HIV Plus Magazine #78

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

RISK ANALYSIS Can you really reduce your odds of viral transmission?

BUTT ENOUGH Why you truly need to stop smoking now

La Vida Latina

Tearing down cultural barriers that get in the way of a full life SEPTEMBER/OCTOBER 2010 www.hivplusmag.com

ATRIPLA Important Safety Information and Indication 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. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get infections that develop because the immune system is weak or other conditions that happen with HIV-1 infection.

Do not stop taking ATRIPLA unless directed by your healthcare provider. See your healthcare provider regularly.

•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:

•Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby.

•Have liver problems, including hepatitis B or C virus infection.

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

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.

IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following •Kidney problems (including decline or failure of kidney function).

If you have had kidney problems, or take other medicines that may side effects or conditions associated with ATRIPLA: • Nausea, vomiting, unusual muscle pain, and/or weakness. These cause kidney problems, your healthcare provider should do regular blood tests. Symptoms that may be related to kidney problems include may be signs of a buildup of acid in the blood (lactic acidosis), a high volume of urine, thirst, muscle pain, and muscle weakness. which is a serious medical condition.

• Light-colored stools, dark-colored urine, and/or if your skin or the •Other serious liver problems. Some patients have experienced serious liver problems, including liver failure resulting in transplantation whites of your eyes turn yellow. These may be signs of serious or death. Most of these serious side effects occurred in patients with a liver problems. chronic liver disease such as hepatitis infection, but there have also • If you have HIV-1 and hepatitis B virus (HBV), your liver disease been a few reports in patients without any existing liver disease. may suddenly get worse if you stop taking ATRIPLA. •Bone changes. Lab tests show changes in the bones of patients treated Do not take ATRIPLA if you are taking the following medicines with tenofovir DF, a component of ATRIPLA. Some HIV patients treated because serious and life-threatening side effects may occur when with tenofovir DF developed thinning of the bones (osteopenia), which taken together: Vascor® (bepridil), Propulsid® (cisapride), could lead to fractures. Also, bone pain and softening of the bone Versed® (midazolam), Orap® (pimozide), Halcion® (triazolam), (which may lead to fractures) may occur as a consequence of kidney or ergot medications (for example, Wigraine® and Cafergot®). problems. If you have had bone problems in the past, your healthcare In addition, ATRIPLA should not be taken with: provider may want to check your bones. ® ® ® Combivir (lamivudine/zidovudine), EMTRIVA (emtricitabine), Epivir ® ® Common side effects: or Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), SUSTIVA® (efavirenz), Trizivir® (abacavir sulfate/lamivudine/zidovudine), •Dizziness, headache, trouble sleeping, drowsiness, trouble TRUVADA® (emtricitabine/tenofovir DF), or VIREAD® (tenofovir DF), concentrating, and/or unusual dreams. These side effects tend to go because they contain the same or similar active ingredients as ATRIPLA. away after taking ATRIPLA for a few weeks. These symptoms may be ® ATRIPLA should not be used with HEPSERA (adefovir dipivoxil). more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate) with or without avoid activities that may be dangerous, such as driving or operating Norvir® (ritonavir) should not be taken with ATRIPLA since they may lose their effect and may also increase the chance of having side effects machinery. from ATRIPLA. Fortovase® or Invirase® (saquinavir) should not be used •Rash is a common side effect that usually goes away without any as the only protease inhibitor in combination with ATRIPLA. change in treatment, but may be serious in a small number of patients.

Taking ATRIPLA with St. John’s wort or products containing St. John’s wort •Other common side effects include: tiredness, upset stomach, vomiting, is not recommended as it may cause decreased levels of ATRIPLA, gas, and diarrhea. increased viral load, and possible resistance to ATRIPLA or Other possible side effects: cross-resistance to other anti-HIV drugs.

This list of medicines is not complete. Discuss with your healthcare •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. provider all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

•Skin discoloration (small spots or freckles) may also happen.

Tell your healthcare provider if you: •If you notice any symptoms of infection, contact your healthcare provider right away.

•Are pregnant: Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects •Additional side effects are inflammation of the pancreas, allergic have been seen in children of women treated during pregnancy with reaction (including swelling of the face, lips, tongue, or throat), one of the medicines in ATRIPLA. Women must use a reliable form of shortness of breath, pain, stomach pain, weakness, and indigestion. barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control, while on ATRIPLA and for 12 weeks You should take ATRIPLA once daily on an empty stomach. Taking ATRIPLA at bedtime may make some side effects less bothersome. after stopping ATRIPLA.

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

Please see Patient Information on the following pages. © 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.

697US09AB07036/TR6101 07/10

“My entire HIV regimen in one pill daily.

For me, that’s great.”

Phil li p

on ATRIPLA for 2 years

ATRIPLA is the #1 prescribed HIV regimen.* About ATRIPLA: • Only ATRIPLA combines 3 HIV medications in 1 pill daily. †

• Proven to lower viral load to undetectable in approximately 7 out of 10 patients new to therapy, and also 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 suddenly worsen if ATRIPLA is discontinued.

Please see detailed and additional Important Safety Information, including the bolded information to the left. †

Defined as a viral load of less than 400 copies/mL. Average increase of 312 cells/mm3. § In this study, 227 patients took the meds in ATRIPLA. ‡

Patient model. Individual results may vary.

Your doctor may prescribe ATRIPLA alone or with other HIV medications.

Talk to your doctor to see if ATRIPLA is right for you. * Synovate Healthcare Data; US HIV Monitor, Q1 2010.

To learn more, visit www.ATRIPLA.com

OUR CONTRIBUTING EDITORS

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Michael W.E. Edwards

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

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

Albert Smith Photography Director

Neal Broverman

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

Stephen P. Jarchow Chairman

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Paul Colichman CEO

Tony Shyngle CFO

Stephen F. Macias Executive Vice President & General Manager

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Sam Page is a certified fitness trainer and journalist. As president of Sam Page Fitness, he operates three private studios in Southern California. He contributes to several national and international magazines and also publishes a weekly e-newsletter from SamPageFitness.com and a daily blog at PeaceLoveLunges.com.

Corey Saucier is a writer, performance artist with a focus on theatrical activism, and blogger (JustWords.Tumblr.com) who lives in Los Angeles. Through workshops and performance, he cultivates his personal histories into a public voice that echoes themes of gay minority identity, neopositive perspective, queer faith, and the crystal meth epidemic.

Antonio Urbina, MD, is an HIV specialist in New York City as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.

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Jon Barrett Advocate Group Editorial Director

Joe Landry Senior Vice President & Group Publisher

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FEATURES

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32 CULTURAL DIVIDE Whether born in another country or right here in the United States, life can feel like an obstacle course to Latinos when they discover they’re HIV-positive. From cultural barries to deeply ingrained traditions that tear families apart, it takes a strong effort to get life back on track.

40 OPPOSITES ATTRACT New research shows that when the HIV-positive partner in a serodiscordant relationship is on regular, effective antiretroviral treatment, the chances of transmitting the virus could be reduced to less than 10%.

DEPARTMENTS & VOICES 12 STATUS SYMBOLS Yeah, so many people think it’s a nasty habit. But there are even more reasons (lifesaving ones, in fact) that you should give up smoking tobacco.

Plus: Advice and news for living your life to the fullest.

15 Mind+Mood

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

42 HAART BEATS Lipodystrophy caused by firstgeneration antiretrovirals might not be easy to overcome. Plus: Lots more treatment news and insight.

45 Rx+Research

46 PERFECTLY FLAWED

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42

Just like Corey Saucier, you too can have a strong set of spiritual beliefs.

But don’t think, he says, that you shouldn’t be taking your meds too.

48 ASK & TELL LaShawn Fowler has launched a disclosure campaign with the hope of getting all HIVers to come out.

ON THE COVER

*

Gabriel Rocha photographed exclusively for HIV Plus by Getty Images.

SEPTEMBER /OCTOBER 2010 HIV PLUS

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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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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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6 | HIV PLUS SEPTEMBER /OCTOBER 2010

ABOUT PREZISTA

IMPORTANT SAFETY INFORMATION

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

PREZISTA (darunavir) is a prescription medicine. It is one treatment option in the class of HIV (human immunodeficiency virus) medicines known as protease inhibitors.

Belief {

in myself in my doctor in my meds

ONCE-DAILY PREZISTA FOR ADULTS TAKING HIV MEDS FOR THE FIRST TIME In a clinical study* of almost 2 years (96 weeks) in people who had never taken HIV meds before, ONCE-DAILY PREZISTA with low-dose ritonavir plus Truvada®…

• Helped 8 out of 10 people achieve undetectable viral load (less than 50 copies/mL) • May help to increase T-cell count • Was associated with low rates of diarrhea, stomach pain, nausea, and vomiting — Diarrhea (8%), stomach pain (5%), nausea (3%), and vomiting (2%) were reported as moderate to severe PREZISTA must be taken with and at the same time as 100 mg of Norvir® (ritonavir), and with other HIV meds and with food.

Once-daily dosing of PREZISTA is not recommended for adults who have taken HIV meds in the past.

Please read Important Safety Information below and ask your doctor if once-daily PREZISTA is right for you.

Individual results may vary.

• Tell your healthcare professional if you What are the possible side effects of PREZISTA? are taking estrogen-based contraceptives • High blood sugar, diabetes or worsening of (birth control). PREZISTA might reduce diabetes, and increased bleeding in people the effectiveness of estrogen-based with hemophilia have been reported in patients contraceptives. You must take additional taking protease inhibitor medicines, precautions for birth control, such as condoms including PREZISTA What should I tell my doctor before I take • Changes in body fat have been seen in some PREZISTA? patients taking HIV medicines, including PREZISTA. The cause and long-term health • Before taking PREZISTA, tell your healthcare effects of these conditions are not known at professional if you have any medical conditions, including allergy to sulfa medicines, this time diabetes, liver problems (including hepatitis B • As with other protease inhibitors, taking or C), or hemophilia PREZISTA may strengthen the body’s immune response, enabling it to begin to fight infections • Tell your healthcare professional if you are that have been hidden. Patients may experience pregnant or planning to become pregnant, or signs and symptoms of inflammation that can are breastfeeding include swelling, tenderness, or redness – The effects of PREZISTA on pregnant women • The most common side effects related to or their unborn babies are not known. You taking PREZISTA include diarrhea, nausea, and your healthcare professional will need to rash, headache, stomach pain, and vomiting. decide if taking PREZISTA is right for you Uncommon but severe side effects such as – Do not breastfeed if you are taking PREZISTA. inflammation of the pancreas and increased You should not breastfeed if you have HIV blood fat levels have also been rarely reported. because of the chance of passing HIV to This is not a complete list of all possible side your baby effects. If you experience these or other side effects, talk to your healthcare professional.

Do not stop taking PREZISTA or any other medicines without first talking to your healthcare professional

• Please refer to the ritonavir (Norvir ®) Product Information (PI and PPI) for additional information on precautionary measures You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

• For adults taking HIV meds for the first time: PREZISTA 800 mg (two 400-mg tablets) must be taken at the same time with 100 mg Norvir ® once daily every day. PREZISTA must be taken with food Please see Important Patient Information on the next page for more information, or visit www.PREZISTA.com.

If you or someone you know needs help paying for medicine, call 1-888-4PPA-NOW (1-888-477-2669) or go to www.pparx.org. *343 adult patients (30% women) received combination therapy with PREZISTA/ritonavir. At the start of the study, the average T-cell count was 245, and 66% of patients had a viral load less than 100,000 copies/mL.

Distributed by: Tibotec Therapeutics/Division of Centocor Ortho Biotech Products, L.P. Titusville, NJ 08560 ©2010 Tibotec Therapeutics 05/10 28PRZDTC0010BR3 All trademarks are property of their respective owners.

www.PREZISTA.com/patient

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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

SNUFFING IT OUT Experts are seeking ways to help the disproportionate number of HIVers who smoke tobacco, putting their health—and lives—at risk

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AV I N G P R E V I O U S LY

worked to document health-related problems associated with the high rate of smoking among HIVers, researchers are now turning their attention to how to get these smokers to kick the habit.

Jenine K. Harris, Ph.D., an associate professor of community health at the Saint Louis University School of Public Health, examined the kinds of research conducted on smoking among HIVers from 1980 to 2008. With results published in the American Journal of Public Health, Harris’s study found the vast majority of research—237 of the 272 published articles—looked at the relationship between smoking and HIV disease. However, fewer than 2% of the articles examined the effectiveness of interventions aimed at preventing or reducing smoking among HIVers.

“The accumulation of nearly two decades of discovery research leaves little doubt,” Harris says, “that smoking is a widespread problem and a major modifiable risk factor for disease and death in people living with HIV.” Researchers admit, though, that they don’t know the best strategy to help people living with HIV to quit

or not even start smoking. Typically, specialized smoking-cessation programs that target specific populations can be effective; however, few studies have examined targeted smoking-cessation programs for HIVers. One study found that a standard smoking-cessation program would not help 86% of smokers living with the virus.

Harris says it’s time for researchers to connect the dots between the health problems associated with HIV and smoking and effective ways to help HIVers to quit: “The delay between discovery of smoking-related health outcomes in people living with HIV/AIDS and the delivery of interventions to reduce smoking among this population has serious consequences.”

To speed the process of finding solutions, Harris suggests that both researchers and clinicians collaborate with experts on tobacco cessation who understand how targeted programs work. In addition, she says, researchers who are examining the link between smoking and HIV and those who are looking at effective programs need to work closer together. The ultimate goal, she explains, is to look at the evidence of what works to come up with effective programs that curb the smoking.

THINKSTOCK

You Should Know Of the estimated 1.1 million Americans who are living with HIV, between 40% and 60% are smokers, according to Saint Louis University School of Public Health researchers. This is two to three times the rate of smokers in the general population.

SEPTEMBER /OCTOBER 2010 HIV PLUS

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Shannon Hader

Focusing on Black Men Recognizing evidence that HIV infections among African-American men are on the rise, the White House convened its first summit on HIV among black men this summer. African-Americans, who represent about 12% of the U.S. population, accounted for 51% of new HIV diagnoses in 2007 in states with long-term, confidential name-based HIV reporting, according to the federal Centers for Disease Control and Prevention. For black men with HIV, the chief mode of infection was sexual contact with other men, followed by injection-drug use and high-risk heterosexual

contact, according to the CDC. As part of the multiyear initiative, the CDC says it is making a concerted effort to help fight the virus’s disproportionate impact among black Americans. A key part of the national media campaign involves addressing HIVrelated stigma among AfricanAmericans and raising awareness about the disease.

“People react with demonization to black men with AIDS,” says Shannon Hader, director of Washington, D.C.’s HIV/AIDS Administration. “This prevents men from getting involved in the response.”

CONFERENCE CALL-OUT

HITS AND MISSES WITH “ROUTINE” CARE Just over half of men (57%) in the United States see a doctor, nurse practitioner, or physician assistant for routine care, compared to nearly three quarters (74%) of women, according to the Agency for Healthcare Research and Quality.

Routine care is typically defined as a visit for assessing overall health rather than one prompted by a specific illness or complaint.

The federal agency’s survey asked respondents if they had made an appointment within the prior 12 months for routine care and also found that h fewer Hispanic and black men made routine medical care appointments than white men (35.5%, 43.5%, and 63%, respectively);

14 | H I V P L U S S E P T E M B E R / O C T O B E R 2 0 1 0

h uninsured people ages 18 to 64 were only about half as likely as those with private insurance to make an appointment for routine care (36% versus 69%); h about three quarters of respondents who said they were in excellent health reported making an appointment for routine medical care versus half of those who said that their health was fair or poor (76% versus 52%); and h a little over half of poor respondents reported making an appointment for routine medical care compared with three quarters of those with higher incomes (54% versus 75%).

“Additional evidence demonstrating the potential use of antiretroviral drugs to prevent infections coupled with other exciting scientific advances discussed this week signal a potential new era in innovation. At the same time, with lifesaving treatment and prevention tools readily available now, world leaders must step up and fund universal access.”

—JULIO MONTANER, MD, president of the International AIDS Society, which holds the biennial international AIDS conference, held in July in Vienna, Austria

STATUS SYMBOLS MIND

MOOD

Feeling Left Out? If it seems like life is passing you by, maybe it’s your turn to make the move to connect with people

Ideology Over Patient Care?

An increasing number of patients are being denied certain kinds of medical care because of hospital policies based on ideological or religious beliefs, according to a report released by the National Health Law Program. The report analyzes policies at hospital systems representing more than 650 medical facilities in the United States.

Susan Berke Fogel, lead author of the report, says, “When people go to the doctor they should be able to expect that the care they receive meets prevailing medical standards.” The report “found a disturbing number of case studies

where patients ended up far worse off,” she adds, “either because their health care providers refused care or because their hospitals prohibited the care they needed for ideological or religious reasons.”

According to the report, one in six U.S. residents receives care in hospitals that have some restrictions on services. The issue is usually portrayed as a moral debate between the conscience rights of health providers and patients’ rights to care. However, that debate overlooks evidencebased decisions about determining the best medical practice, the report says.

HADER AND MONTANER BY GE T T Y IMAGES; IDEOGOGY BY THINKSTOCK.COM

OVERHAUL OPPOSITION DECLINES

41% f 35% Opposition to the landmark health care overhaul declined over the month of July, according to the results of a tracking poll by the Kaiser Family Foundation. Fifty percent of the public held a favorable view of the law, up slightly from 48% in June, while 14% expressed no opinion about the measure. The approval level was the highest for the legislation since it was enacted in March, after a divisive yearlong debate. In April the poll found 46% in favor and 40% opposed.

Although the legislative battle is over, the political tug-of-war continues.

Democrats and Republicans have been fighting to shape public opinion on the issue in hopes of influencing the fall election.

Did you ever feel left out when you were a kid—like when your two best friends decided that three was a crowd and pushed you to the sidelines? Have you ever felt the same way as an adult? Maybe some of your coworkers sneak off to have lunch without you, or you find out about a party you didn’t get invited to? Most likely, you didn’t feel a whole lot different as an adult than you felt as a child: hurt, annoyed, confused, disrespected.

No matter how independent we human beings try to be, we all need friends, and we are reminded of this when we feel like friendship is going on around us but we aren’t included. And sometimes coping with other challenges, like living with HIV, can leave us feeling even more sensitive when we feel disrespected or ignored by others. It’s not unusual to feel a little jealous of the stress-free companionship that others seem to be enjoying.

If you have ever experienced rejection—and who hasn’t?—here are some ideas to help you keep your perspective. h Accept your feelings. When it seems that someone has wounded us, memories of past rejection can come up, along with a lot of uncomfortable feelings. While you may be tempted to tell yourself that you are an adult now, this doesn’t make the feeling go away. Don’t deny your emotions. Pain can lead to growth. h Look at things from another angle.

Chemistry, even among friends, is unpredictable. Sometimes people just connect, through common interests or their outlook on life. Just because they want to spend time together doesn’t mean there is something wrong with you or that you’re not likable. It just is. h Get your information straight. We’re all human. We get in bad moods. We

Gary McClain, Ph.D.

become preoccupied. We forget people around us. That person you thought was your friend yesterday—but who seems to look through you today—may just be having a bad day. And you might be having one of those days when you feel especially sensitive. Don’t make assumptions and push your friends out of your life without knowing why, or if, they have had a change in attitude. Their bad day may be coinciding with yours.

Don’t deny your emotions.

Pain can lead to growth. h Take a look at what’s missing in your life. One reason for feeling envious of someone else is that we see them enjoying something that we don’t have enough of in our life—like personal relationships.

Do you feel like you have a support system in place with people who care about you, and whom you care about? The envy you feel toward others who seem to have more fun together may actually be about the lack of support in your life. Maybe it’s time to expand your network of friends. h But also take a look at who’s on your team. Before you pronounce the cup as half empty, take an inventory of the people in your life that you really care about and who care about you—friends, family, anybody else that you count on to be there when you need them. Have you spent enough time with them lately? h Take the first step. Pick someone from your list and give her or him a call.

Find out how that person is doing. Make plans to get together. Somebody out there is waiting for you to make a move.

McClain welcomes e-mail at Gary@JustGotDiagnosed.com

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MEETING OF MINDS President Obama greets New York City–based Housing Works’ Charles King, who’d heckled him during his remarks unveiling the new National HIV/AIDS Strategy at a ceremony at the White House on July 13. The president says the new plan will use federal resources to reduce the number of people who become infected with HIV, to increase access to care for HIVers, and to reduce HIVrelated health disparities.

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RON SACHS/GE T T Y IMAGES

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ROYAL HOPE

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AP PHOTO/JEROME DELAY

During a tour of their charity projects in June in the African nations of Botswana, Lesotho, and South Africa, Britain’s Prince Harry and Prince William have their bodies outlined on paper by treatment advocates.

Afterward, the princes wrote in the outlines their wishes for local children who are infected and affected by HIV.

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RESCUE MISSION Sheila Nichols is silhouetted as she stands in a room at the Charles Cobb Apartments in Los Angeles in late July. After two decades of living on the streets of Skid Row, the 55-year-old was dying.

Her body had wasted to 61 pounds, ravaged by a heavy-duty crack cocaine addiction, hepatitis, HIV, and late-stage syphilis.

Nichols was rescued by Project 50, a pilot program to get the 50 people most likely to die if they remained homeless into housing, medical care and social services.

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AP PHOTO/JAE C. HONG

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PHOTO CREDIT

AP PHOTO/RONALD ZAK

Life Ball, the gala HIV fund-raiser held annually in Vienna, Austria, consistently draws attendees from across the globe, but this year’s event was especially highprofile because it preceded the XVIII International AIDS Conference. See our Rx+Research section in this issue for reports released at this year’s conference.

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

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

On REYATAZ,

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

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

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

Serevent Diskus® (salmeterol) and Advair® (salmeterol with fluticasone) are not recommended with REYATAZ. Do not take Vfend® (voriconazole) if you are taking REYATAZ and Norvir® (ritonavir).

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

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

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

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

• A change in the way your heart beats may occur. You may feel dizzy or lightheaded. These could be symptoms of a heart problem.

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

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

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

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

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

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

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

Wedn esda y Ma ry ’s birthd ay pa rty Thursda y 5:30 C h oi r e practic

Bu y new shoes for Latish a

Fight HIV your way.

Please see Important Patient Information about REYATAZ on the adjacent pages.

how you spend your time is up to you.

Individual results may vary.

Once-daily REYATAZ can help fight your HIV. REYATAZ, a protease inhibitor (PI), in HIV combination therapy: ◆

Can help lower your viral load and raise your T-cell (CD4+ cell) count

◆ Has

a low chance of diarrhea (shown in clinical trials)

— REYATAZ in combination therapy had a 1%-3% rate of moderate-to-severe diarrhea in adults. ◆ Is taken once a day with a snack or meal REYATAZ is one of several treatment options your doctor may consider.

Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

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

REYATAZ is a registered trademark of Bristol-Myers Squibb.

All other trademarks are the property of their respective owners and not of Bristol-Myers Squibb. © 2010 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US10AB05503 05/10

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LA VIDA

LATINA Stigma, belief systems, and other cultural differences can combine to create formidable obstacles—but barriers can be torn down B Y B E N J A M I N R YA N PHOTOGRAPHY BY STEVE JENNINGS

SYSTEM FAILURE: “Doctors wouldn’t touch me,” says Gabriel Rocha of his failing health in his native Mexico. “They condemned me to a death sentence.”

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AVING LIVED WITH HIV for well over a decade, Carlos Hernandez had pretty much resigned himself to not having a future. He eventually “ran out of T cells altogether,” he says, but he still refused to take antiretroviral medications. He’d tried them a couple of times in the early days of the newly formulated drug cocktails and was adamant that he’d never face the side effects again.

The fact that more tolerable medications had been rolling out of the pipeline over the years since his last attempt at treatment in 1999 escaped him.

“I told myself, Screw it! My days are numbered,” he recalls. “I quit paying my taxes.

I just quit paying attention. I didn’t plan on being around. To me, my only future was that I was just going to have a slow death from AIDS.” After two bouts of meningitis, he wound up in the hospital for what seemed like the third and final time—so ill that the 5-foot8 Hernandez dwindled from his usual 170 pounds to 85. It was finally time, he felt, to tell his family that he was HIV-positive.

Similarly apathetic, heroin addict Samuel Morales, who tested HIV-positive and was given six months to live in 1985, blazed through the go-go decade on a spree of theft and drug dealing, bouncing back and forth between prison and the streets of Philadelphia. “That was my thing: drugs and stickups,” the 53-year-old preacher’s son and one-time honors student says. “I didn’t really care about life. My life was like… I walked in the streets and felt like people knew who I was. I would stick them up and tell them, “It’s not me. It’s the drugs.” I guess I was looking for somebody to kill me, or I was trying to kill myself. I ain’t care about life.”

In 1990, facing a bundle of charges, including attempted murder and skipping out on bail, Morales pleaded no contest and was sent to prison for eight to 20 years. There, continuing to deal and use drugs on the inside, he faced the dismal medical care typical of U.S. prisons throughout much of the early days of the AIDS epidemic, extended stays in solitary confinement, and the apparent certainty that he would die before ever getting out.

In contrast, 41-year-old Mexican native Gabriel Rocha says that he was desperate to live but was unable to find any help that would allow him to. In 1999 while living in Puerto

H

Vallarta his health declined to a point as dire as Hernandez’s at its worst. “Doctors wouldn’t touch me,” he wrote earlier this year in his fund-raising pledge for the California AIDS/ LifeCycle. “They told me I was going to die and there was nothing they could do for me.

They condemned me to a death sentence and were unwilling to lift one little finger to help.”

Fortunately, Rocha had a patron saint of a friend in the United States who flew him to San Francisco. Cheating death, he would remain in the hospital there for the next four months. Eventually, he applied for and was granted political asylum in the States. But it wasn’t just the lack of proper medical care in Mexico that threatened his life; he was once abducted by a group of men and tortured over a two-day period because of his sexual orientation.

THE OBAMA ADMINISTRATION RELEASED its long-awaited domestic National HIV/AIDS Strategy in July. Having consulted over the past two years with ethnic advocacy groups like the Latino Commission on AIDS about the needs of their constituents, the authors of the report stressed the importance of redirecting federal efforts to better target, for one, Latinos living in the United States. The White House set a five-year goal to increase the number of HIV-diagnosed Latinos with an undetectable viral load by 20% and to make CD4 and viral load testing more available to Latinos.

The need for improved strategies to target Latino men at risk for and living with HIV is great—perhaps even greater than for any other demographic because of the historical lack of attention paid to their plight. Theirs is an epidemic that has run silently over the decades. Latinos have no Magic Johnson to serve as a role model or as a public face for living with the disease. Latino churches, by and large Catholic, tend to be as AIDS-phobic and homophobic as—or more so than— African-American churches. In comparison, though, there is little public outcry over this major source of stigma, which otherwise has the potential to become a pulpit for greater awareness.

The rate of new AIDS diagnoses among Latino men, according to the White House strategy report, is three times that of white men, and as a risk category, Hispanic men who have sex with men have the fourth-highest numbers of new HIV infections per year at 5,710,

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Theirs is an epidemic that has run silently over the decades. Latinos have no Magic Johnson to serve as a role model or as a public face for living with the disease.

behind white and black MSM, respectively, and black heterosexual women.

More than any other an ethnic group in the United States, Latinos are alienated from health care and proper health screenings, according to the Kaiser Family Foundation.

Nearly a quarter of HIV-positive Latinos are uninsured; 41% test late and develop AIDS within a year of their HIV diagnosis; and, as Carlos Hernandez’s story illustrates, they are more likely to delay medical care after a diagnosis.

The triple-layered effects of poverty, racism and homophobia drive the epidemic among Latino gay men in particular, according to Rafael M. Díaz, Ph.D., who studies HIV in Latin culture at San Francisco State University. Men so heavily oppressed are more likely to seek solace by taking sexual risks and are likely to do so while under the influence of alcohol or illicit drugs. With HIV infection thrown into the mix, men are at even higher risk for substance abuse disorders, anxiety, and depression—which can all compromise antiretroviral treatment. Díaz’s research of HIV-negative gay Latinos’ attitudes has found that they tend to blame HIV-infected men both for their infections and for infecting others and also shun them as potential romantic partners.

“The number 1 problem is the stigma associated with HIV and AIDS,” says Guillermo Chacon, president of the Latino Commission on AIDS. This stigma, which is fueled in part by a rigid Catholic belief system and the machismo ideal of the masculine, domineering head of the household discourages Latinos from getting tested and into care.

Also to blame, says David Ernesto Munar, who is vice president of the AIDS Foundation of Chicago, is the isolation Latinos experience because of cultural or language barriers.

HIV-positive Latino men may have to fracture their sense of self and wind up with a lack of full emotional support from their family—the bedrock of existence across the many diverse

shades of Latin American culture.

“They may be out in the gay community, or they may be bicultural or more Americanized,” Munar says, “but in their Latino family or their Latino enclave, they can’t talk about gay issues, or they don’t feel safe talking about health issues or HIV issues.”

Like Morales, heterosexual Latino men are largely infected through unsterilized needles.

And they can suffer homophobia by association for their HIV status and shoulder yet another layer of blame because of their substance abuse.

“They’re often faced with the idea that this is a community of discard,” says Ruben Acosta, who is a health educator at the Los Angeles Gay and Lesbian Center. Speaking ironically, he continues, “I mean, they’re drug addicts. If somebody wants to take a needle and stick it in their arm and it’s not clean, that’s on them.” twice nearly cost Carlos Hernandez his life. As an effeminate child growing up in conservative San Diego, he suffered violent abuse from his Guadalajaraborn father over his apparent homosexuality.

“Broken nose, popped lip, broken teeth, head through the wall,” recites Hernandez, now 38. When he was 15 he attempted suicide, he says. Leaving his four older siblings behind, he went to live in a foster home in what he calls a bad neighborhood in San Diego. Soon after, he dropped out of school, took off on his own, and managed to support himself with a job at SeaWorld. He was infected with HIV by the time he was 17.

His parents have remained married for half a century. “They’re a typical Latino family— where the mother has no say,” Hernandez says. Over the years he’s managed to maintain a relationship with both his mother and father and his four siblings. At 18, he disclosed that he was HIV-positive to a sister in secret. In his mid 20s, when he told one of his brothers—“another macho Latino who was in the Marines”—the brother responded, “I A LACK OF FAMILY SUPPORT

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love you, you’re my brother, but I don’t want to talk about it.”

Hernandez’s apathy about his future ran parallel to the tenuous support he received from family. Not bothering to enter into the proper medical care that had by then been available for a decade, he nearly died in 2006.

“When you don’t have the support—if you don’t talk about it—you’re not going to deal with it,” he says. “It’s a lonely struggle. My dad

would’ve been a lot happier if I had had cancer.

At least then you can die with some dignity in his eyes and that’s ‘respectable’. ” Twenty-five year old Anthony Solder suffered similar dismay when, early last year, he approached his family with the news that his former boyfriend (who still maintains he’s HIV-negative) had infected him shortly before their breakup. While one of his two older brothers became a strong supporter,

the other, a pharmacist, responded, “How could you do this to the family?” and cut all ties with him. In the weeks that followed, his Puerto Rican mother began furiously sterilizing things he’d touched and refused to drink out of the same glass.

“I understand the stigma that my family had already, because they’re not educated,” says the native New Yorker who is in school in Tampa to become a registered nurse. “I

was like, ‘Listen, you cannot be acting like this toward me,’ ” he told his mother, “ ‘You cannot contract it from water, you cannot contract it from using my restroom.’ ” Ruben Acosta, a 19-year veteran of living with the virus, says what he sees as an “anti-intellectual tendency” in Latino culture makes discussing and learning about HIV more challenging for those infected and their family members alike. “It’s like my brother

Nearly a quarter of HIV-positive Latinos are uninsured, 41% test late and develop AIDS within a year of their HIV diagnosis, and‌they are more likely to delay medical care after a diagnosis.

says, ‘Don’t start talking smart to me,’ � Acosta explains. “Trying to elevate yourself with just using the proper vernacular in the language, sometimes in the Latino community, is looked down on. Oftentimes, the community isn’t ready to say such things as ‘nondetectable’ or ‘T cells’ or ‘viral load’. �

Word choice also illuminates what Acosta sees as a certain defeatist identiďŹ cation with the virus among HIV-positive Latino men. “When they identify, they say, ‘I’m HIV,’ â€? he says. “And I say to them, ‘You’re not HIV. You’re actually HIV-positive. But you’re hot, you’re sexy, looks like you’ve got a lot to oer—I mean, there’s a lot about you that you are that I’d love to know more about!’ â€?

TWO YEARS INTO HIS SENTENCE in prison, Morales had caused so much trouble that he was transferred to a maximum security prison in Huntington, Pa. That didn’t stop him from dealing, though. Friends on the outside would mule drugs in for him. “They always took care of me,� he says. “I had a lot of connections.�

Then on a day like any other in 1993, he returned to his cell with some heroin he’d scored and, as he recalls, “Something just clicked in me. I was like, You know what, Sam? You’re doing the same thing you did in the streets. And you’ve got 20 years to do. So I said to myself, I’ve got to stop this. So I just stopped. I had to take an inventory of myself.�

He got his GED. Then, fed up with the poor medical treatment oered to him and his fellow HIV-infected inmates, he went to the law library and approached a friend who was in for life. “Teach me the law,â€? he said.

By 1995, he initiated a civil suit against the corrections institution for misuse of funds for their care for HIV-positive prisoners. He started an HIV support group and by 1998 got a job on the inside as a law clerk.

Hernandez experienced a similar moment of reckoning. A hospice nurse approached

him as he was waiting to die and said, “Why are you giving up? Why aren’t you ďŹ ghting anymore?â€? “That night,â€? he says, “I remember getting on my knees and I just prayed. I said, ‘God, just give me a second chance.’ And I kind of made a deal with him. I said, ‘If you give me a second chance, I will completely turn my life around. I will dedicate my work to sharing what I’ve been through with other guys who are avoiding their status, who are hiding from it.’â€?

The process of healing included helping his parents cope with both the shock that he’d been hiding his serostatus from them for 15 years and their lack of education about the virus. Eventually, a social-service organization for HIV-positive Latinos and their families in San Diego called CASA was able to provide the Hernandezes with the right kind of education and support to bring them together again as a family.

WRITING ABOUT LATINO HIVERS , Rafael M. Díaz says that family acceptance—as well as support from friends or romantic relationships—is key to the kind of resiliency that doubled Hernandez’s once skeletal weight and returned him to robust health. Also, Díaz says, the community involvement Hernandez has committed himself to since he made his pledge to God four years ago is an eective way to improve self-esteem and to reduce the social isolation that nearly killed him.

Today, Hernandez is a health educator at the Los Angeles Gay & Lesbian Center, doing just the kind of work he promised he would.

Even though he and his father still have their rough patches, he has reconciled with him and says he no longer blames him for the abuse that drove him to try and take his life as a teenager. “It’s that cycle of abuse that was passed down,� Hernandez says. “He had extreme abuse. By the age of 10 he was living on the

streets of Mexico City with no shoes, nothing.

So I just had to put myself in his shoes and try to understand what he was trying to deal with, seeing that he has a son who’s obviously gay—kind of has this feminine side growing up—and didn’t know how to deal with it.�

Since his release from prison in 2000, Morales has committed himself to HIV education and advocacy work in Philadelphia, gathering an armful of awards for his service to the community. In 2008 he and a friend founded Proyecto Sol, an outreach program targeting local HIV-positive Latinos. “I tell people, ‘You don’t let HIV live you, you live HIV,’ � he says. “My life changed. I continue doing it. My only pleasure that I need is to see people smile. If I see people smile, that’s the pleasure I get—helping people.�

Anthony Soler, who also does outreach HIV education work in his free time, successfully got his mother to see the error of her ways. Not long after their heart-to-heart, she approached him as he was drinking out of a cup. “ ‘What are you drinking?’ � he remembers her asking. “And she grabbed my cup and started drinking out of it. It made me cry, because I kind of felt like, OK, the stigma’s being broken little by little.�

Gabriel Rocha, who now calls San Francisco home and is waiting on becoming a full U.S. citizen, has participated in the 545mile AIDS Life/Cycle beneďŹ t ride from San Francisco to Los Angeles. Riding through the farmlands one day, he and his fellow riders struck up a conversation in Spanish with some migrant farmworkers, who asked about the ride. “They came together and scratched through their pockets—and they give us money right there—and they said, ‘We want to support you,’ â€? Rocha says. “That’s how we have an impact. That’s how we make a dierence.â€? “One of the things I always tell people: is that it’s all about being proactive,â€? Hernandez says. “Get involved, be your own advocate, be informed. And the last thing I tell them, he says with a laugh, ‘Do your taxes! Those are never going to go away. They’ll ďŹ nd you.’ â€?

He adds, “If you live in denial, little things become bigger problems. Then they become stressors and they just aect your health overall.â€?

It wasn’t easy, but after keeping up his end of things with God, Hernandez says he has ďŹ nally settled his bill with the I.R.S. He’s glad he can laugh about it now. í˛‘

BACK ON TRACK: Now at 41, Rocha is in the process of becoming a U.S. citizen, his health has rebounded, and he completed his ďŹ rst AIDS ride this year.

MIXINGITUP When HIVers are on regular antiretroviral therapy, new research shows, they can reduce the chances of transmitting the virus to a seronegative partner to less than 10%

R E AT I N G H I V E R S with anti retroviral therapy can reduce the risk of their transmitting the virus to sexual partners by roughly 92%, according to a study published in the medical journal The Lancet. “These results are an important ďŹ nding in the search for eective HIV-prevention strategies and the strongest evidence to date that antiretroviral therapy might decrease HIV-transmission risk,â€? says Connie Celum, a professor of medicine and global health at the University of Washington, located in Seattle.

The ďŹ ndings were part of the Partners in Prevention study, a six-year eort coordinated by the International Clinical Research Center at the University of Washington and funded by the Bill & Melinda Gates Foundation. More than 3,400 heterosexual couples in which only one partner had HIV were enrolled from seven African countries. At the beginning of the study, the HIV-infected members had high CD4-cell counts and were not on anti-HIV treatment. Couples were provided counseling and prevention services and were followed for up to two years, with regular CD4 measurements as well as being given treatment referrals when they became eligible for them.

During the study, 349 of the HIVers started treatment at an average CD4-cell count of 198. Of the 103 HIV infections that occurred in the couples, there was only one HIV transmission after treatment initiation. In that single event the HIV-infected partner had

T

started antiretroviral therapy about three months prior to HIV infection being ďŹ rst detected in her partner.

Deborah Donnell, the study’s lead author and a biostatistician with the Vaccine and Infectious Disease Institute at the Fred Hutchinson Cancer Research Center in Seattle, says, “The one transmission indicated that HIV-serodiscordant couples should maintain safer-sex practices even when HIV-positive partners are on treatment.� And in fact, the proportion of couples who reported having unprotected sex decreased over time, according to the study, and the couples received frequent counseling on HIV risk reduction.

Although the rate of new HIV infections has been declining worldwide, an estimated 7,400 people a day are being infected with HIV, according to the Joint United Nations Programme on HIV/AIDS. More than 60 million people have been infected with HIV since the pandemic began. AIDS-related complications are the leading cause of death in sub-Saharan Africa and are the fourth leading cause of death globally. “Our analysis of HIV-discordant couples indicates that the risk of HIV transmission is signiďŹ cantly lower after HIV-infected people initiate antiretroviral therapy,â€? Celum says.

She notes that a randomized trial is under way to determine the longer-term impact of antiretroviral meds on transmission of the virus. “While awaiting those results,â€? she adds, “our study indicates that initiation of antiretroviral therapy may have a signiďŹ cant public-health beneďŹ t as well as clinical advantages for the individuals being treated.â€?

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Antiretroviral therapy is known to decrease the concentration of HIV in blood plasma to low levels, the authors explain, likely making the individual less infectious to others. Viral suppression to very low levels was achieved in 70% of individuals in this study at an average of seven months after starting treatment.

Transmission occurred at all CD4-count levels. However, since transmission risk was highest among people with CD4 counts less than 200 and not on treatment, ďŹ ndings from this observational cohort indicate that the eect of anti-HIV therapy on prevention of transmission could be greatest in people with CD4-cell counts less than 200. Additionally, the investigators found that among HIV-infected individuals with CD4 counts above 200, transmission rates were highest among those with a viral load above 50,000, suggesting that targeting this group could be an eective way to achieve further transmissions of the virus.

This study suggests that starting HIVers on antiretroviral therapy—even late in the disease—has beneďŹ ts for the individual and HIV prevention. While there is movement to initiate treatment earlier for clinical beneďŹ ts and increasing recognition of the potential HIV-prevention beneďŹ ts with anti-HIV treatment, especially in developing countries, many programs have insuďŹƒcient resources to provide coverage to those already in need. “[Antiretroviral treatment] appears to confer a signiďŹ cant prevention beneďŹ t across all CD4 ranges,â€? Donnell says, “and this study quantiďŹ es that more accurately.â€? í˛‘

STARTING HIVERS ON ANTIRETROVIRAL THERAPY—EVEN LATE IN THE DISEASE—HAS BENEFITS FOR THE INDIVIDUAL AND HIV PREVENTION. SEPTEMBER /OCTOBER 2010 HIV PLUS

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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

GONE ALL PEAR-SHAPED? Lingering effects of redistributed body fat caused by first-generation meds in HIVers could increase their risk for heart disease

ISTOCKPHOTO

E

VEN

FIVE

YEARS

AFTER

switching to newer medications, HIVers who lost subcutaneous fat as a result of taking first-generation anti-HIV meds still show strikingly less body fat than seronegative individuals, according to a study published in the July 17 issue of the journal AIDS. That lack of fat—just below the layer of skin—was marked in HIVers’ legs and lower trunk, where body fat is associated with a lower risk of cardiovascular disease—but less so in the visceral, or deep, fat and upper-body fat associated with increased cardiovascular risk.

“This shows that the damage done by certain antiretroviral drugs, which were lifesaving at the time but reduced body fat, is long-term,” says Carl Grunfeld, MD, Ph.D., who is chief of the metabolism and endocrine sections at the San Francisco Veterans Affairs Medical Center, which conducted the study with the University of California, San Francisco. “This is the first study to demonstrate that the effect lasts at least five years.”

The study authors twice measured total body fat among 477 HIV-infected participants and 214 noninfected control subjects. The first measurement was taken between 2000 and 2002, when most people in the United States with HIV were taking drug combinations that included the fattoxic drugs stavudine and zidovudine. The second measurement was taken five years

after the first, by which time most patients had been switched to modern highly active antiretroviral therapy, which has not been shown to destroy body fat. The researchers found that at both the first and second measurements, the HIVers in the study had significantly less body fat, especially lower body fat, than the control participants.

The difference in upper-body fat was much smaller, says Grunfeld: “The worst initial loss was in the best fat, and the least loss was in the worst fat. Five years later at the second measurement the HIV-infected patients had gained very little lower body fat.” The result, he says, is increased risk of cardiovascular disease among HIVers.

There are several reasons for the increased cardiovascular disease risk, explains Grunfeld, who is also a professor of medicine at UCSF. Upper-body fat is known to be associated with elevated insulin resistance and high blood triglycerides—two known heart disease risk factors—while lower-body fat is associated with decreased insulin resistance and lower triglycerides.

In addition, HAART is known to be associated with increased triglycerides, as is HIV itself. “It all adds up to bad cardiovascular-disease risk for HIV-infected people,” Grunfeld says. “Furthermore, it’s a risk that is probably not going to go away.

Patients and physicians need to be aware of it—and take whatever other steps they can to reduce that risk.”

SEPTEMBER /OCTOBER 2010 HIV PLUS

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FACING THE NEW FLU SEASON With the new flu season only months away, a universal influenza vaccine—so called because it could potentially provide protection from all flu strains for decades—may become a reality, according to scientists from the National Institute of Allergy and Infectious Diseases.

In experiments with mice, ferrets, and monkeys, the investigators used a two-step immunization approach to elicit infection-fighting antibodies that attacked a diverse array of influenza virus strains.

Current flu vaccines do not generate such broadly neutralizing antibodies, so they must be reformulated annually to match the predominant virus strains circulating each year.

“Generating broadly neutralizing antibodies to multiple strains of influenza in animals through vaccination is an important milestone in the quest for a universal influenza vaccine,” says NIAID director Anthony S. Fauci, MD. “This significant advance lays the groundwork for the development of a vaccine to provide long-lasting protection against any strain of influenza. A durable and effective universal influenza vaccine would have enormous ramifications for the control of influenza, a disease that claims an estimated 250,000 to 500,000 lives annually, including an average of 36,000 in the United States.”

HIVers are among the key groups of individuals who are advised to get an annual flu vaccination because of compromised immune systems.

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COULD DISCOVERY HALT HIV? Scientists have discovered two potent human antibodies that could stop more than 90% of known global HIV strains from infecting human cells, according to their laboratory research, and they have demonstrated how one of these disease-fighting proteins accomplishes this feat. According to the scientists, these antibodies could be used to design improved HIV vaccines—or they could be further developed to prevent or treat HIV infection. Moreover, the method used to find these antibodies could be applied to isolate therapeutic antibodies for other infectious diseases as well.

“The discovery of these exceptionally broadly neutralizing antibodies to HIV and the structural analysis that explains how they work are exciting advances that will accelerate our efforts to find a preventive HIV vaccine for global use,” says Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

“In addition, the technique the teams used to find the new antibodies represents a novel strategy that could be applied to vaccine design for many other infectious diseases.”

Led by a team from the NIAID Vaccine Research Center, the scientists found two naturally occur-

ring, powerful antibodies called VRC01 and VRC02 in an HIVinfected individual’s blood. They found the antibodies using a novel molecular device they developed that homes in on the specific cells that make antibodies against HIV. The device is an HIV protein that the scientists modified so it would react only with antibodies specific to the site where the virus binds to cells it infects. The scientists found that VRC01 and VRC02 neutralize more HIV strains with greater overall strength than previously known antibodies to the virus.

“We have used our knowledge of the structure of a virus—in this case, the outer surface of HIV—to refine molecular tools that pinpoint the vulnerable spot on the virus and guide us to antibodies that attach to this spot, blocking the virus from infecting cells,” explains Gary J. Nabel, MD, Ph.D., the Vaccine Research Center director.

Finding individual antibodies that can neutralize HIV strains anywhere in the world has been difficult because the virus continuously changes its surface proteins to evade recognition by the immune system. As a consequence of these changes, an enormous number of HIV variants exist worldwide.

HAART BEATS Potential Moms Face Stigma For some women, planning a family can be the first step toward one of life’s most rewarding experiences. But a new study has found strong evidence that some HIV-positive women feel that they are being judged negatively for wanting to become moms.

The study, conducted by researchers at the HIV Prevention Lab within the psychology department of Toronto’s Ryerson University, examined social stigmas perceived by HIV-positive women in the Canadian province of Ontario. After asking the women if they felt they were being negatively judged by their health care providers, family, and friends about their desire to have children, “we do have strong evidence that women are feeling they are being judged negatively by health care providers for wanting to have babies,” says Trevor Hart, director of the HIV Prevention Lab. Women born in Canada reported they

Rx

Upon completion of two Phase III clinical trials, Tibotec Pharmaceuticals says it has submitted a new drug application to the U.S. Food and Drug Administration for TMC278 (rilpivirine), an investigational nonnucleoside reverse transcriptase inhibitor, being studied for once-daily use with other antiretroviral agents.

Ð

Bio-Rad Laboratories has submitted a premarket approval application to the FDA for its fourth-generation HIV assay. Bio-Rad says its GS HIV Combo Ag/ Ab enzyme immunoassay can detect HIV antigens as well as antibodies, thus offering early detection of HIV infection as well as acute infection.

THINKSTOCK

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DEVELOPMENTS IN MEDICAL STUDIES

RESEARCH

Ð

A microbicide gel containing Gilead’s tenofovir used by women before and after sex has been shown to reduce their risk of HIV infection by 39% and by 54% among women who used it consistently, according to results of a Centre for AIDS Programme of Research in South Africa

felt negatively judged by their health care providers but not to the same degree as those women born outside of the country, usually from the regions of sub-Saharan Africa and the Caribbean. Interestingly for both groups, family and friends did not play a significant role in the perceived stigmatization of the women’s desire to have kids.

“Physicians may also be following outof-date guidelines created in the late 1980s recommending that HIV-positive women shouldn’t plan a family, which could explain this perceived stigmatization by these women,” says Anne Wagner, a Ph.D. student working on the study.

Hart says with the advent of new antiretroviral medications on the market, HIV-positive women can now conceive without worrying about passing on HIV to their newborns, and health care providers should be informing their patients.

study released at AIDS2010, the XVIII International AIDS Conference, held in July in Vienna, Austria. Despite their limited nature, this is the first microbicide in roughly a decade and a half of research to show promising results.

Ð

A clinical trial in Cambodia has found it possible to prolong the survival of untreated HIV-infected adults with very weak immune systems and newly diagnosed tuberculosis by starting anti-HIV therapy two weeks after beginning TB treatment, rather than waiting eight weeks, as has been standard, according to research presented at AIDS2010.

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An investigational, once-daily extendedrelease formulation of nevirapine (Viramune) is not inferior to the twice-daily immediate-release version of the medication when both were taken in combination with Truvada, according to data from the VERxVE study presented at AIDS2010.

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Most older gay and bisexual men enrolled in a long-term study of HIV used recreational drugs infrequently over a 10-year period, according to a University of Pittsburgh report released at AIDS2010. The study explored the drug use habits of 1,378 HIV-positive and negative gay and bisexual men in the Multicenter AIDS Cohort Study.

The World Health Organization issued new guidelines at AIDS2010 to improve efforts to prevent mother-to-child HIV transmission, calling for earlier testing for women after they become pregnant and earlier treatment with antiretrovirals to protect mothers’ health and halt viral transmission to newborns.

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Shionogi–ViiV Healthcare announced at AIDS2010 that it will move into Phase III clinical trials its once-daily, unboosted investigational integrase inhibitor, currently known as S/GSK1349572 (‘572).

A combination of protease inhibitor Kaletra and integrase inhibitor Isentress performed as well as a regimen of Kaletra and combination nucleotide/nucleoside drug Truvada, according to data from a 48-week study presented by Abbot at AIDS2010. The results, while not definitive, researchers say, suggest that the nucleoside-sparing regimen may be an alternative treatment option for patients new to HIV therapy.

Emotional barriers (such as stigma, fear, denial, and shame) and structural barriers (such as lack of knowledge, transportation, and insurance coverage) can prevent HIVers from seeking care and treatment, according to data from a national survey presented by Bristol-Myers Squibb at AIDS2010. Researchers recommend targeted programs, such as the Positive Charge project, to reach HIVers in communities facing such barriers.

SEPTEMBER /OCTOBER 2010 HIV PLUS

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PERFECTLY FLAWED

BY C OR E Y SAU CI E R

OF TWO WORLDS Although it can be easy to lose yourself in the world of spirituality and faith, be sure to have your feet firmly planted in science too

THINKSTOCK

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’ M C U R E D ! Two weeks ago I went to a special “healing service” at a spiritual event held downtown; a week later I went to see my doctor—and guess what.

I was healed! No more disease! It’s a miracle!

I was cleaned by the blood of Jesus, saved by the holy lamb, and made new by the blessing of the divine spirit. I am no longer coinfected.

My hepatitis C is gone. Hallelujah!

The truth is, I am a Jesus freak and a hardcore crazy Christian. Spirituality and faith are at the center of pretty much everything I do, and because of that, I tend to see the world through a haze of magical reality. So it should come as no surprise that I attribute the remarkable change in diagnosis to a miraculous gift from God. As far as I’m concerned, prayer changes everything.

The other truth is that many of you know I have also been on a rigorous treatment of weekly interferon injections and twice-daily doses of ribavirin for the past year that left me physically and emotionally deficit. I suffered a difficult year of additional medications, doctor visits, and literal headaches just for a 16% to 20% chance that this highly ineffective treatment would work. But it did! Some would say that I am one of the lucky ones. And I would agree.

Science is parenthetical and faith is absolute—or vice versa, depending on how you feel about one or the other. But in my opinion, both are equally necessary. I stand firmly in both worlds. A course of action is just as important as a course in miracles. Personal, emotional, and spiritual care is not something to be underestimated. When the chips are down, the struggle is difficult, and the out-

come is unsure, sometimes all you have is the intangible to hold onto. Just how music can change your mood and looking at the ocean can make everything else fall away, so too can prayer change the laws of physics. But don’t get crazy! Science has its place too.

At this healing event I went to (think fundamental charismatic Christians filled with the Holy Ghost, speaking in tongues, falling out, and praising God in the hope that they would be healed—and yes, I was one of them) at one point people were asked to go up and give their “testimony,” and this lady went onstage to speak. I guess I should add that earlier the preacher had asked us to commit $900 each to “activate” this healing because “all blessing requires an act of faith.” (I ignored that part.)

So the lady said something like, “I have [insert awful debilitating disease here], and my doctor says that I need to have this very expensive [insert awful debilitating treatment], but I can feel the spirit in this room, and I know God will heal me. So as an act of faith, I’m going to give the money that I have been saving for treatment to activate this blessing.”

OK, now. I have as much faith as the next person. I believe that everybody has a right to her or his own metaphysical path—or lack thereof. I believe that whatever gets you through the day and makes your journey easier is the best thing for the situation. But I’m still going to take my pill! One doesn’t have to supersede the other. Take your fucking pill, and then pray about it! It worked for me.

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

SEPTEMBER /OCTOBER 2010 HIV PLUS

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ASK & TELL Q & A W I T H L A S H AW N F OW L E R

A prolific author and blogger, LaShawn Fowler hones his energies on encouraging other HIVers to disclose. Once incarcerated for securities fraud, the 41-year-old Michigander has recently headed back to court, this time to file a civil suit against a Bible publisher for mental anguish and emotional duress for its Bible’s translation and word choices in passages widely believed to condemn homosexuality. —Benjamin Ryan

What motivated you to sue a Bible publisher? The Bible does

not discriminate. No one knows who goes up to heaven and who goes down to the world below.

So when they [published those antigay words], that was more or less discrimination. I looked at the laws for First Amendment freedom of press. The Supreme Court ruled that not all things that are printed are protected.

Anything that conveys a message that is [defamation]—that incites a riot, that incites violence—is not protected.

You filed this suit on your own.

Do you have any legal training?

I’ve taken paralegal courses, so I was abreast of how to file the claim from that.

You are on a “disclosure campaign” in your blog. What inspired this? I think it’s important that

people who are HIV-positive take the responsibility and disclose with their potential sexual partners. The only way a person is being infected is by someone who is already infected.

You’ve written one novel and are finishing another. What are they about? I just finished one based

on the civil complaint that I filed

against the Bible publisher, and I bring out issues and scriptures that were brought up in the case in an entertaining way.

And the novel you’re finishing now? The main character is a

medical student whose uncle dies of AIDS, and he becomes interested in finding a cure. During the process of him playing around in the lab, he gets pricked with a needle and gets infected with HIV himself. It provokes him to want to gain access to a cure faster than normal.

You’ve said when you first found out you were HIV-positive, you were in denial for some time.

What gave you a sense of acceptance? My attitude about the

whole scenario of being positive was very nonchalant. I knew I was sexually active, and I knew I wasn’t using precautions to protect myself from being infected.

[After my diagnosis] then I started taking medicine and I became a certified HIV educator and counselor through the Michigan department of community health.

And once I started learning more about the virus, that’s when I said, “This is more serious than I’ve given it credit.” That’s when I started getting serious about it.

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What are the main pieces of advice that you’ve given to people in your other book—the one about how to disclose your HIV status? Disclose your status with-

out being afraid. Relinquish all fear about being positive. Maintain a positive attitude. And continue to live your life as if you have no tomorrow.

What gives you the most satisfaction in your work fighting HIV? Helping others. Utilizing my

mind, standing up and being honest about my diagnosis, and having an ability to speak out when others refuse to—or are afraid to.

I think it’s something that a lot of people who are infected should take heed of.

“It’s important that people who are HIV-positive take the responsibility and disclose with their potential sex partners.”

TIPS +TOOLS

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Learn more about Fowler’s disclosure campaign on HIVPLUSmag.com

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