between appointments. But there was still enough time to work on demos for a singing careerâ&#x20AC;&#x201D;which heâ&#x20AC;&#x2122;s still hoping will pan outâ&#x20AC;&#x201D;and also to dabble in modeling and dancing. In his mind the sexual urge was the equivalent of professional drive and ambition: He believed his prowess was laying the foundation for a glittery career in pornography. â&#x20AC;&#x153;I wanted to go to Las Vegas and win me a â&#x20AC;&#x2DC;Woody,â&#x20AC;&#x2122; â&#x20AC;? he says, referring to a porn-industry award. â&#x20AC;&#x153;I wanted to be so popular that everybody on the street knew what I did.â&#x20AC;? Fame eluded him, though. He bounced from city to cityâ&#x20AC;&#x201D;Miami, Tampa, Atlanta, Detroitâ&#x20AC;&#x201D;in search of contacts in the adultďŹ lm industry, but he was only ever able to perform in a couple of scenes. â&#x20AC;&#x153;I was like, Something has got to give,â&#x20AC;? he says. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m just too good with all these things that nobody wants to hire me.â&#x20AC;? Now 38, Luv lives in New Orleans and gets by on the Social Security beneďŹ ts heâ&#x20AC;&#x2122;s received since suďŹ&#x20AC;ering a stroke eight years ago. Heâ&#x20AC;&#x2122;s had a few relationships over the years, but he says itâ&#x20AC;&#x2122;s been diďŹ&#x192;cult to ďŹ nd anyone who could match his sexual intensity. â&#x20AC;&#x153;I wasnâ&#x20AC;&#x2122;t sure if I could ever ďŹ nd a person who could deal with it,â&#x20AC;? Luv explains. â&#x20AC;&#x153;I would meet people,

and they would say, â&#x20AC;&#x2DC;I have a really high sex drive.â&#x20AC;&#x2122; And I would say, â&#x20AC;&#x2DC;I donâ&#x20AC;&#x2122;t think you do. I donâ&#x20AC;&#x2122;t think you know what a high sex drive is.â&#x20AC;&#x2122;â&#x20AC;? The way he saw it, human contact was a transactionâ&#x20AC;&#x201D;two people with perhaps competing wants and needs come together and either hash out a deal with some compromise or walk away if the sacriďŹ ces are too great. â&#x20AC;&#x153;I couldnâ&#x20AC;&#x2122;t ďŹ nd someone whoâ&#x20AC;&#x201D;when I said, â&#x20AC;&#x2DC;I want someâ&#x20AC;&#x2122;â&#x20AC;&#x201D;would give me what I want,â&#x20AC;? he says. â&#x20AC;&#x153;And I wanted consistency. If we start oďŹ&#x20AC; doing it three times a day, letâ&#x20AC;&#x2122;s stay consistent.â&#x20AC;? Luv continues, â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;ve never had a â&#x20AC;&#x2DC;dateâ&#x20AC;&#x2122; in my life. If it did not have sex in it, I didnâ&#x20AC;&#x2122;t do it.â&#x20AC;? But he laments, â&#x20AC;&#x153;I wanted to know what it felt like to have somebody just take me out on a date or just go to the movies and just go our separate ways.â&#x20AC;? One boyfriend tried to crack Luvâ&#x20AC;&#x2122;s stoic exterior by demanding to see him cry. â&#x20AC;&#x153;I donâ&#x20AC;&#x2122;t cry for anybody,â&#x20AC;? Luv says. â&#x20AC;&#x153;I wonâ&#x20AC;&#x2122;t even cry at funerals. Iâ&#x20AC;&#x2122;m not willing to give you that just to prove to you that I care about you.â&#x20AC;? The two promptly split up. He eventually took up with a new man, and the two of them enjoyed steady sex at Luvâ&#x20AC;&#x2122;s desired fever pitch, often with other men in the mix. Until one day his partner declined his demand for sex. Luv was enraged. His boyfriend wasnâ&#x20AC;&#x2122;t holding up his end of the bargain, he felt. Luv says he considered breaking oďŹ&#x20AC; the relationship. Instead, he was able to take a step outside himself and recognize how his sex drive was blinding him to reasonâ&#x20AC;&#x201D; and possibly spoiling a good thing. He says, â&#x20AC;&#x153;I was like, Iâ&#x20AC;&#x2122;ve got to ďŹ nd a way of curbing this appetite.â&#x20AC;? He and his boyfriend went to a couple meetings of Sex Addicts Anonymous, which he saw as â&#x20AC;&#x153;asinineâ&#x20AC;? gripe sessions. Nevertheless, he began to identify as a sex addict.

ISTOCKPHOTO

The concept of sex addiction is controversial within psychiatric circles. Some argue that borrowing the terminology of alcohol or drug abuse is inďŹ&#x201A;ammatory and a misuse of the concept of addiction. â&#x20AC;&#x153;But certainly the fact of the matter is that there are people out there struggling to integrate their sexual needs into otherwise productive, successful, and responsible lifestyles,â&#x20AC;? says Fred Berlin, an associate professor of psychiatry at Johns Hopkins University and an expert on sexual disorders. â&#x20AC;&#x153;They may need help either because theyâ&#x20AC;&#x2122;re personally distressed by the behavior or by the kind of temptations that they are succumbing to. Or like a severe alcoholic, theyâ&#x20AC;&#x2122;re just not ableâ&#x20AC;&#x201D;despite the dictates of their conscience and intellectâ&#x20AC;&#x201D; to bring their behavior under control without some sort of professional assistance.â&#x20AC;? Luv says he eventually was able to make the adjustments he felt he needed to in order to change his life without professional helpâ&#x20AC;&#x201D; but not entirely on his own. â&#x20AC;&#x153;I found that I wanted something more substantial,â&#x20AC;? he says. â&#x20AC;&#x153;I wanted to be intimate with one person. Multiple partners was great, but it gets old after a while.â&#x20AC;? While doing volunteer work at the New Orleans AIDS Task Force, he met his current boyfriend, whom he gushingly calls his â&#x20AC;&#x153;sexy man.â&#x20AC;? So far, the two are having a monogamous relationship and sexâ&#x20AC;&#x201D;cut back to what Luv considers a more reasonable three times a weekâ&#x20AC;&#x201D;that he describes as â&#x20AC;&#x153;wonderful, phenomenal.â&#x20AC;? â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s the emotional side that Iâ&#x20AC;&#x2122;ve come to realize does exist in me,â&#x20AC;? he says. â&#x20AC;&#x153;That I can actually leave everything else alone and focus on one individual.â&#x20AC;? And while transactional language still coats his description of love and commitment, heâ&#x20AC;&#x2122;s made progress toward balance. â&#x20AC;&#x153;I have to give,â&#x20AC;? he says, â&#x20AC;&#x153;as much as I get.â&#x20AC;? í˛&#x2018;

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T RE ATME N T

RE SE ARC H

N EW S

HAART BEATS

Global Cataclysm? Resistant strains of HIV promise a greater worldwide public nightmare than anyone might have ever imagined

SAUL GRAVY/PHOTOGRAPHERâ&#x20AC;&#x2122;S CHOICE/GE T T Y IMAGES

ew research suggests that many of the drug-resistant strains of HIV that have evolved over the past decade in San Francisco are more transmissible than had been thought. And experts predict that within the next ďŹ ve years these strains are likely to cause a new wave of virus thatâ&#x20AC;&#x2122;s highly resistant to medications, potentially proving disastrous by hindering control of the pandemic. In a study published January 14 on the website of the journal Science, researchers from the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, and the University of California, San Franciscoâ&#x20AC;&#x2122;s HIV AIDS Program at San Francisco General Hospital developed a mathematical model that tracks the transmission of multiple strains of HIV. The model can be used to predict drug resistance in any setting where individuals are treated for HIV infection. While in this case it was applied to San Francisco, the researchers found that the drug-resistant strains emerging in that city are also very likely to emerge in many African countries where treatment is just beginning. â&#x20AC;&#x153;This isnâ&#x20AC;&#x2122;t just about San Francisco,â&#x20AC;? says senior author Sally Blower, director of UCLAâ&#x20AC;&#x2122;s Center for Biomedical Modeling and a member of the UCLA AIDS Institute. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s basically about many other com-

munities in resource-rich countries and has signiďŹ cant implications for global health. San Francisco is like the canary in the mine. In fact, the most signiďŹ cant implications of our work are for countries where treatment is just being rolled out.â&#x20AC;? â&#x20AC;&#x153;What is very unsettling,â&#x20AC;? Blower continues, â&#x20AC;&#x153;is that our modeling shows that the current strategy for HIV elimination that is being proposed by the World Health Organization could inadvertently make things worse and signiďŹ cantly increase levels of drug resistance in many African countries.â&#x20AC;? The researchers studied the evolution of drug-resistant strains over the past 20 years and predicted their spread over the next ďŹ ve years, according to Robert Smith, who was a postdoctoral fellow in Blowerâ&#x20AC;&#x2122;s lab when the research was conducted. Surprisingly, he says, their analysis showed that HIV was becoming more than simply stronger in its resistance to medications. â&#x20AC;&#x153;What was very disturbing was we found that some of the drug-resistant strains were increasing,â&#x20AC;? says Smith, now an assistant professor in the department of mathematics and statistics at the University of Ottawa. The model was able to explain this increase, according to Justin T. Okano, also a research associate in Blowerâ&#x20AC;&#x2122;s group. â&#x20AC;&#x153;What is going on in San Francisco is very complicated, but in a nutshell,â&#x20AC;? he elaborates, â&#x20AC;&#x153;it is due to the bug, the drugs, and sex.â&#x20AC;?

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HIV PLUS

HAART BEATS

MEDICINE

Removing a Path for HIV

WELLNESS

Researchers at the University of California, Los Angeles, AIDS Institute have successfully removed CCR5, a receptor on CD4 cells to which HIV binds for infection but which the human body does not need, from human cells. Individuals who naturally lack the CCR5 receptor have been found to be essentially resistant to HIV. Using a humanized mouse model, the researchers transplanted a small RNA molecule known as short hairpin RNA, which induced RNA interference into human blood stem cells to inhibit the expression of CCR5 in human immune cells. The ďŹ ndings, reported in the journal Blood, provide evidence that this strategy can be an eďŹ&#x20AC;ective way to treat HIV-infected individuals by prompting long-term and stable reduction of CCR5.

Elite Controllers With the failure to ďŹ nd a vaccine to either prevent or just help control HIV, scientists are busy looking for novel ways to approach the issue Dan Bowers, MD

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gressors. Even though this â&#x20AC;&#x153;antiviralâ&#x20AC;? factor defies identification despite years of research, CD8 cells remain a primary research focus. The Pasteur Institute has reported that HIV-specific CD8 cells from elite controllers have a unique activation marker called HLA-DR, which enables effective HIV suppression upon first contact with HIV. This bypasses the usual mechanism of infection control by CD8s that first requires CD4s to be infected, which then triggers the CD8 response. In other words, the CD 8 cells are able to attack HIV even before it finds its natural host: a CD4 cell. Recently in the journal Immunity, the National Institute of Allergy and Infectious Diseases reported that another part of our defense system, the natural killer cells, worked better in elite controllers, destroying 68% of HIV-infected cells per hour versus 8% in people whoâ&#x20AC;&#x2122;d with AIDS. Then in February of this year a team from Barcelona reported that the dendritic cells in those patients who immediately control HIV secrete higher levels of an antimicrobial peptide that has potent anti-HIV activity. This may be important because dendritic cells sit on our mucous membranes and are therefore the very first cells that confront HIV after exposure. As these studies demonstrate, there are many avenues to exploreâ&#x20AC;&#x201D; even using the Human Genome Project to study the DNA of elite controllers. If you are an elite controller or want more answers, visit us online at HIVPLUSmag.com.

BROKEN HEARTS CLUB? Young to middle-aged men with long-standing HIV infection are signiďŹ cantly more likely to have coronary atherosclerotic plaques than uninfected men, according to a new study. Researchers at Massachusetts General Hospital examined 110 men (78 HIV-positive, 32 HIVnegative) between the ages of 18 and 55 who had few traditional cardiovascular risk factors. All were asymptomatic for cardiovascular disease. The vast majority of HIVers were receiving antiretroviral therapy. â&#x20AC;&#x153;We were particularly surprised to ďŹ nd that several of the HIV patientsâ&#x20AC;&#x201D;none of whom had symptoms of heart diseaseâ&#x20AC;&#x201D;had obstructive coronary artery disease, which was found in none of the controls,â&#x20AC;? says Janet Lo, MD. â&#x20AC;&#x153;It appears that both traditional and nontraditional risk factors are contributing to atherosclerotic disease in HIV-infected patients.â&#x20AC;? While a CT scan can identify calcium deposits in coronary arteries, CT angiography can also detect noncalciďŹ ed arterial plaques; both tests were used in the study. Among those with HIV, the scans showed coronary calcium that might be expected, based on past studies, in men who were six years older. Angiography found atherosclerosis in 59% of the HIVers, compared with 34% of the HIV-negative men. Five of the men with HIV had critical coronary stenosis, or a 70% or greater restriction, while none of the uninfected men did. â&#x20AC;?Our ďŹ ndings highlight the need to address reduction of cardiac risk factors early in the course of HIV disease,â&#x20AC;? Lo says, â&#x20AC;&#x153;and for caregivers to consider that even asymptomatic patients with long-standing HIV disease and minimal cardiac risk factors may have signiďŹ cant coronary artery disease.â&#x20AC;?

PHOTOS.COM

There is one avenue starting to create some interest for researchers around the potential for an HIV vaccineâ&#x20AC;&#x201D; the ongoing studies of elite controllers, those people whose viral load remains below 50 without ever taking antiretrovirals. In 2006, Bruce Walker, MD, of Harvard Medical School initiated the International HIV Controllers Study with the goal of identifying at least 1,000 elite controllers from around the world to uncover what mechanism in their immune system is responsible for complete viral control. A new report on approximately 4,500 HIVers receiving care at U.S. military hospitals has indicated that 0.55% of them were elite controllers. Since there are about 1 million HIV-infected people in the United States, there should be about 5,000 elite controllers. To date, about 500 have agreed to participate in the study, and there are over 400 researchers and physicians in 200 centers around the world who are collaborating with the U.S. group. The researchers started out by looking to see if elite controllers were simply infected with a defective virus, since HIV is a sloppy replicator and makes lots of bad copies. But the vast majority of elite controllers have a virus that replicates perfectly fine. One clue goes back to 1986, when Jay Levy, a researcher at the University of California, San Francisco, noted that HIV-infected CD4 cells donâ&#x20AC;&#x2122;t reproduce HIV in the presence of CD8 cells (also called T-suppressor cells, or cytotoxic lymphocytes) from long-term nonpro-

PHOTOS.COM

Controlling Herpes Doesn’t Stop HIV Transmission Re s e arch f rom a f ive- ye ar international clinical study has shown that acyclovir, a drug commonly prescribed to suppress symptoms of the herpes virus, does not affect HIV transmission by people with both viruses. The results of the Partners in Prevention HSV/HIV Transmission Study were published in The New England Journal of Medicine in February. The largest risk group worldwide, but particularly in Africa and Asia, for contracting HIV is stable, heterosexual couples where only one partner is infected. Among those infected, about 90% also have herpes simplex virus-2, the most common cause of genital herpes, according to study coauthor Kenneth H. Fife, MD, Ph.D., a professor of medicine in the division of infectious diseases at the Indiana University School of Medicine.

”Logic indicated that outbreaks of HSV-2 sores could enhance the transmission of HIV,” Fife says. “This is the first comprehensive study to look at the potential for reducing the transmission of HIV through treatment of the herpes virus.” Multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. It is known that HIV is shed through genital herpes ulcers, and people with those ulcers transmit HIV to others more efficiently. The study found that acyclovir reduced the occurrence of HSV-2 genital ulcers by 73% and thus the amount of HIV present in the blood and genital tract decreased twofold. Despite the reduction of HIV present in blood levels, the researchers found there was no significant difference in the transmission of HIV.

Back Where We Started? HIV infection rates among high-risk groups such as gay men, drug users, and sex workers are on the rise around the world, according to a United Nations study. Michel Sidibé, executive director of the Joint United Nations Programme on HIV/AIDS, says the increase could be due to worsening discrimination against these groups in certain countries. In the United States, for example, despite laws that are more tolerant of homosexuality, more than half of all new HIV infections in 2009 occurred among gay men, which Sidibé calls “sho c k ing.” In the United States, he says, “it seems like we have come full circle,” and not in a good way. Contrary to what many perceive, Sidibé adds, HIV is not going away. These increases in HIV rates nationally and globally demand a renewed focus on how governments and organizations worldwide can battle this pandemic.

B Y

CO RE Y

SAUCIE R

PERFECTLY FLAWED

BAD ASS

LOUNGEPARK/THE IMAGE BANK/GE T T Y IMAGES

With a sore bottom, a foggy head, and an open heart, Saucier gives postoperative advice on love and survival today i popped a vicodin, said a prayer, spoke to my mother, kissed my boyfriend, and thanked my bestest best friend for being the bestest friend a best friend could ever have! Needless to say, Iâ&#x20AC;&#x2122;m feeling pretty darn pleased with myself. Right now this very second, I feel content, happy, and loved; connected, cared for, blessed, and heard. Today when I look at myself in the mirror I see myself clearly. There is no obfuscation, no distraction, and no internal dialogue discouraging me from the truth. As I string the sequence of the past 10 years together, I can be only proud of what Iâ&#x20AC;&#x2122;ve achieved and the grace with which Iâ&#x20AC;&#x2122;ve managed to survive. Yesterday I had surgery on my bottom (hence the Vicodin). Two months ago I was hospitalized with an infection that almost took me out. Last year I was on a diďŹ&#x192;cult and tedious treatment for hepatitis C. Four years before that I was an intravenous-drug user homelessly roaming the Internet looking for my next ďŹ x and the next boy to ďŹ x it. And if we jump back a full 10 years, we ďŹ nd a young, skinny, scared, green-eyed black boy going up the stairs to an HIV testing center to get his result. And when they pulled me into

a diďŹ&#x20AC;erent room from everyone elseâ&#x20AC;&#x2122;s, I knew that my life had suddenly taken a drastically different turn from everyone elseâ&#x20AC;&#x2122;s. My life had instantly become badass! HIV has shown me the strength of my mettle, the quality of stuďŹ&#x20AC; Iâ&#x20AC;&#x2122;m made of, and all the beauty that I possess. And to be honest, I surprised myself! There is no weakness here, there is no â&#x20AC;&#x153;woe is me,â&#x20AC;? and thereâ&#x20AC;&#x2122;s no sad story, because in case you didnâ&#x20AC;&#x2122;t notice, Iâ&#x20AC;&#x2122;m a fucking badass! I donâ&#x20AC;&#x2122;t scare easily. I donâ&#x20AC;&#x2122;t break under pressure. Iâ&#x20AC;&#x2122;m more compassionate than I ever thought I could be. Iâ&#x20AC;&#x2122;m as intimately connected to God as any one person should be. I laugh louder than anyone in the room. I look past the superďŹ cial and grasp tightly to the deeper things. I value and respect the relationships that I fosterâ&#x20AC;&#x201D;and demand that others oďŹ&#x20AC;er the same. Every single one of my days is owned by meâ&#x20AC;&#x201D;and me alone. Love is my only weakness. And even when Iâ&#x20AC;&#x2122;m cut my blood gives me a deadly radioactive superpower. Now, tell me thatâ&#x20AC;&#x2122;s not badass! I was going to write about relationships because Iâ&#x20AC;&#x2122;m dating again, and Iâ&#x20AC;&#x2122;m in that ridiculously silly phase. That phase where the other person is all you can think about, and everything he or she

says sounds brilliant, and you just want to share it with the world and make everyone sick with all your gushing and hand-holding and obnoxiously loud kissing. But when I thought about all the stuďŹ&#x20AC; Iâ&#x20AC;&#x2122;ve gone through in the past yearâ&#x20AC;&#x201D;and the people who have been there for me (and with me) throughout it and how brave, compassionate, and beautiful they wereâ&#x20AC;&#x201D;I changed my mind. I realized how easy it would have been for them to shut down, break down, and run away. But they didnâ&#x20AC;&#x2122;t. And thatâ&#x20AC;&#x2122;s what counts when it counts. So here are my 2 cents: We are badasses, and we should only make room for other badasses! Because everyone else is just a waste of time. So thank you, Mom; thank you, Javier; and thank you, Michael! Iâ&#x20AC;&#x2122;ve always known I was a badassâ&#x20AC;&#x201D; but thankfully so are you!

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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HIV PLUS

ASK & TELL

let the sobering news keep him from pursuing a lifelong dream: to enter and win a Dallas leatherman competition. That win ultimately propelled 42-yearold Payne to the top of the competition circuit in May 2009 when he was crowned International Mr. Leather. Now, at the end of his yearlong reign, Payne reďŹ&#x201A;ects on what itâ&#x20AC;&#x2122;s like to publicly be the ultimate leatherman and simultaneously try to shatter HIV stigmaâ&#x20AC;&#x201D;at appearances in more than 30 cities across ďŹ ve continents. â&#x20AC;&#x201D;Bob Adams

tips+tools To learn more about Payneâ&#x20AC;&#x2122;s travels and the next International Mr. Leather competition, coming up over the Memorial Day weekend, visit us at HIVPLUSmag.com

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W I TH

J E F F R E Y

PAY NE

What drove you to compete for the IML title and the contests leading up to it? I entered for personal and commu-

nity reasons. The personal reasons were to test my own limits and comfort zone. The community reasons were to give a larger voice to issues I feel are important and to be the voice of a community that I absolutely love and care for. Were you open about your HIV status during competition? I was very

open about it. In fact, during the speech portion at the IML contest, I spoke about being HIV-positive. I wanted to let others know that it was my local communityâ&#x20AC;&#x201D; the Dallas leather communityâ&#x20AC;&#x201D;that helped me through the emotional roller coaster when I found out I was positive. My community didnâ&#x20AC;&#x2122;t shun me or avoid me but quite the opposite; it embraced me more than ever and helped me. As the IML titleholder, youâ&#x20AC;&#x2122;ve participated in nearly 50 public events. Did you speak about HIV at those?

I do use the title as a springboard to being vocal about HIV issues. To a certain degree, there is still a stigma attached to HIV-positive people, and being given the chance to speak about HIV gives me the opportunity to hopefully lessen that stigma. Some folks like to keep blinders on and avoid the topic, so we need to keep pushing to ensure that everyone has frank and honest discussions. Even among gay men, thereâ&#x20AC;&#x2122;s often a divide between HIV-negative and HIV-positive people. Does that exist in the leather community? To an extent, I would say a divide exists; however, it

So whatâ&#x20AC;&#x2122;s been the crowd reaction in general to your candidness about your life with HIV? Itâ&#x20AC;&#x2122;s been terrific! In

is one that is shrinking. More people are being open about the subject and are developing a growing understand about HIV. However, broadening HIV awareness shouldnâ&#x20AC;&#x2122;t be limited to the leather community. It should be happening everywhere. We seem to have reached this era of complacency concerning HIV, where some people are under the belief that contracting the virus is not such a bad thing. Thatâ&#x20AC;&#x2122;s bullshit!

fact, at one conference where I gave a speech about being HIVpositive, one of the MCs also came out of the â&#x20AC;&#x153;HIV closetâ&#x20AC;? and said heâ&#x20AC;&#x2122;d been positive for eight years but never felt comfortable telling anyone before. I know that if I continue to share my journey, others like him may draw strength and be able to free themselves of those invisible chains that HIV has wrapped around them.

â&#x20AC;&#x153;We seem to have reached this era of complacency concerning HIV where some people are under the belief that contracting the virus is not such a bad thing. Thatâ&#x20AC;&#x2122;s bullshit!â&#x20AC;?

BRE T T VANDER PHOTOGRAPHY

When Jeffrey Payne learned he was HIV-positive in 2008, he didnâ&#x20AC;&#x2122;t

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