HIV Plus Magazine #77 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

increased life expectancy long-acting meds

reverse lipodystrophy

test & treat reservoir purge

WHAT DOES THE

FUTURE HOLD? Experts weigh in on the treatment advances that we could see in the decade ahead

ANNUAL

HEROIN CHIC? An illicit drug source could be harboring a cure

T EA TREA TR ATM T EN ENT T

UPDATE

JULY/AUGUST 2010 www.hivplusmag.com

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

R E A D U S O N L I N E E V E RY DAY WWW.HIVPLUSMAG.COM

As much as you love reading about the people and events going on in the world in HIV Plus, our companion website at HIVPLUSmag.com has plenty of extras to keep you going and well-informed between issues.

HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10960 Wilshire Blvd., Suite 1050, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2010 by Here Publishing Inc. All rights reserved. Printed in the USA.

YOUR DAILY DOSE Check in with us every day for news you can use to help live your life to the fullest. Our updates include reports on promising meds and research, social and cultural happenings, dispatches on the global battle, and so much more.

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HAVE A VOICE Our online polls give you a chance to weigh in on issues that are near and dear to your hearts. And if you feel passionate enough about a topic and want to tell more of your story, you can take the opportunity to contact us.

NEED SOME ADVICE? Our contributing editors include physicians, therapists, and ﬁtness and nutrition experts—all who have years of experience in working with HIVers—and they each have columns that are available exclusively online.

OUR MISSION At HIV Plus we are dedicated to helping our readers lead their fullest life possible by providing the tips, tools, and personal stories that motivate them to make the best of their friendships and relationships, work and leisure time, treatment, and overall sense of health and wellness. By helping our readers seek out their most rewarding and fulﬁlling experiences and to improve their outlook in everything that they do—to live their lives above and beyond being HIV-positive— they get the wholistic eﬀect of our Health + Spirit + Culture + Life focus.

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Do you have an interesting story about yourself or someone you know that you want to share? You might be a candidate for a proﬁle in one of our departments or another section of the magazine. We want to hear from you, and we want to know what you’ve been up to. So e-mail us at mail@hivplusmag.com, or write us at HIV Plus, 10960 Wilshire Blvd., Suite 1050, Los Angeles, CA 90024. We’ll even take faxes at (310) 806-6350. EDITORIAL SUBMISSIONS We would like to hear your thoughts about HIV-related issues. Submissions should be approximately 300 words in length, become the property of HIV Plus, and will be edited for length, style, and grammar. Acceptance is completely up to the discretion of the editors. Return postage must accompany all unsolicited manuscripts and photographs if they are to be returned; no responsibility can be assumed by HIV Plus for unsolicited material. All rights in letters or manuscripts sent to HIV Plus will be treated as unconditionally assigned to HIV Plus for publication and copyright purposes. REPRINT PERMISSIONS To make requests to reprint articles, contact us by fax at (310) 806-6350 or by e-mail at mail@hivplusmag. com with the author’s name and information on the article’s title, cover date, and page numbers from the issue in which it appeared. Also provide detailed information about the publication in which you wish to reprint, the context in which you wish to use the article, and when it is expected to be published.

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INSIDE J U LY / AU G U ST 2 0 1 0 | I S S U E 7 7

FEATURES

30 2010 AND BEYOND As we approach the 30th anniversary of the onslaught of the AIDS pandemic, research has so far given us 30 meds to ﬁght the virus. But other than one option for one-pill, oncea-day dosing—a formulation that is a few years old now—the arsenal to combat HIV hasn’t changed much. But the coming decade could change that. We spoke with experts with various backgrounds in research, treatment, and advocacy and asked them to go out on a limb to paint a portrait of what advancements in treatment they believe could be coming to us by 2020.

DEPARTMENTS & VOICES 10 STATUS SYMBOLS A new study reveals that counseling services about HIV and sexually transmitted diseases are inadequate for teen guys. Plus: Advice and news for living your life to the fullest.

13 Mind+Manner

16 H-EYE-V Eyewitnesses deliver events from around the globe in living color.

42 HAART BEATS A derivative of the opium poppy could very well hold the secret for keeping HIV in control. Plus: Lots more treatment news and insight.

44 Medicine+Wellness 45 Rx+Research

46 PERFECTLY FLAWED

Even when everything returns to “normal,” columnist Corey Saucier is ﬁlled with reminders that life for HIVers never really ﬁts that label.

48 ASK & TELL Lisa Dukes is teaching women about life with HIV through a fairly innovative—yet familiar—method.

ON THE COVER

The future of HIV treatment by DrGrounds/27 Pixels Media/IStockphoto

J U LY/A U G U S T 2 0 1 0 H I V P L U S

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

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

I have HIV.

I am cherished.

Models used for illustrative purposes only.

Models for illustrative purposes only.with other LEXIVAused is indicated in combination antiretroviral agents for the treatment of HIV infection. • The PI-experienced–patient study was not large enough to reach a deﬁnitive conclusion that LEXIVA/ritonavir and lopinavir/ritonavir are clinically equivalent • Once-daily administration of LEXIVA plus ritonavir is not recommended for PI-experienced patients or any pediatric patients LEXIVA does not cure HIV or prevent passing HIV to others. Please see Important Patient Information below and on the following page. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch, or call 1-800-FDA-1088. IMPORTANT SAFETY INFORMATION • You should not take LEXIVA if you have had an allergic reaction to LEXIVA or AGENERASE® (amprenavir).

• High blood sugar, diabetes or worsening of diabetes, and bleeding in hemophiliacs have occurred in some patients taking protease inhibitors. • 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 a er starting your HIV medicines, be sure to tell your doctor. • Changes in body fat may occur in some patients taking antiretroviral therapy. The cause and long-term health effects of these conditions are not known at this time. • Skin rashes can occur in patients taking LEXIVA. Rarely, rashes were severe or life threatening. • Opportunistic infections can develop when you have HIV and your immune system is weak. It is very important that you see your healthcare provider regularly while you are taking LEXIVA to discuss any side effects or concerns. • Kidney stones have been reported in patients taking LEXIVA. Tell your healthcare provider if you have pain in your side, blood in your urine, or pain when you urinate. • Most common side effects in clinical studies were diarrhea, headache, nausea, rash, and vomiting. In most cases, these side effects did not cause people to stop taking their medicine.

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

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

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

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

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STATUS SYMBOLS I N T E L F O R B E T T E R L I V I N G

WHAT THEY DON’T KNOW… A new study says that counseling for HIV and sexually transmitted diseases is inadequate for teen men

PLUSH STUDIOS/PHOTODISC/GE T T Y IMAGES

ESPITE

N AT I O N A L

guidelines aimed at improving sexualhealth services for teenagers, most sexually active young men—even those who report high-risk sexual behaviors—still get too little counseling about HIV and other sexually transmitted diseases during their visits to the doctor, according to a study led by researchers at Johns Hopkins Children’s Center. The study, published in the Journal of Adolescent Health, analyzed data from the 1995 National Survey of Adolescent Males and the 2002 National Survey of Family Growth and found that only 26% of teens who reported highrisk behaviors—such as having sex with a prostitute or an HIVinfected person or having sex while high or drunk—said they received HIV or STD counseling at their doctor’s oﬃce in the year preceding the survey. Only 21% of all sexually active young men— regardless of risk level—said they discussed HIV and other STIs with their doctors. The study also found no improvement in how well teenage males were screened for STDs and HIV between 1995 and 2002, even though in the early 1990s the American Medical Association and the American Academy of

Pediatrics both issued guidelines urging physicians to make sexualhealth counseling and related services part of the regular exam for teenagers. The researchers who worked on the study say their findings signal the need for better counseling of young male patients in order to minimize risky behaviors. “If guidelines alone can’t change what is being done at the doctor’s office, then the million-dollar question becomes how to get doctors and nurses to talk with their patients about sexual health,” says lead investigator Arik Marcell, MD, MPH, a pediatrician and adolescent medicine specialist at Johns Hopkins Children’s Center. Marcell and his colleagues say the first step to better counseling is the use of evidence-based, uniform guidelines to reduce confusion among providers. And, they say, it is critical to understand what prevents providers from counseling and devise ways to eliminate any such barriers. In the meantime, Marcell advises, pediatricians on the front lines should think of the acronym ACT—for ask, counsel, and test—when counseling young men about their sexual health. “Ask the patient if he is sexually active, counsel him about risk, and test accordingly,” he says.

Other Study Highlights hIn 1995 less than one fourth of teen men said they had discussed HIV and other STDs with a doctor or a nurse, compared to less than 22% in 2002.

hIn 2002 less than 18% of young men reported ever discussing birth control with their doctors. The 1995 survey did not include birth control questions. J U LY/A U G U S T 2 0 1 0 H I V P L U S

A QUIT-SMOKING SHOT? In an unusual twist to a decadesold health crisis, Michigan State University researchers are testing a new vaccine to help people quit smoking as well as avoid relapses. Using a vaccine—as opposed to patches or gums, which attempt to wean people oﬀ nicotine—is a novel approach to the addiction that results in more than $192 billion in health care costs each year, according to federal estimates. The vaccine, called NicVAX, is being developed and manufactured by Nabi Biopharmaceuticals of Rockville, Md. It will be tested at 25 sites nationwide.

Jonathan Henry, an associate professor with MSU’s department of psychiatry and the Clinical and Translational Sciences Institute, who is leading the clinical trial, says, “Using a vaccine to treat nicotine dependence is one of the most unique approaches to battling addiction. We are very hopeful this strategy will help smokers kick the habit.” The vaccine works by preventing a smoker from “feeling good” while smoking. When nicotine enters the bloodstream it triggers the release of stimulants, such as dopamine, that provide the smoker with a positive sensation,

eventually leading to addiction. NicVAX stimulates the immune system to produce antibodies that bind with nicotine and keep it from crossing the blood-brain barrier, therefore preventing the highly addictive pleasure sensation that smokers experience.

YES, IT’S AN EMERGENCY!

THE “WHAT’S WRONG WITH ME?” BLUES Because people with depression often don’t recognize that they have a problem—or they’re unable to describe their distress—many do not seek treatment, according to a study published in May in the Journal of General Internal Medicine. About a quarter of those with major depression are undiagnosed, according to several other studies, and less than half receive treatment. To improve recognition and treatment of depression, Ronald M. Epstein, MD, a professor of family medicine and psychiatry at the University of Rochester Medical Center, says that primary care physicians should do three things: (1) help their patients name their distress, (2) provide explanations for the depression that conform to patients’ experiences, and (3) reduce blame and stigma.

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Many study participants reported to researchers that they didn’t know something was wrong, sometimes for years. Some who described themselves as “always dark,” “introspective,” and “always in a bad mood” had been so acclimated to being “gloomy,” researchers explain, that it was difﬁcult for them to appreciate what they were experiencing. The researchers conclude, “Physicians, families, friends, and the media can prompt people who have depressive symptoms to seek care by adopting a multifaceted understanding of the experience of depression from the patient’s perspective—and helping them ﬁnd the words to bring their experiences and concerns to the attention of their physician.”

A National Center for Health Statistics study has found that of the one in ﬁve Americans who visit an emergency room every year, most have health insurance. Researchers on the study say their results help dispel the myth that ERs are ﬁlled with people who don’t have health insurance or who are illegal immigrants. It also helps to counter the assumption, they add, that people are using ERs for routine care— since only 10% of visits were for nonemergency causes.

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MANNER

Damaged Goods? Are you feeling like you aren’t measuring up to what it takes to experience life fully? It’s time to reevaluate your value

SUMMER ISN’T SO CAREFREE A Red Cross survey has shown that 68% of Americans have been involved in some kind of summer emergency, ranging from insect bites, heat stroke, and broken bones to more life-threatening situations. One in every four people say they have been in a situation where someone needed cardio-pulmonary resuscitation. The survey of more than 1,000 adults has found that Americans say they are most comfortable giving CPR to family members, friends, and coworkers, but less than half were likely to perform such lifesaving efforts on a stranger. The survey also revealed that physical appearance was a signiﬁcant factor when people are deciding whether to perform CPR on a stranger, and men with a disheveled or sloppy appearance were the least likely to receive assistance, with only half of respondents saying they would very likely try to give them CPR. The survey found that Americans plan to be very active

this summer, with more than 40% saying they will go hiking or camping and almost 75% planning to go swimming. While people expect to be active, the Red Cross found that many were not confident that they knew what to do in an emergency. Less than two thirds felt confident about helping a heat-stroke victim, and less than half could help someone with an allergic reaction to an insect or snake bite. Previous Red Cross research has found that nearly 90% of Americans say they want to be prepared for an emergency, but they don’t know where to start or what to do. “With so many people outdoors camping, hiking, and swimming, it’s important that someone in every household get trained in CPR and first aid skills,” says Connie Harvey, a health and safety expert for the American Red Cross. “Learning these lifesaving skills is easier and more convenient than you might think.”

PHOTOS.COM

CHEW, CHEW...ACHOO? Percentage of Americans who actually have food allergies—compared to the 30% who believe they have them, according to a study commissioned by the National Institute of Allergy and Infectious Diseases. The primary reason that so many people believe they have such an allergy? The unreliability of the skin test that’s most commonly used by doctors for diagnosis.

When the third client in a week referred to herself as “damaged goods,” I had to ask whether this was some kind of a trend or maybe just that the summer was bringing heat, humidity—and thoughts of love. A client who I’ll call Jenn said it best: “I really want to meet someone and start a relationship, but I have to ask myself if being HIV-positive doesn’t make me damaged goods in the eyes of the guys who might be interested in dating me.” I won’t pretend that disclosing your HIV status—and the potential of rejection—isn’t a real issue. But if you’re looking to fall in love, thinking of yourself as the last choice isn’t exactly putting your best foot forward. hWhose team are you on? Talking to yourself day in and day out about how bleak your chances are of ﬁnding the right person is self-defeating. Decide now to build yourself up, not tear yourself down. hTrade up the little picture for a bigger one. Being HIV-positive doesn’t mean you are a walking medical diagnosis. You are still a human being with a multitude of talents, interests, qualities, hopes for the future, and yes, a few interesting quirks. Look at yourself with a wide-angle lens that includes everything that you bring to a relationship. hAnd while you’re at it, look for a new picture frame. Is your self-talk something like, “Sure, I could be a great partner, but…”? That’s like putting a masterpiece in a frame you picked up at the junkyard. Maybe it’s time to do some active reframing. Kick the “but,” so to speak, and use self-talk that goes something like, “I have a lot to give, and I’m ready to share myself with someone who’s ready to share himself with me.”

Gary McClain, Ph.D.

hDon’t read minds without a license. Romantic chemistry is always a mystery. You are always going to ﬁnd some people who are naturally attracted to you and others who aren’t. When you run into somebody who isn’t, don’t assume you know why and then beat up on yourself. After all, you know—when you assume something—what it makes out of you and me. Smile and keep circulating. hGather your posse around you. Life isn’t all about being in that one special relationship. While it’s hard not to think about what you want, don’t forget to appreciate what you have. Be a friend to the people you care about; be open and generous, and enjoy the love you already have in your life.

When you run into somebody who isn’t [attracted to you], don’t assume you know why and then beat up on yourself. hTake your eye off the ball. Sometimes what we are looking for pops up when we ﬁnally stop looking so hard. Be yourself, enjoy your life, follow your passion. You might discover that when you’re simply enjoying your life for what it is—without the agenda of having to ﬁnd that one true love—you are so interesting and attractive that all kinds of opportunities to meet new friends and, who knows, perhaps potential love interests, will present themselves. Get out and enjoy the world around you. Life is beautiful. And so are you!

McClain welcomes e-mail at Gary@JustGotDiagnosed.com

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POSITIVE RHYTHMS For their ﬁfth studio album, Fire Away, the globe-hopping Latin band Ozomatli found unexpected inspiration in Africa. Percussion on opening track “Are You Ready?” is provided by gumboot dancers that the band recorded at a South African orphanage for HIV-positive children. “We’re fairly open-minded musicians,” says Ozo’s Wil-Dog. “With our travels comes picking up CDs on the street. And we get to hear all kinds of sounds from all over the world. We’ve always been a band that emulates different sounds. There’s always somebody saying ‘Oh, I have an idea. Why don’t we make it sound like...’ whatever. It could be James Brown or salsa or…some hip-hop beat.” Still, the 15-year-old group’s sound remains distinctly rooted in its home base of Los Angeles—a mash-up of Latin rhythms with hip-hop, funk, rock, and ska plus whatever they happen across in their travels through the U.S. State Department’s “cultural ambassadors” program. Under the taxpayer-funded program, the band has traveled since 2007 to Nepal, Jordan, Vietnam, and other countries to represent the United States and connect with people who rarely see Americans in person.

LOUGANIS BACK TO HIS ROOTS Greg Louganis says he’s ready to help U.S. divers regain the Olympic podium, so the fourtime Olympic gold medalist made his debut as a mentor to up-and-coming Americans at the USA Diving Grand Prix in May. His involvement comes nearly 22 years after he defended his gold medals in three-meter springboard and 10-meter platform at the 1988 Seoul Games, where he also cracked open his head on the springboard on a dive, causing him to bleed in the Olympic pool. The incident eventually led him to announce that he is HIV-positive. “To be invited back to a mentoring program and to help bring back the fun into diving is great,” Louganis says. “Our goal is just to get somebody back on the podium,” he adds, referring to the United States’ failure to win a medal in the sport since the 2000

Sydney Games. Ron O’Brien, who coached Louganis when he was an Olympic champion, says he’s thrilled that USA Diving is beginning to take advantage of Louganis’s wealth of knowledge: “I was kind of sorry that didn’t happen right after he retired. He still has great name recognition and there’s a lot of things he can do to promote the sport. I’m sure he can teach those kids a lot of tricks of the trade.” Initially, Louganis says, he felt the young divers were intimidated by his legendary stature. But he said he was quickly able to dispel their nervousness around him: “The kids have been great. A lot of what we’ve been talking about has been totally undiving related. I broke down those perceived barriers of intimidation toward me. I said, ‘You know what; I’m just a guy.’ ”

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WOMEN NEED JOBS TOO Gender matters when it comes to predicting employment status for HIVers, according to results of a 2001–2004 Spanish study published in the journal Health Economics. “The probability of HIV-positive individuals participating in the labor market varies signiﬁcantly depending on gender, type of transmission, health, and level of education,” says Juan Oliva, main author of the study and a researcher at the University of Castilla–La Mancha. “Gender is a statistically signiﬁcant variable when predicting employment status,” Oliva says. “In this sense, women are 13.4% less likely than men to be in employment.” But psychological factors are also a trackable variable, he adds. “People who need psycho-

logical treatment to overcome the impact of discovering they are infected see their chances of employment diminish,” Oliva says. According to the study, this probability decreases by 14% when people require this type of treatment. Oliva’s study also found that hwhen the infection is transmitted through the use of injectable drugs, individuals have a signiﬁcantly lower probability of being employed than people who are infected in other ways, ha person with a strong immune system is 25% more likely to be employed, and hpatients recently diagnosed HIV-positive (in the 12 months prior to the survey) were 11.2% more likely to work than patients who were diagnosed earlier.

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U.S. SHIFTS ITS DRUG POLICY

PREGNANCY IS HARD ON MEN While numerous studies have shown that pregnant women are at increased risk of acquiring HIV from an infected partner, a new study has found that pregnancy is a time when men are also at greater risk—double the risk, in fact—for infection. Presented at the International Microbicides Conference in May, the Partners in Prevention HSV/HIV Transmission Study, which involved 3,321 couples in which one partner was HIV-infected and the other not, is the ﬁrst to show that a man in a relationship with an HIVpositive woman has a greater chance of becoming infected while she is pregnant than when she is not. Even after accounting for behavioral and other factors that usually contribute to HIV risk, the increased risk associated with pregnancy remained. Biological changes that occur during pregnancy, researchers theorize, may make women more infectious than they would be otherwise.

PHOTOS.COM

61%

23%

Four decades after President Richard Nixon declared a “war on drugs,” the White House announced in mid May a shift in national drug policy that would treat illegal drug use more as a public-health issue and plunge more resources into prevention and treatment. The new drug-control strategy boosts community-based antidrug programs, encourages health care providers to screen for drug problems before addiction sets in, and expands treatment beyond specialty centers to mainstream health care facilities. President Obama called the plan a “balanced approach to confronting the complex challenge of drug use and its consequences.” His drug-policy setter, Gil Kerlikowske, was more blunt: “Calling it a war really limits your resources. Looking at this as both a public-safety problem and a publichealth problem seems to make a lot more sense.” The plan—the ﬁrst drug strategy unveiled by the Obama White House—calls for reducing the rate of youth drug use by 15% over the next ﬁve years and for similar reductions in chronic drug use, drug abuse deaths, and drugged driving. Kerlikowske criticized past strategies for measuring success by counting the number

of kids and teens who have not tried marijuana. “Quite often,” he says, “the marijuana issue was front and center in almost all of the discussion, and yet we have seen significant increase in drug overdose deaths mainly driven by prescription drugs.” The new plan encourages health care professionals to ask patients questions about drug use even during routine treatment so that early intervention is possible. It also helps more states set up databases to identify doctors who are overprescribing addictive painkillers. “Putting treatment into the primary health care discussion is critical,” Kerlikowske explains. The policy shift comes in the wake of several other drug-policy reforms since Obama took office. The president signed a measure repealing a two-decade-old ban on the use of federal money for needle-exchange programs to reduce the spread of HIV. His administration also said it won’t target medicinal marijuana patients or caregivers as long as they comply with state laws and aren’t fronts for drug traffickers. Earlier this year Obama called on Congress to eliminate the disparity in sentencing that punishes crack crimes more severely than those involving powder cocaine.

WHAT MEN DO BUT WOMEN DON’T Just 23% of New York City women who had anal sex with men in the past year reported always using condoms, according to a city Department of Health and Mental Hygiene report. Among men who have sex with men, 61% reported always using a condom during anal sex.

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H-EYE-V GRAIN OF TRUTH Members of the Aadhar Mahila Seva Trust prepare traditional dishes for their stall at a food festival in Ahmadabad, India. The trust helps establish small-scale businesses that will create jobs for HIVers.

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WHAT A DRAG RACE Drag queens dash down around Sydney’s Royal Randwick horse-racing course on Pink Stiletto Day. Touted by organizers as the “world’s inaugural gay, lesbian, bisexual, and transgender race day,” the February 26 events were established to raise funds for the Bobby Goldsmith Foundation, an HIV charity.

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H-EYE-V

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WARE, O WARE

FOOD (PAGE 16) BY SAM PANTHAKY/AFP/GE T T Y IMAGES; RACE (PAGE 18) BY REUTERS/TIM WIMBORNE; ART WORK (THIS PAGE) BY MICHELLY RALL/WIRE IMAGE/GE T T Y IMAGES

Beadwork created by members of a South African HIVer group from the Hillcrest AIDS Center Trust goes on display at the Design Indaba global creativity expo, held in February in Cape Town. The group, Woza Moya, provides the artisans with supplies and access to venues to be able to sell their crafts.

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MARCH (THIS PAGE) BY RAVEENDRAN/AFP/GE T T Y IMAGES; GALA (PAGE 22) BY JOE KLAMAR/AFP/GE T T Y IMAGES; PROTESTER (PAGE 24) BY CHRIS HONDROS/GE T T Y IMAGES

H-EYE-V

LEFT WITHOUT RIGHTS HIVers rally in New Delhi on May 4 against the termination of 1,000 outreach workers. The protesters wanted to bring attention to their belief in the rights of all Indian citizens to access essential medicines and to demand government jobs.

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FACE A CHALLENGE Life Ball, one of the largest annual HIV charity events worldwide, will kick off July 17 in Vienna ahead of the XVIII International AIDS Conference, which will run July 18â&#x20AC;&#x201C;23 in the Austrian capital. In keeping with Viennese ball tradition, attendees don elaborate costumes and masks, and the gala draws celebs, politicians, and fashionistas from across the globe. In July 2012 the biennial AIDS conference will return to American soil-after a 22-year absence resulting from a U.S. ban on HIV-positive visitors, which the Obama administration ended this year--when it is held in Washington, D.C.

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PHOTOS.COM

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H-EYE-V

DISSENT ALOUD An activist shouts as he is arrested by New York City police on May 13 after chaining himself to other demonstrators and blocking Fifth Avenue near a hotel where President Obama was attending a fundraising dinner. The protest was sparked by Administration changes to federal AIDS-funding policies.

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HIV Plus takes a look at forthcoming new meds—and novel ways that treatment could advance—over the coming decade B Y B E N J A M I N R YA N

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MAGINE IF YOU COULD chuck your daily supply of anti-HIV meds and replace them with a monthly transfusion at your physician’s office or, if possible, even a single shot that you give yourself. A small but determined group of biotech companies are researching new therapies that would last in the body for weeks or longer. TaiMed Biologics and Progenics Pharmaceuticals, for example, are each looking into drugs known as monoclonal antibodies; these have already revolutionized cancer treatment and have made some chemotherapy far more tolerable when it comes to possible side effects. TaiMed’s agent is an antibody that blocks HIV’s attachment to the CD4 coreceptors. It is made by injecting mice with those same coreceptors, harvesting the natural antibodies the mice produces as a reaction, and then altering the DNA of those antibodies so that they are 99% human. Infused into an HIV patient, these antibodies, it’s theorized, could last up to a month. Progenics is in clinical trials of PRO 140, a monoclonal antibody that blocks the CCR5 coreceptor. Study results published this year indicated that once-weekly and every-otherweek subcutaneous injections of the antibody both suppressed viral loads significantly, and patients could potentially administer the injections themselves. PRO 140 has received fast-track designation from the Food and Drug Administration. Tibotec Pharmaceuticals, the antiviral division of Johnson & Johnson, is attempting to produce a long-acting version of one of its upcoming nonnukes, currently referred to as TMC278. The medication is processed to create a mixture of tiny particles of TMC278 with a liquid to create a solution called a nanosuspension. When injected into the body this solution works to extend the release of medication over the course of weeks. Another compound, EFdA, a nucleoside reverse transcriptase inhibitor being developed in academic and National Institutes of Health labs, meanwhile, has shown itself to be extremely powerful in both test-tube and primate studies. “This new compound is 60,000 times more potent than any other drug that is currently being used to treat HIV,” says Stefan Sarafianos, an assistant professor of microbiology and immunology at the University of Missouri school of medicine. “This compound has a different chemical makeup than other approved therapies and creates an exceptional amount of antiviral activity. It’s activated very quickly and stays long in

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the body to fight the virus and protect from infection.” Curiously, the EFdA compound was discovered by a soy sauce manufacturer in Japan that was developing it as a flavor enhancer. The company’s product tests eventually found it had antiviral capabilities. With a half-life of three weeks, EFdA could be taken less often than currently available options. It also has shown potential for use in a microbicide. But there’s a major question yet to be addressed: Can researchers develop enough of these long-lasting medications to piece together a viable full cocktail? After all, currently successful combination therapies contain at least three compounds—whether in the form of three drugs taken together or combo pills taken with one or more additional meds— since each attacks HIV in different points of the infection cycle. That’s not to say, though, that they won’t have their benefit. “I see these long-acting drugs as a potential answer to adherence problems,” says Jeffrey Jacobson, the cochair of the long-acting drug task force for the AIDS Clinical Trials Group. With this type of treatment breakthrough possibly becoming available in the next few years, HIV Plus decided to check in with experts to see what other advancements they think could be in store for HIVers over the decade ahead. And of course, we’re looking at the current traditional treatments that are working their way through clinical research.

Can researchers develop enough of these long-lasting medications to piece together a viable full cocktail? After all, currently successful combination therapies contain at least three compounds.

PIPELINE PROGRESS While drugmakers have produced 30 individual or combination antiretrovirals since 1987 (28 of which are still on the market) the federal Food and Drug Administration hasn’t approved any new medications since the nonnucleoside analog Intelence (etravirine) in 2008. Although output from the new-drug pipeline has slowed, manufacturers are still looking for medications that have fewer side effects, are better at fighting resistance, and reduce pill burden. Companies are racing to develop a once-a-day combo pill for treatment-naive HIVers that is as effective or more effective than Atripla but that has fewer side effects, providing an alternative for people who are troubled in particular by Atripla’s tendency to cause vivid dreams—a side effect attributed to its Sustiva (efavirenz) component. But even though there has been no new antiretroviral released to the market for almost two years, there are a dozen or so anti-HIV candidates currently in advanced clinical studies (Phase II and III). If they make it through these stages, at least six compounds could be submitted for Food and Drug Administration approval in the next few years. hBevirimat, a maturation inhibitor being developed by Panacos and purchased by Myriad Genetics, showed mixed results in Phase IIb trials in 2007, working in only 60% of HIVers studied because of mutations in their respective viral populations.

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hElvitegravir is an integrase inhibitor being developed by Gllead; it’s in Phase III. hGSK-572 is an integrase inhibitor being developed by ViiV Healthcare, the combined antiretroviral development units of GlaxoSmithKline and Pfizer. Promising results from its Phase IIa trials were released in July 2009. If ultimately successful, this med could become an alternative to Atripla when combined in a daily dose with Ziagen (abacavir) and Epivir (3TC). Although there is an effective screening test to rule out those who would not tolerate the drug, the allergic reaction some HIVers have to Ziagen remains a barrier. hThe “Quad” is a once-a-day combo pill from Gilead that combines forthcoming integrase inhibitor elvitegravir, Truvada (Viread and Emtriva), and a new boosting agent that researchers hope will be bettertolerated than Norvir (ritonavir). Currently being studied in treatmentnaive patients, with good results in Phase II trials, it could also become an alternative to Atripla. hRilpivirine (TMC278) is a second-generation nonnucleoside analog from Tibotec that entered Phase III trials in April 2008; study completion is expected in January. If successful, the new nonnuke may challenge Atripla if studies show it is as potent when combined in a single pill with Truvada. hVicriviroc is a CCR5 antagonist, being developed by Merck, that did not show promise for treatmentexperienced HIVers; but Phase II/III studies are ongoing for people who have not previously been on treatment. A previous CCR5 inhibitor, Selzentry (maraviroc), was approved in 2007. While none of these specific drugs promises to revolutionize treatment, over the coming decade, experts and pharmaceutical representatives say they anticipate even more combination pills will hit the market—and not just formulations aimed mostly at treatment-naive HIVers. Otherwise, there are many other scientific endeavors still in their infancy that could one day drastically change how HIV is treated and possibly even lead to a cure. We may not see such total ground shift by the end of the decade, but there should at least be a better idea of where we’re headed by then.

those last remaining HIV cells from the body. “Ten years from now I think we’ll have made progress toward eradication,” says Steven Deeks, an HIV researcher at the University of California, San Francisco. “I don’t think anyone will have been cured. Hopefully by that time we’ll be actively involved in clinical trials to try and cure HIV.” David Margolis, a professor of medicine, microbiology, and immunology at the University of North Carolina at Chapel Hill’s school of medicine, whose research lab has been studying viral reservoirs for the past decade, says, “Progress has been very exciting in the past year or two because more groups are seriously looking at these questions of [whether it is] possible to eradicate infection or to treat someone in such a way that they don’t have to be on chronic suppressive therapy.” The reservoir can mean different things to different scientists. In part, it is made up of resting memory T cells, which for some reason will stop replicating the virus and go into a kind of extended hibernation. During this time, antiretrovirals do not recognize that these T cells are infected with HIV. The challenge for researchers like Margolis is to provoke these cells to express the virus again. “You could imagine a cure pack— where you get diagnosed, and you go on antiretrovirals for six months to knock down your viral load to zero,” says Bob Huff, a member of the Drug Development Committee at the AIDS Treatment Activists Coalition. “Then you take another series of pills to express all the residual HIV. Next, you stop that and follow up with a few more months of [antiretrovirals], and then you stop and see if it ever comes back or not. That counts as a revolution. That would be awesome.” There may be an additional type of cell—or more than one—that quietly harbors HIV, but researchers have yet to figure out this mystery. Also, HIV may hide from antiretrovirals in tissues that are inaccessible to the medications, such as the testes, brain, or lymph tissues. AmfAR, the Foundation for AIDS Research, which prides itself on adopting maverick causes, has now put its weight behind cure research, making the cause the cornerstone of its research program with an initial $1.2 million round of funding. Rowena Johnston, vice president of research at amfAR, says that a “functional cure,” in which a person still has HIV in the body but is able to control the infection without the use of ongoing drug therapy, could come from better understanding what are known as “elite controllers,” the rare HIV-positive people who are somehow able to produce this effect on their own, without the aid of treatment. Koronis Pharmaceuticals, a biotech company in Redmond, Wash., is working on a therapy that randomly inserts genetic errors into HIV’s

Experts and pharmaceutical representatives say they anticipate even more combination pills will hit the market—and not just formulations aimed mostly at treatmentnaive HIVers.

CURE RESEARCH Long gone are the days when scientists believed extended suppression of HIV through highly active antiretroviral therapy could permanently eradicate the virus from the body. Elusive viral reservoirs continue to harbor small amounts of HIV and evade medications. Now, as newdrug development slows and researchers look to the next big thing, some of the more enterprising among them are trying to better understand these reservoirs—what they are and how they manage to remain mostly untouched by treatment—in order to one day perhaps purge

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UPDATE DNA as it replicates itself. If successful, this treatment, currently in Phase II clinical trials, would eventually lead to a “viral collapse,” in which the entire HIV population is so riddled with errors that it is no longer able to infect new cells or pass from person to person. Jeff Parkins, vice president of clinical development at Koronis, says that as the reservoir turns over with time, the end result of the therapy could be a cure. Unfortunately, he adds, it’s anybody’s guess as to how long this would take. Ask one scientist the life cycle of the reservoir and he’ll say six months. Ask another: six years. And even another: 60 years. Other hope for the so-called functional cure comes from the many labs currently researching genetic therapies that would train the body to better fight off HIV. After harvesting a patient’s T cells or stem cells that produce T cells, scientists are inserting genes that, for example, lack the expression for the CCR5 coreceptor that most HIV cells need in order to latch onto the T cells. They then return the cells to the body and hope that these HIV-resistant T cells will flourish and become the dominant aspect of the immune system. A major consideration of this line of therapy is the price tag—since the process, still in its infancy, costs tens of thousands of dollars. However, if it were needed only twice a year, the savings in comparison to daily medications could tip the balance in its favor.

STOPPING TRANSMISSION Science has advanced at a snail’s pace in finding medications—topical microbicides or oral preexposure prophylaxis—that can prevent HIV transmission. Early studies of microbicides have informed further research, but they have so far failed to prove the agents can be effective. Ian McGowan, a principal investigator of the Microbicide Trials Network, says the next few years will be sink or swim for microbicide research. If current studies show promise, a product may reach the market within 10 years, he predicts. Otherwise, all research will likely close up shop for good. “By 2020 we may have a toolbox,” McGowan says. “It may have pills in it; it may have gels. Depending on people’s circumstances, they may use one or the other, or they may use both.” A big conundrum with both microbicide and PrEP research is in developing a proper dosing schedule for a product that is both convenient and effective to use in advance of unpredictable sexual encounters. Antiretroviral agents may take up to 12 hours to activate after they’re either ingested in pill form or placed in the vagina or rectum in a microbicide gel. One potential answer is the investigatory nucleoside analog EFdA, whose form mimics human cells, so it is recognized by the immune system and activated in only 15 minutes. Because it is so potent, it also lasts much longer than other antiretroviral agents. Research is currently deducing whether administering a daily oral antiretroviral to high-risk HIV-negative populations can curb transmission. Assuming this method is effective, further studies will look to see if occasional doses—a “disco pill,” in McGowan’s words—are also effective. At that point, cost will become a major consideration. Will insurers pay? Will certain high-risk populations be willing to spend the money for such precautions? With luck, a successful drug would go off patent by 2020, allowing for cheaper generic versions and more widespread use. Another option, however, is an occasional infusion of a long-acting HIV therapy, such as the potential nano formulation of Tibotec’s TMC278 compound, which the company is hoping will work as PrEP.

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UPDATE In theory, the drug would last long enough once applied to provide protection for a month.

TEST AND TREAT While the jury is still out, recent signs indicate that scientists are beginning to move toward a greater consensus that starting antiretroviral treatment earlier now outweighs the risks of long-term therapy. The San Francisco department of health has made “test and treat”—getting HIV patients on therapy as soon as possible after diagnosis—its recommended policy. Even if T-cell counts remain at healthy levels for years, it seems that untreated HIV still harms the body, leading to a higher risk of conditions down the line, like heart disease, cancer, and kidney failure. A University of Washington study published in The New England Journal of Medicine in 2009 found a significant survival benefit for people who began treatment when their T-cell counts were still above 500. And also in 2009 the first randomized, controlled trial to compare the risks and benefits of earlier versus delayed treatment, the National Institutes of Health’s START study, began. The results of the study, expected by 2015, should finally provide a definitive answer to this long-running mystery. Additional research going on around the world will hopefully prove whether widespread antiretroviral treatment, by lowering overall “community viral load,” can in turn reduce infection rates.

The goal of research on this matter is twofold: First, to understand why HIVers have a higher incidence of age-related illnesses. And second, if inflammation is indeed a major source of the problem, to find some sort of anti-inflammatory agent that can tone down the body’s overreaction to the low levels of virus.

AT-HOME MONITORING Keith Alcorn of London-based AIDS organization NAM predicts that by 2020 HIVers will be able to monitor their own viral load and CD4cell levels at home and then report back electronically to their physician. This will mean fewer doctor visits and move the self-management of HIV closer to that of diabetes patients checking their glucose levels. He also says aﬀordable at-home rapid antibody tests should be widely available. Unfortunately, though, the “window period,” when someone is infected with the virus but hasn’t yet developed the antibodies that will lead to a positive test, will remain a problem. People testing themselves within this approximately six-week time frame won’t be able to get a completely accurate read from a home viral-load test either, Alcorn believes, since those tests have a wide margin of error when detecting low levels of the virus.

HIVers will be able to monitor their own viral load and CD4cell levels at home and then report back electronically to their physician. This will mean fewer doctor visits and [some] selfmanagment of HIV.

AGING ISSUES By the middle of the decade half of all HIVers will be older than 50. As the population grays, research is putting its muscle behind trying to understand why HIV infection seems to lead to accelerated aging in long-term survivors. The research is particularly critical considering that, among the deaths in today’s older HIVers, one third are due to non–AIDS-related causes. A major culprit under study is what’s known as immune inflammation, which has been shown to contribute to aging in non-HIVers. When any virus enters the body the immune system releases inflammatory cytokine cells. In the case of an ordinary flu, for example, these cells would help clear the body of the illness in a relatively brief period of time and would then retreat. However, in HIV patients this inflammation seems to last indefinitely and can cause major damage to other human cells. Antiretrovirals don’t stop this effect because the body maintains its inflammatory response to the low levels of virus still replicating in reservoirs. The consequence is an elevated risk of many potentially fatal conditions associated with advanced age, including heart disease, osteoporosis, diabetes, muscle wasting, liver damage, and Alzheimer’s.

NORMAL LIFE EXPECTANCY Brian Risley, a treatment educator at AIDS Project Los Angeles, predicts that HIVers will eventually have a normal life expectancy, thanks to improved treatments and better understanding of when to begin antiretroviral therapy. He points to a recent European study that found “near normal” survival for HIVers who kept their T-cell count above 500 for three years or more.

REVERSING LIPODYSTROPHY There are few options for permanently reversing the effects of lipodystrophy—the redistribution of fat throughout the body that is a side effect of some anti-HIV medications—outside of expensive, temporary facial fillers. The FDA is on the verge of approving a drug called tesamorelin, which has been shown to cut deep belly fat deposits—a.k.a. “Crix belly”—by an average of 18%. APLA’s Risley sees a time not far off when scientists will better understand the causes of lipodystrophy and can then reverse the condition through the use of statin and glucoseregulating drugs.

HEALTH CARE REFORM Today, three in 10 HIVers are uninsured. Forty-ﬁve percent have an income of less than $10,000, and 62% are unemployed. More than half

J U LY/A U G U S T 2 0 1 0 H I V P L U S

ANNUAL

TREATMENT

UPDATE receive health coverage through Medicaid or Medicare. Considering this portrait of the population, the passage of health care reform promises big changes for HIVers as the legislation is rolled out between now and its full implementation in 2014. Robert Greenwald, director of the Health Law and Policy Clinic at Harvard Law School, applauds the bill. â&#x20AC;&#x153;While I certainly have some concerns and disappointments,â&#x20AC;? he says, â&#x20AC;&#x153;there is no question that this health care reform bill represents a signiďŹ cant step forward in meeting the care and treatment needs of many, many people living with HIV.â&#x20AC;? Some of the major beneďŹ ts this year: hThe infamous medication â&#x20AC;&#x153;doughnut holeâ&#x20AC;? gap, during which beneďŹ ciaries have to pay out of pocket for prescriptions under the Medicare Part D prescription drug beneďŹ t, will phase out by 2020. Starting this year, the government will provide a $250 rebate. In 2011 brand name drugs will be 50% oďŹ&#x20AC;, but their full price will still count toward the total doughnut-hole expenditures, potentially cutting out-of-pocket costs in half. AIDS Drug Assistance Program coverage will also count toward the doughnut hole. hTemporary high-risk insurance pools will provide health insurance to people who have been shut out of coverage because of preexisting conditions for six months or longer. hIf you are 26 or under, you can still qualify for coverage under your parentsâ&#x20AC;&#x2122; health plan. hNew insurance policies must provide coverage for annual checkups and preventive care, like cancer screenings. hLifetime beneďŹ t caps will end. Some of the major beneďŹ ts by 2014: hAll Americans must obtain insurance coverage. hAnyone with an income of 133% or less of the federal poverty level will qualify for Medicaid (currently $14,403 for an individual or $29,326 for a family of four). A disability diagnosis (an AIDS diagnosis counts as one; an HIV diagnosis doesnâ&#x20AC;&#x2122;t) will no longer be necessary. hUnderwriting and preexisting condition exclusions will end; insurers may not reject you or charge you a higher premium based on your health status. hGovernment subsidies will help with premium costs for people with incomes up to four times the federal poverty level ($43,320 for an individual or $88,200 for a family of four). hPlans will have to provide coverage for mental-health and substanceabuse treatment. hInsurance exchanges will pool risk, allowing for more aďŹ&#x20AC;ordable individual or small-business health policies. This will reduce the likelihood of workplace discrimination based on HIV status if an employer is concerned an HIVerâ&#x20AC;&#x2122;s medical bills may drive up premiums. hHIVers will have more ďŹ&#x201A;exibility in where they live and how they work, since the availability and aďŹ&#x20AC;ordability of health beneďŹ ts will no longer depend entirely on an employerâ&#x20AC;&#x2122;s beneďŹ ts package or a certain stateâ&#x20AC;&#x2122;s public-assistance budget. However, there is a major drawback to health reform plan. By 2019, there will still likely be 23 million uninsured Americans, one third of whom will be undocumented immigrants. The rest will likely be members of hard-to-reach populationsâ&#x20AC;&#x201D;for example, the homelessâ&#x20AC;&#x201D;who have not gotten themselves into the system. Depending on the political climate as the decade unfolds, the undocumented population may ďŹ nd itself increasingly squeezed out even from Ryan White Act sources of medical funding. í˛&#x2018;

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HAART BEATS T R E AT M E N T A N D R E S E A R C H N E W S

BEAUTY AND THE BEAST Could a heroin-like product developed from the poppy ﬂower hold clues for a new protective agent against HIV?

TIM GAINEY/GAP PHOTOS/GE T T Y IMAGES

N E W ST U D Y H A S R E V E A L E D

that morphine, a derivative of the opium poppy that is similar to heroin, protects rat neurons against HIV toxicity—a finding that researchers say could help in the design of new therapies for patients who are infected with the virus. The discovery, presented at the annual meeting of the Society of NeuroImmune Pharmacology, also helps explain why a subset of people who are heroin abusers and become infected with HIV through needle sharing don’t develop HIV-related brain dementia. This brain disorder includes cognitive and motor abnormalities, anxiety, and depression. “We believe that morphine may be neuroprotective in a subset of people infected with HIV,” says the study’s lead investigator, Italo Mocchetti, Ph.D., a professor of neuroscience at Georgetown University Medical Center. “That is not to say that people should use heroin to protect themselves—that makes no medical sense at all—but our findings give us ideas about designing drugs that could be of benefit.” The researchers initiated the study because they knew that a number of HIVpositive people are also heroin abusers, and because of that, these people are at high risk of developing neurological complications from the infection. Others, however, never develop these cognitive problems, Mocchetti says. “Needless to say,” he adds, “we were very surprised at the findings. We started with the opposite hypothesis—that heroin was going to destroy neurons in the

brain and lead to [HIV-related] dementia.” Because little is known about the molecular mechanisms linking opiates and neurotoxicity caused by HIV in humans, Mocchetti and his team conducted experiments in rats. They found that in the brain, morphine inhibited the toxic property of the HIV protein gp120, which mediates the infection of immune cells. With further investigation, they concluded that morphine induces production of the protein CCL5, which they discovered is released by brain cells. CCL5 is known to activate factors that suppress HIV infection of human immune cells. “[We knew this protein is] important in blood, but we didn’t know it is secreted in the brain,” Mocchetti says. “Our hypothesis is that it is in the brain to prevent neurons from dying.” Mocchetti and his team members say morphine blocked HIV from binding to CCR5 receptors on CD4 cells—a method it typically uses to enter and infect these immune-system protectors. The researchers believe CCL5 itself attached to those receptors, preventing the virus from using it. In this way it prevented HIV-associated dementia. Th is eﬀect, however, worked only in the M-trophic strain of HIV, the strain that most people are ﬁrst infected with. It did not work with the second, T-trophic strain that often infects patients later. “Ideally,” Mocchetti says, “we can use this information to develop a morphinelike compound that does not have the typical dependency and tolerance issues that morphine has.

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MEDICINE

DID SMALLPOX’S DEMISE LEAD TO HIV’S RISE?

WELLNESS

The Quad Another all-in-one, oncea-day pill is advancing through clinical trial stages—and is so far showing promising results Dan Bowers, MD

When drugmakers Gilead and BristolMyers Squibb agreed to collaborate to create a three-drugs-in-one pill, Atripla was born. The holy grail of treating HIV with just one pill a day soon became a treatment of choice when starting patients on their ﬁrst anti-HIV regimen. However, Atripla was not for everyone. Some patients could not tolerate the side effects of the efavirenz component, which gave some patients sleep problems, like uncomfortably vivid dreams or daytime drowsiness. Other patients were already resistant to efavirenz, since in some populations over 10% of transmitted HIV carries the efavirenz resistance mutation. Now it looks like the next all-in-one pill is on the way. Researchers presented data in February at the annual Conference on Retroviruses and Opportunistic Infections on a combination drug containing tenofovir plus emtricitabine (Truvada) combined with elvitegravir (a new integrase inhibitor) and cobicistat (a booster)—since nicknamed the Quad. Note that this pill contains an integrase inhibitor instead of a nonnucleoside reverse transcriptase inhibitor, like efavirenz, so it will work when there is resistance. [Learn more about current treatment research in our cover story, on page 30.] These drugs are all made by Gilead, which licensed elvitegravir from a Japanese company in 2005 for further development. Gilead then discovered that elvitegravir needed to be boosted with ritonavir to achieve effective blood levels, just like most protease inhibitors. So Gilead created cobicistat, which blocks a metabolic enzyme pathway in the liver similar to ritonavir. The CROI presentation was a Phase

II trial comparing the Quad to Atripla in treatment-naive patients. The study showed that 90% of the Quad patients and 83% of the Atripla patients achieved viral loads below 50 at the 24-week point. This difference was not statistically significant. The study size of only 71 patients did not allow for formal efficacy comparisons, but the Quad did statistically meet the criteria for noninferiority. There were no significant differences in side effects between the two groups, other than the specific side effects of efavirenz mentioned above. Larger, Phase III trials are now just beginning. In an interesting and logical move, Gilead ran a parallel study comparing cobicistat to ritonavir as boosters in a standard combination of Reyataz plus Truvada. At 24 weeks 84% of patients on cobicistat had undetectable viral loads compared to 86% for those on ritonavir. Researchers had hoped that cobicistat might be better tolerated than ritonavir, but there were no significant differences in side effects, specifically nausea or diarrhea, or changes in blood lipids. Finally, researchers in the two studies had some concern that cobicistat might reduce kidney function, since the drug seemed to cause a small increase in creatinine. Further kidney clearance studies have shown, fortunately, that the kidney function remains intact, and the creatinine elevations are caused by cobicistat slightly slowing creatinine excretion by the kidney without impairment of total kidney function. It was a bright new day when the first all-in-one pill came out. It will be an even brighter day when I can tell my patients that we have a second option.

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Researchers have found that the process of vaccinia—immunization with live virus, as given to prevent the spread of smallpox— produces a ﬁvefold reduction in HIV replication in laboratory testing. Writing in the journal BMC Immunology, they suggest that the end of smallpox vaccination in the mid 20th century may have caused a loss of protection that contributed to the rapid contemporary spread of HIV. George Mason University scientist Raymond Weinstein, working with a team of researchers from George Washington University and the University of California, Los Angeles, looked at the ability of white blood cells taken from people who’d been recently immunized with vaccinia to support HIV replication compared to unvaccinated controls. They found signiﬁcantly lower viral replication in blood cells from vaccinated individuals. “There have been several proposed explanations for the rapid spread of HIV in Africa,” Weinstein says, “including wars, the reuse of unsterilized needles, and the contamination of early batches of polio vaccine. However, all of these have been either

disproved or do not sufficiently explain the behavior of the HIV pandemic. Our finding that prior immunization with vaccinia virus may provide an individual with some degree of protection to subsequent HIV infection suggests that the withdrawal of such vaccination may be a partial explanation.” Smallpox immunization was gradually withdrawn from the 1950s to the 1970s following the worldwide eradication of the disease, and HIV has been spreading exponentially since approximately the same time period. Weinstein and his colleagues propose that vaccination may confer protection against HIV by producing long-term alterations in the immune system, possibly including the expression of a certain receptor, CCR5, on the surface of a person’s white blood cells that is exploited by both viruses. “While these results are very interesting and hopefully may lead to a new weapon against the HIV pandemic,” Weinstein cautions, “they are very preliminary, and it is far too soon to recommend the general use of vaccinia immunization for fighting HIV.”

HAART BEATS ATS T ADDED ALCOHOL DANGER

A MOTHER’S PROTECTIVE POUCH By using medications packaged just like fast-food ketchup, HIV-positive mothers in developing countries could potentially more easily provide protection to newborn babies born at home. Biomedical engineers at Duke University have developed an inexpensive and easy-touse system that allows mothers to give their newborns a potentially lifesaving dose of an anti-HIV medication shortly after birth. This is especially important since such drugs can be found only in clinics or hospitals, which can be days away from an expectant mother. In order to be eﬀective, the antiretroviral nevirapine must be given to the newborn within days of birth. The challenge has been reaching mothers who give birth at home in isolated areas. Since most mothers are not up to traveling that soon after delivery to get medication, biomedical engineers have developed a way of providing the medication

Gilead Sciences has announced that it has dosed the ﬁrst patient in the Phase III clinical program evaluating “Quad,” its investigational ﬁxed-dose, single-tablet regimen of elvitegravir, cobicistat (formerly GS 9350), emtricitabine, and tenofovir disoproxil fumarate. The trial includes two studies that will evaluate the regimen versus a standard of care among treatment-naive HIV-positive adults.

ISTOCKPHOTO

DEVELOPMENTS IN MEDICAL STUDIES

RESEARCH

Critical Outcome Technologies has announced positive results from the ﬁrst phase of its integrase inhibitor discovery program, in which it is exploring new

in a simple manner and with a long shelflife—pouches made of foil and plastic that can hold a single dose of nevirapine. “The World Health Organization estimates that in Africa more than 90% of 430,000 new cases of AIDS in 2008 were attributable to mother-to-child transmission,” says Carolina Gamache, program coordinator of the Developing World Healthcare Technology Laboratory at Duke’s Pratt School of Engineering. “A single dose of nevirapine right after birth has been shown to be eﬀective in protecting the baby from the virus.” While health care workers in Africa have in the past tried packaging single doses by other means—syringes and containers, for example—they have all suﬀered from evaporation during storage and loss of preservatives. Also, Gamache explains, drug manufacturers have not shown much interest in devising single-dose systems because of development costs and limited marketing potential outside the Third World. The new pouch has been shown in tests to greatly reduce evaporation while remaining potent at various temperatures.

HIV disease tends to progress at a faster rate in infected individuals who consume two-plus alcoholic drinks a day, according to a report published in May in the journal AIDS Research and Human Retroviruses. The article, “Alcohol Use Accelerates HIV Disease Progression,” states that frequent alcohol use— deﬁned as two or more drinks daily—is associated with declining CD4-cell counts in both treatmentexperienced and treatment-naive HIVers. Based on the results of their 30-month study, the report’s authors conclude that alcohol has a direct effect on CD4 cells and that the accelerated decline in CD4 counts in frequent alcohol users is not simply due to poorer medication adherence. “It is important that HIV-infected individuals make informed decisions relating to alcohol consumption,” warns Thomas Hope, Ph.D., who is editor in chief of AIDS Research and Human Retroviruses and a professor of cell and molecular biology.

methods of binding to and blocking HIV cells. The drugmaker has two more phases in its analysis.

The Centers for Disease Control and Prevention is making funds available for a cooperative program for health departments to increase testing opportunities for populations disproportionately affected by HIV—primarily African-American and Hispanic men and women as well as men who have sex with men and injection-drug users, regardless of race or ethnicity. Ofﬁcials hope the program will increase the proportion of HIVers who

are aware of their infection and are then linked to clinical services.

Researchers testing the first vaginal microbicide based on an integrase inhibitor (L-870812) have found it provided monkeys with significant protection against infection with a combination simian immunodeficiency virus and HIV, according to a study reported at the International Microbicides Conference. In separate studies reported at the conference researchers found that a microbicide containing a fusion inhibitor referred to as L’644, another microbicide based on

the protease inhibitor darunavir, and one formulated with maraviroc all showed early promise at preventing HIV infection.

Argos Therapeutics presented data at the Annual Canadian Conference on HIV/AIDS Research from its Phase IIa trial of AGS-004, a dendritic cell-based immunotherapy that is matched to a patient’s viral burden. Results show that personalized immunotherapy has a positive impact on the genetic diversity of residual HIV and also results in increased time to viral rebound in HIVers treated with the compound following treatment interruption.

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PERFECTLY FLAWED BY C OR E Y SAU CI E R

JUST LIKE EVERYONE ELSE? Even as HIV fades into the background of his daily life, Corey Saucier realizes that he still may never be able to blend in with the crowd

IVAN ABJIC/PHOTODISC/GE T T Y IMAGES

O T H I S I S DO W N T I M E . Life is good, people are beautiful, my skin is back to normal, and my HIV is in the background. It happens like that sometimes. No little emergency on the horizon, no emotional or spiritual lesson manifesting in physical form, and no interpersonal relationship being fragmented by the dynamics of this disease. Simply put: Things are simple lately. And that’s a good thing. A really good thing! As far as the world, my body, and my doctor are concerned, I’m absolutely normal. But I’m not. Not really. HIV is always there ticking silently in my blood, undeniably marking me as different. My virus is scientifically undetectable, sure. But socially, intimately, and personally, I am still very much defined as “other”: queer, outcast, alien, odd, strange, bizarre, weird, unusual, and heteromorphic. Undetectable my (bad) ass! The truth of the matter is that I always know that at any moment a scarlet letter can be splashed across my chest, labeling me as the one who is separate from the others. So why on earth would I do that to someone else? My difference is in my blood. It’s innate to who I am and inextricably bonded to my identity. And whether I am healthy, beautiful, innocent, celibate, or safe, I am judged for it. Get the metaphor? Lately, I’ve been bombarded with politics, barraged by religious dogma, and inundated with racial and sexual prejudice; and I wonder what the big deal is. We are all separate and the same, different and similar; oddly normal and perfectly flawed in one way or another— even if it doesn’t show. It just so happens that some people wear their issue on their skin like leprosy or their faith on their brain like some metaphysical disability. Or perhaps they were just born in the wrong place, at the

wrong time, like some geographic deformity. But we’re all the same…in a different sort of way. I don’t think I get the fear. Over the years I’ve learned to wear my differences like a beautiful badge that colors my life in a spectrum that bedazzles the eyes. I let race, sexuality, nationality, and biological infection flow freely from my form and brush my personality with things that have made me stronger for it. And luckily, I’ve come to realize that the motley colored patchwork of other people’s stories represents exactly the things that make them beautiful; it’s exactly what makes them unique and special and precious. And their difference doesn’t threaten my own—because surely we both can be beautiful. But society has somehow gone astray. Some people are not so lucky. Some of us are ostracized, put aside, quarantined, deported, ignored, and shunned; and through no fault of their own, they are spotted, categorized, and forced to bear the brunt of a judgment that the majority decides is the “norm.” Until all of a sudden everyone else is telling them what they need to do. I would hate for that to happen to me. So for the moment, I’m free! As far as the world is concerned my HIV is under control. There is no drama, no doctor appointments, no fears, insecurities, or physical hardships. Once again I’m like everyone else—because they can’t see my HIV. We’re just going to pretend that me being poor, black, and gay has nothing to do with it. Because, of course, no one would judge me on those things anyway, right? Saucier is a writer, blogger, and performance artist based in Los Angeles. Find more of his writing online via our website. J U LY/A U G U S T 2 0 1 0 H I V P L U S

ASK & TELL Q & A W I T H L I SA D U K E S

Lisa Dukes knows the power of a good idea. A counselor at the Pittsburgh AIDS Task Force, Dukes wanted to make one of her programs—Sisters Informing Sisters About Topics on AIDS—more eﬀective. The SISTA gatherings were two-hour formal sessions, and Dukes believed she could reach more women if she made them fun. Soon the Girlfriends Project was born. Inspired by Tupperware parties, the project invites a group of women to the home of a friend. Dukes uses the relaxed setting—food and drinks are served—to speak frankly about safer sex and oﬀer HIV tests to attendees. The Girlfriends Project has been so successful that Dukes has presented it at the Centers for Disease Control and Prevention’s National HIV Prevention Conference. —Neal Broverman

What happens at the party? I usually have 10 to 15 women, but I’ve had a party with 22. At the event I give women basic information on risk and sexually transmitted diseases. I’ve added to the curriculum some domestic-violence information too. I do a lot of hands-on demonstration; I take my [synthetic] penis and vagina to demonstrate how to put on condoms. Everyone gets her own party pack of lubricant and condom

cases, which are very cute for your purse. Would men be amenable to attending parties similar to the Girlfriend Project? I think that’s something we need to look at, because if I go to a party and a woman’s son is upstairs, the mother usually asks, “Miss Lisa, can you please talk to my son?” and “Why don’t you have programs like these for men?” Brothers need to know too. I think we need to do something for the heterosexual population of men. Nothing against gay men, but we still have a population of heterosexual men not being reached. If we’re going to be in this sector of prevention, we need to be teaching prevention across the board. Gay, straight—it doesn’t matter; we need to create curricula designed for every population, not just women. Are people shy at the parties? Honestly, I haven’t come across any women who don’t want to get involved. I’ve had women say, “Oh, my goodness. This makes things

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easier to talk about.” Another lady said, “If you didn’t have a program like this, I doubt I’d try to get information about HIV— or even have a conversation about being tested.” That’s why it’s important to meet people in their comfort zones—it breaks down a lot of barriers in communication. What was it like presenting the project at the national HIV prevention leadership conference? A bit overwhelming, because so many women there said, “We need this in our community.” It took my breath away because I thought it was easier for women to get tested than it really is.

“One lady said, ‘If you didn’t have a program like this, I doubt I’d try to get information about HIV.’ ”

TIPS +TOOLS

Learn more about the Girlfriends Project on HIVPLUSmag.com

RICHARD KELLY

Tell us about a typical event. If someone comes in contact with one of my brochures or has attended another house party, it’s usually a domino eﬀect—I’ll get a call and a woman will want to schedule a party. I meet with the hostess and talk about what kind of food she wants. Anytime a hostess caters a party, she’s given a $50 gift card, and guests who get tested receive a $20 gift card. I’ll ﬁnd out from the hostess who will be at the meeting so that I can tweak the information for the group I’m working with. For instance, if the women are more conservative, I won’t be as graphic.

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By starting HIV

treatment,

I went from being in denial to

discovering acceptance. If youâ&#x20AC;&#x2122;re HIV positive, the decision to begin taking medication can be difficult. But it can be the first step toward reclaiming your life and living longer. Talking to your doctor and getting the right information on HIV treatment can help take you from being in denial to feeling in control.