HIV Plus Magazine #80

Project Runway’s Mondo Guerra / When Civil Rights Met HIV / Black AIDS Awareness Day

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

BRIDGING THE GAP JANUARY/FEBRUARY 2011 www.hivplusmag.com

How visibility equals the empowerment to fight AIDS in black America

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

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

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

ISENTRESS will NOT cure HIV infection or reduce your chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system.

Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage.

When ISENTRESS has been given with other anti-HIV drugs, side effects included nausea, headache, tiredness, weakness, trouble sleeping, stomach pain, dizziness, depression, and suicidal thoughts and actions.

Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild.

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

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

In clinical studies lasting 96 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — The most common side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping — This side effect occurred more often in patients taking ISENTRESS plus Truvada (4%) versus Sustiva plus Truvada (3%) Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 21 mg/dL with Sustiva plus Truvada

Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

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

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

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

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

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

21052250(45)(110)-01/11-ISN-CON Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc.

Hey, have you heard the news?

For eligible patients, Merck covers up to $400 on out-of-pocket costs, for each of up to 12 prescriptions.

Introducing the Savings Coupona for ISENTRESS. Eligibility restrictions, terms, and conditions apply.a To ďŹ nd out more, call 1-866-350-9232 or visit isentress.com.

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

a For

eligible privately insured patients. Not valid for residents of Massachusetts. Restrictions apply.

Please see full Terms and Conditions on isentress.com.

Copyright Š 2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. 21052655(5)-12/10-ISN-CON

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Living the Questions On December 1, 2009—World AIDS Day—28-year-old advertising executive Tyler Helms came out and told the world that he’s HIV-positive. Now, as part of his aim to create a dialogue on the subject, he’s sharing his experiences and milestones, and answering the questions he’s been asked along his journey in a new column on HIVPlusMag.com.

Living the Questions runs biweekly on Tuesdays.

Q&A: Sheryl Lee Ralph From her annual Divas Simply Singing! event to Fight HIV Your Way, her new HIV awareness project with Bristol-Myers Squibb and the Alvin Ailey American Dance Theater, the original Dreamgirl has been fighting AIDS since the early days of her career.

In an exclusive interview, the actress looks back on a life of activism and discusses the battles yet to be won.

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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. 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, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. We’ll even take faxes at (310) 806-4268.

HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, 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.

TABLE OF CONTENTS JANUARY / FEBRUARY 2011

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6 MIND ALWAYS MATTERS Activist Cleo Manago uses self-esteem to battle AIDS—now the CDC wants to know more about his work

8 DRUG PROBLEM Cash-strapped states are dropping HIV-positive people from their ADAP eligibility lists

9 PREP WORK Studies show HIV-negative men who take Truvada have a good chance of staying negative—what will this mean for HIVers?

H-EYE-V 19 WORLD AIDS DAY DAWNS Dozens of landmarks are lit up red, including Sydney’s glorious Harbour Bridge, for a global day of awareness

HAART BEATS 40 UNDER CONTROL New research shows why some people with HIV don’t exhibit any symptoms

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42 EMPOWERMENT, IN GEL FORM New science could give women more choices in fighting the spread of HIV

43 COUNT IT OUT Determining the pace at which a person with HIV loses CD4 proteins may signal the ideal time to begin antiretrovirals

43 WASTE NOT HIVers with kidney problems don’t need to live in fear of a transplant

COLUMNS 44 MIND + MOOD

24 BREAKING THE SILENCE

How to talk with friends about your status without freaking them out

In honor of Black HIV/AIDS Awareness Day on February 7, we take a look at some of the creative ways organizations are working to defeat HIV in black America

46 PERFECTLY FLAWED

32 A NEW STRUGGLE As the HIV epidemic hits record highs among African-Americans, the nation’s largest civil rights groups become weapons against the virus

36 FASHION FORWARD With Mondo Guerra’s heartfelt announcement on Project Runway, a new HIV-positive star is born

Facing the dating game is never easy, but it’s a lot less scary when you don’t see your HIV as a failing COVER: Andre (pictured left) and Albert, a San Francisco couple who talk about getting tested together and staying HIV-negative in the Greater Than AIDS campaign (see page 24). To learn more: GreaterThan.org/DecidingMoments

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Mind Always Matters The CDC validates the work of Cleo Manago, who’s spent more than 20 years fighting HIV with self-esteem for many people, 2010 was a difficult year. But for AIDS activist Cleo Manago, last year was a triumph—and 2011 is looking good too.

Working for decades to fight HIV among African-Americans, Manago saw three of his innovative race-based programs receive millions of dollars in funding from the Centers for Disease Control and Prevention in 2010. Already helping thousands of people, Manago’s initiatives now have the potential to reach countless more.

Founder of the AmASSI (AfricanAmerican Advocacy, Support-Services, and Survival Institute) Centers for Wellness, Education, and Culture, the 47-year-old Manago has devoted his career to reducing internalized racism among African-Americans and homophobia among same-gender-loving black men since the first center opened in Inglewood, Calif., in 1989. He stresses the term same-gender loving as opposed to gay, and says the difference between the terms is what prompted him to open the center.

“When this disease began to get federal funding and foundation support, it occurred inside a white gay identity vacuum,” Manago says. “There was a need for more inclusion of men at risk who go to prison, who are bisexual, who sleep with men but don’t identify as gay.”

AmASSI, which now operates centers in Inglewood, Oakland, Atlanta, and Harlem, and initiatives in Baltimore and Johannesburg, South Africa, offers more than testing, treatment, and help with drug adherence; there are substance abuse prevention programs, art shows, and physical fitness and selfdefense classes.

“They’re cultural centers as opposed to health centers,” Manago says, adding

that the centers serve women as well.

“When it comes to primary prevention, HIV centers don’t work because people won’t access them until they have a crisis or are symptomatic.”

At the Inglewood wellness center in 1994, Manago gathered a group of black men who had sex with men and queried them on their HIV knowledge. He found that many of the men were HIV-literate; they knew what caused AIDS, but they nevertheless continued to routinely engage in unsafe sex.

“A lot of these men had questionable value for their sexuality and their [African-American] community,” Manago says. “It was that lack of value that fed into their inability to be consistent with reducing their HIV risk.”

To address the specific circumstances of these high-risk men, Manago developed an approach he calls Critical Thinking and Cultural Affirmation.

This model teaches black men who have sex with men how to unlearn some of the stereotypical myths about themselves. The program utilizes counseling and workshops to demonstrate the history of accomplishment by AfricanAmericans, the importance of critical thinking and self-respect, and the practical ways to protect oneself. There are also media literacy activities to help participants identify inaccurate portrayals of black men.

After receiving glowing feedback from participants for years, the CTCA model will now be formally evaluated by the City University of New York, on behalf of member campus Hunter College, in a $2 million, five-year study funded by the CDC that began in March. Should the model prove effective, it could be included in the agency’s influential Compendium of Evidence-

Based HIV Prevention Interventions. “[The CDC] saw its promise and decided to take it through the evaluation process with a control group to show its efficacy,” Manago explains.

The AmASSI Center also will receive $350,000 a year for five years from the CDC to implement another of Manago’s health models. The MAGIC (Mobilizing Against Growing Incidences of Communicable Disease) Black Leadership Initiative piggybacks off the idea of CTCA but features a diverse group of black people: female and male, gay, straight, bisexual, and same-gender-loving people. The main message is the same as CTCA’s—more self-esteem equals better self-care—but there will be a greater emphasis on showcasing success stories through peer training and personal storytelling delivered by local role models.

“We’ll locate people who successfully overcome challenges to protecting themselves, and their stories will be shared on social networks,” Manago says of the program, which went into full implementation in January 2011.

The final coup of late for Manago was that Black Men’s Xchange, a national group he founded in 1989 to promote healthy self-concepts in same-genderloving men of African descent, was one of the 19 organizations chosen by the CDC to be part of its $16 million Act Against AIDS Leadership Initiative. The initiative aims to harness the collective energy of long-standing African-American groups to increase HIV awareness and places the Black Men’s Xchange alongside organizations including the NAACP and the Urban League.

“We’ll be doing a lot of bridge building,” Manago says, sounding both weary and excited. ✜

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Light Switch Pope Benedict’s recent change of heart on condoms comes after decades of stiff Catholic resistance Coming from one of the most revered people on the planet, Pope Benedict XVI’s words resound greatly with Catholics around the world. When it comes to sexuality, Benedict and the popes before him have rarely offered progressive, sex-positive messages.

Instead, they have urged followers to remain abstinent until marriage, and, once a heterosexual couple is married, to never use contraception, even in a world where HIV is present. However, in the recent book Light of the World: The Pope, the Church, and the Signs of the Times, Benedict XVI indicates some movement regarding the morality of condom use in preventing HIV transmission. Here is a look at the Vatican’s mostly static stance on condoms: OCTOBER 6, 1979: “All human life, from the moments of conception and through all subsequent stages, is sacred.” —Pope John Paul II, at the White House during a trip to the United States

Pulling the Rug Out States are tightening their purse strings, and several are kicking HIVers off government-funded drug programs with unemployment high, most state budgets in the red, and spending-averse Republicans in control of the House of Representatives and 26 state legislatures, the bad news keeps coming for uninsured people with HIV. As of last fall, nine states had waiting lists for the AIDS Drug Assistance Program because of ballooning enrollment.

“The [wait lists are] indicative of how serious this crisis is,” says Ann Lefert, the director of the care and treatment program at the National Alliance of State and Territorial AIDS Directors, an organization representing the states’ top HIV leaders. “Advocates continue to push for more dollars, but when you hear the sentiments about spending, I don’t see what real investment we’ll see in this program.”

Since the states provide some of the funding for ADAP (along with the federal government), some are plugging budget holes

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by dropping those already in their programs, forcing many HIVers to apply for medication programs at pharmaceutical companies: Florida: The state announced in November that it was considering a change to its program formulary, lowering financial eligibility from 400% of the federal poverty level to 300%—as a result, 350 uninsured HIV patients could be dropped from ADAP. The state also has 2,200 people on waiting lists for the program. Tom Liberti, chief of the Bureau of HIV/AIDS for the Florida Department of Health, said in late November that the state was doing the “legal processing [for the formulary change] as we speak.” But, he says, “I’m optimistic that there will be increases for ADAP in both the Ryan White Care Act and our own state legislature.”

Ohio: With a budget deficit of around $8 billion, lawmakers are working overtime to slash budgets. NASTAD reports that after lowering its formulary from 500% to 300% of the poverty level in July, the state removed 257 people from ADAP rolls—that’s on top of a 328-person wait list for the program.

Utah: This state changed its program formulary in October 2009 from 400% to 250% of the poverty level, which booted 89 people from ADAP.

JANUARY 22, 2005: “[Pope John Paul II]… considers that it is necessary above all to combat this disease in a responsible way by increasing prevention, notably through education about respect of the sacred value of life and formation of the correct practice of sexuality, which presupposes chastity and fidelity.” —Statement from the Vatican JANUARY 22, 2005: “If someone is incapable of controlling their instincts…then they should do whatever is necessary in order not to infect others.” —Felipe Arizmendi, bishop of San Cristobal de las Casas, at a news conference in Mexico City MARCH 17, 2009: “You can’t resolve it with the distribution of condoms. On the contrary, it increases the problem.”—Pope Benedict XVI, referring to the AIDS crisis in Africa SUMMER 2010: “There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.” —Pope Benedict XVI, in response to a question posed by Light of the World: The Pope, the Church, and the Signs of the Times author Peter Seewald. The book was released November 24.

NOVEMBER 23, 2010: “I personally asked the pope if there was a serious, important problem in the choice of the masculine over the feminine [in discussion of condom use]. He told me no.… if you’re a woman, a man, or a transsexual.” — Vatican spokesman Federico Lombardi, clarifying Pope Benedict’s words in Light of the World: The Pope, the Church, and the Signs of the Times

PrEP Work Now that studies show pre-exposure drugs cut infection rates, will there be a run on your meds?

Clockwise from top left: Duane, Waxman, Pelosi, Yarbrough, Collins, and Quinn

Good Representation They’re not all bums—the elected officials who stand up for people with HIV

GE T T Y IMAGES (4); TRUVADA: AP IMAGES

to draw attention to a recently vetoed New York state bill that would have capped the amount of rent paid by low-income HIVers, Democratic state senator Tom Duane joined with several AIDS organizations in early November to block traffic in Manhattan; Duane was among 18 people arrested and escorted from the scene in handcuffs.

The politician’s actions spurred numerous headlines and kept this issue front and center—there’s hope that new governor Andrew Cuomo will be supportive of the measure.

Duane’s actions may be an extreme example, but he’s not the only politician sticking his neck out for people with HIV. According to the public policy and government relations departments of the Gay Men’s Health Crisis in New York, AIDS Project Los Angeles, and the AIDS Foundation of Chicago, these are some of the elected officials working hard for you: Rep. Nancy Pelosi (D-Calif.)

The former speaker of the House and current minority leader often trumpets her work on HIV causes, including her success in passing the Ryan White HIV/AIDS Treatment Extension Act of 2009. Pelosi also says that since she became House speaker in 2007, discretionary funding for HIV/AIDS has increased by over $500 million. As speaker, Pelosi pushed for an end to the ban on HIVpositive travelers to the U.S., which was officially dropped in January 2010.

New York City council speaker

Christine Quinn (D–N.Y.) Even though she upset AIDS activists in 2007 for initially opposing additional financial support for low-income HIVers, Quinn has regained their favor by blasting former New York governor David Paterson for his veto of the recent rent legislation and, in March, urging the Food and Drug Administration to end its ban on gay men donating blood. In October, Quinn also helped reverse most of a $1.88 million budget cut that affected formerly homeless New Yorkers with HIV. Rep. Henry Waxman (D-Calif.)

Waxman was one of the earliest congressional proponents of national funding to fight HIV, convening hearings on the matter in 1982. Eighteen years later, in November 2010, Waxman joined 13 other politicians in urging the Obama administration to increase HIV funding in 2011.

Two Illinois state legislators, Sen. Jacqueline Collins and Rep. Karen Yarbrough, persuaded the state to gamble on a novel idea for funding AIDS services— and they produced a winner. In 2008 the two Chicago-area Democrats backed legislation to establish state lottery games whose proceeds would be directed to AIDS education, prevention, research, and care. To date, the Quality of Life tickets have generated $1.4 million. In 2010, the third Quality of Life scratch-off ticket, “Red Ribbon Cash,” was unveiled December 1, World AIDS Day.

A pill can help prevent HIV infection.

That was the stunning finding in the November 2010 New England Journal of Medicine regarding pre-exposure prophylaxis, or PrEP. Clinical studies showed that HIV-negative people, specifically gay men and transgender women, who had sex with men were 44% less likely to be infected by HIV if they regularly took the antiretroviral pill Truvada, and study participants who took a daily regimen saw their infection rates drop by a staggering 73%.

This is great news in the fight to contain AIDS, but could it mean a longer wait for drugs or more expensive medications for people already HIVpositive?

“It’s hard to say,” says Kevin Sullivan, executive director of the Ohio AIDS Coalition. Sullivan’s organization operates in a state that has already established waiting lists for and dropped people from its AIDS Drug Assistance Program (see previous page). “Obviously, with funding for services declining, anything we can do to decrease new infections would be good—new infections are going to do nothing but add people who need more services.”

It’s also unclear who might pay for PrEP treatment; insurance companies, drug companies, or government agencies. Regardless, Cornelius Baker, the senior communications adviser at the AED Center on AIDS and Community Health, concurs with Sullivan and says keeping people negative saves resources—like other antiretroviral medications. That’s especially true if PrEP is only utilized for the most at-risk individuals, like prostitutes or IV-drug users.

“HIV prevention likely remains less costly than treating those already infected with the virus,” Baker says.

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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

H-EYE-V

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W Sir Elton John himself tickles the ivories at the Elton John AIDS Foundation’s ninth annual “An Enduring Vision” benefit in New York City on October 18. The rock star– philanthropist told reporters that the event has no overhead, so every dollar raised goes directly to HIV causes.

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THIS SPREAD AND PREVIOUS: GE T T Y

▲ A woman in Beijing contemplates a painting in the city’s “Creative Condom” exhibition, an art show intended to increase knowledge about HIV, on October 27. The Chinese government has pledged to step up its HIV prevention efforts, especially now that AIDS-related deaths in the country jumped by 20,000 in 2010, according to official records.

W Former president Bill Clinton talks about the importance of safe sex, being tested, and staying healthy as part of the “Fight for the Future” AIDS awareness event in Kiev, Ukraine, on October 3.

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▲ (Top) Professional U.K. cricket player Kevin Pietersen returns to his native South Africa to play for the Durban Dolphins in two October matches. Children who have been orphaned by AIDS were invited to the October 16 match, and Pietersen made a point of getting a little face time with them.

(Above) Protesters demand more government-funded AIDS programs at a September 20 demonstration in front of the French National Assembly in Paris. The bottom banner reads, “To fight AIDS, that’s not the right amount!”

X Australia’s Sydney Harbour Bridge is illuminated in commemoration of World AIDS Day on December 1. As part of the (RED) campaign, 80 iconic landmarks in 13 nations were lit in red to promote AIDS awareness.

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GE T T Y

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Take a picture Tell your story Inspire a dance If your photo and essay are chosen, the Alvin Ailey American Dance Theater will choreograph a new dance performance inspired by your story.

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.

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

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

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

These lists of medicines are not complete. Taking REYATAZ with some other medicines may require your therapy to be monitored more closely or may require a change in dose or dose schedule of REYATAZ or the other medicine.

Discuss with your healthcare provider all prescription and non-prescription medicines, vitamin and herbal supplements, or other health preparations you are taking or plan to take.

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

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

• Severe rash has occurred in a small number of patients taking REYATAZ. This type of rash is associated with other symptoms that could be serious and potentially cause death. If you develop a rash with any of the following symptoms, stop using REYATAZ and call your healthcare provider right away: –Shortness of breath –Conjunctivitis (red or inflamed eyes –General ill-feeling or “flu-like” like “pink-eye”) 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.

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.

Enter online at:

(Ailey company member Linda Celeste Sims; not a patient dramatization. Photo

by Andrew Eccles)

fightHIVyourway.com Entry forms may also be available at some healthcare providers’ offices.

Submit your entry between December 1, 2010 and February 28, 2011 • 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.

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

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

© 2010 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US10BC08707 11/10

Contestants must be 18 years of age or older.

Other restrictions may apply. See Web site for full details, including contest rules and additional eligibility requirements; or write to: Dept. 7372, PO Box 5010, Stacy, MN 55079-5010

Submit a photo and essay to enter

In honor of National Black HIV/AIDS Awareness Day on February 7, HIV Plus takes a look at some of the creative ways organizations are utilizing images of African-Americans to contain, and eventually defeat, HIV in this hard-hit community

By NEAL BROVERMAN

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tions happening each year” than assumed, Hoff says. “And when you looked at the epidemic in certain communities, particularly black Americans and men who have sex with men, we were seeing trends indicating we may see a rise in those specific groups.”

The hard numbers that Hoff and Wilson saw were indeed disturbing. While

African-Americans make up 12% of the U.S. population, they accounted for 51% of all HIV/AIDS cases diagnosed in 2007, according to the CDC figures (the most recent available). The rate of new HIV infections for black men in 2006 was six times higher than for white men and nearly three times that of Latino men. New infection

OPENER & THIS PAGE: COURTESY K AISER FAMILY FOUNDATION

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T AGE 19, Marvelyn Brown thought she’d met her Prince Charming. He was sweet, attentive, and hot—so when he asked to have sex one time without a condom, she obliged. Brown worried about getting pregnant, not about getting HIV, but contracting the virus was exactly what happened.

“At that age, I didn’t care about HIV,” says Brown, now 26. “It wasn’t an issue of mine. Up until then, my concerns were boys, school, and the prom. HIV was really at the bottom of the totem pole.”

Brown is now an AIDS activist, and often speaks about the importance of treatment and testing in New York City and Nashville, the cities where she splits her time. Her story is heartbreaking, yet inspiring. And it’s exactly the kind of relatable tale that an expansive media campaign called Greater Than AIDS hopes will encourage African-Americans, a group hit especially hard by HIV, to stay vigilant against the disease. This approach is emblematic of a new kind of campaign, featuring black faces and personal testimonies—on subway cars, on YouTube screens, and even on the fans fluttered by ladies in church, to reduce the stigma and change the perception of HIV. Brown tells her story on the website for Greater Than AIDS (GreaterThan.org), which includes a microsite called Deciding Moments, which contains a dozen personal stories about people and their relationships with HIV, including African-Americans who remain negative, knowledgeable, and empowered. Launched in the late summer of 2009, Greater than AIDS was sparked by a conversation at the 2008 International AIDS Conference in Mexico City between Phill Wilson, the president and CEO of the Black AIDS Institute, and Tina Hoff, the director of entertainment media partnerships at the Kaiser Family Foundation, a nonprofit health advocacy group.

“At the time of that AIDS conference, the Centers for Disease Control had just released new statistics on infections in the U.S. that showed that the situation wasn’t improving, but was actually worse than we thought it was—with about 40% more infec-

rates for black women, according to the same 2006 numbers, are almost 15 times that of white women and nearly four times that of Latinas. Blacks account for half of the approximately 1.1 million Americans currently living with HIV, according to the Black AIDS Institute.

Even with numbers like that, focus

groups conducted in mid 2009 by KFF (not affi liated with the Kaiser Permanente health insurance company) and the Black AIDS Institute showed the issue of AIDS was falling off the radar of African-Americans, mostly because it had fallen off the media’s radar. “AIDS the epidemic is out there, but nobody really talks about it,” said a young

woman at one of the focus groups. “That’s probably our biggest disease, lack of knowledge,” said another focus group attendant.

In response to the findings, KFF, working with guidance from the Black AIDS Institute, created a broad campaign that targeted African-Americans with a goal of keeping the issue front and center in magazines and

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really resonated with us.”

KFF manages the campaign, which receives additional funds from the Elton John AIDS Foundation, the MAC AIDS Fund, and the Ford Foundation. The CDC and local health departments contribute their resources for local Greater Than AIDS promotions at community centers and clinics.

Working with companies like Clear Channel and American Urban Radio Networks, Greater Than AIDS has placed print ads and public service announcements, many featuring the Deciding Moments individuals, in magazines such as Essence, Ebony, Vibe, and this magazine—dozens of

radio stations around the country have also broadcast Greater Than AIDS PSAs. Each of the media companies has offered free ad space and time, which allows KFF to direct costs to the physical campaign production, like photo and video shoots.

KFF has extended the reach of the campaign by producing programming that’s entertaining and informative. For some radio spots, up-and-coming musical artists spoke about their “deciding moments” when it came to HIV and AIDS. Comedian Steve Harvey hosted a Greater Than AIDS– sponsored radio show that promoted testing and treatment. “Black media is now more engaged with HIV” due to the campaign,

LEFT: COURTESY GMHC; RIGHT: KRISHNA STONE

television, on radio and billboards, and at concerts and sporting events. The hope was that the issue of AIDS would permeate the public’s consciousness and lead to discussions and healthy decisions.

“We felt there was really an opportunity for a mobilization that brought together a broad cross section of partners—media and others—to mobilize around AIDS in this country,” Hoff says.

The name for the campaign came from a World AIDS Day speech in 2006 by thensenator Barack Obama in which he “spoke about the power of individuals coming together to achieve something greater, in that case reducing HIV,” Hoff says. “That

GMHC has numerous campaigns geared to the black community. Marketing materials for, from left, “I Love My Boo,” “We’re Not Taking This Lying Down,” and “First Ladies Care.”

says the Black AIDS Institute’s Wilson.

Greater Than AIDS also set up booths at the football games of historically black college teams to direct people to HIV information and resources, and it provided testing at the 2009 and 2010 Essence Music Festivals. Also, state and local AIDS organizations in six states and Washington, D.C., approached the campaign to incorporate Greater Than AIDS billboards with local resources and information—that added up to almost 4,000 outdoor advertisements, with Georgia, Louisiana, New Jersey, and Ohio coming on board with promotions in the coming year.

The hard question, of course, is whether

any of this makes a difference. Are more people getting tested? Are more people using condoms? Are more seeking treatment and sticking to their drug regimens?

It’s difficult to gauge the benefit of a single campaign, and new infection numbers from the CDC don’t come out until this spring.

But if Brown had been more aware of HIV at a teenager—if she saw images of people like herself dealing with the issue—she says she would have thought twice about having unprotected sex seven years ago.

“What I like most about [Greater Than AIDS] is how they work to make you relate and how it targets a group disproportionately affected,” she says. When African-

Americans don’t see their faces or stories, she says, “You can lose them.”

If Greater Than AIDS is a broad campaign that stretches from newsstands to billboards to airwaves, from coast to coast, other efforts are trying a more focused approach. Urban black men who have sex with men and churchgoing African-Americans are being targeted by efforts from the New York–based GMHC. Glossy images of black and Latino couples promising fidelity, respect, and honesty make up GMHC’s “I Love My Boo” campaign, which fi rst appeared in the restrooms of New York’s gay bars and nightclubs last year before transitioning to 1,000 New

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York City subway cars and 150 subway stations. The posters carry the message, “We’re PROUD of who we are and how we LOVE.” Like Greater Than AIDS, the campaign promotes positive self-images and uses its message to encourage responsible behaviors— like monogamy, safe sex, and testing.

“Black and Latino gay men have absolutely no representation of themselves in the media and mainstream society,” says Francisco Roque, GMHC’s director of community health. “Typically, when gay folks are portrayed in the media, they’re white gay men. So, for these young men to be on the subway and see an image that looks like them really communicates to folks that you matter, that you’re worthy, that people are creating campaigns that speak to you. It

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changes the conversation and brings people in.”

GMHC made sure the posters were of high quality, for reasons deeper than aesthetics.

“We’ve really made an effort to change the landscape of [HIV-related] materials,” Roque says. “Previously, materials that targeted people of color were Xeroxed and of poor quality. You didn’t really see images of people of color in the gay community that really lifted them up.”

In October, GMHC launched another campaign, decidedly different from “I Love My Boo.” Capitalizing on the prominent role that many pastors’ wives play in church culture, the “First Ladies Care” initiative places the photos of those wives on hand-

held fans distributed at Sunday services— with information on testing, safe sex, and the importance of HIV discussion stressed on the back.

Brooklyn’s First Baptist Church of Crown Heights is the campaign’s fi rst congregation, and that church’s prominent first lady, Ellen Norman, is its fi rst spokesmodel.

Having female role models like Norman encouraging HIV education and discussion is imperative, says Alicia Heath-Toby, director of GMHC’s Women’s Institute.

“We wanted to empower women of color to engage in discussions around sexuality and prevention and holding women of color very high while doing that,” Heath-Toby says.

GMHC is planning to bring the program

“[We’ll say] to faith-based communities, ‘I’m not here to convince you about biblical tenets, I’m here to talk to you about the health of your parishioners.”

COURTESY K AISER FAMILY FOUNDATION

— Whitney Engeran, AIDS Healthcare Foundation public health director

to other black churches in the city, and it may spread to other areas outside the organization’s purview.

“The fans have really caught on,” says Krishna Stone, assistant director of community relations at GMHC. “People are mailing them to their family and friends who go to churches in other states so their churches will think about launching a campaign—they’ve gone down south, up north, everywhere. It’s very exciting.”

Women are targeted in GMHC’s “We’re Not Taking This Lying Down” campaign, which features images of women in authoritative poses with messages like “HIV. Get Tested. Get Control” in newspaper ads, telephone kiosks, and on fliers passed out at community events. A photo exhibit of HIV-

positive women of color, launched as an antistigma measure, was featured in various venues throughout New York this fall.

Roque says it’s important for GMHC and other HIV organizations to remember African-Americans are as varied as any other minority group.

“We realized that all black men don’t respond to the same message, so we have to have a variety of things and we have to reach people via their social networks in ways that are really specific to whatever it is they might be into,” Roque says. “Sometimes we target congregations, sometimes we go after the Ball community, which is another social network, or we work within beauty shops.

Sometimes we work within the network of sex parties and reach people with messages that speak to them inside the culture of that social network.”

Los Angeles–based AIDS Healthcare Foundation is betting sex will be an effective tool in getting people’s attention—the group has a new campaign launching this winter called “Th is is Me, Raw,” featuring 14 men, several of color, talking about their experiences with HIV while they take off items of clothing. In the two-minute-long videos, which AHF is considering making part of a national TV and online campaign, all the men end their conversation completely naked—though viewers don’t see anything X-rated. The intention is to get people to speak honestly about sex and AIDS, to remind people how intertwined they are, and to show there’s nothing about either to be ashamed of.

“Inside this context of being raw, we mean being real, and we intentionally picked up on the double entendre, given the prevalence of barebacking [sex without a condom],” says Whitney Engeran, AHF’s public health division director. “We want to really start a conversation with people about being raw and truthful about HIV.” In the videos, AHF intentionally cast a diverse group of men—white, black, Asian, Latino—betting that the variety of faces will

cast a wide net. Instead of launching into these men’s sexual orientation or describing their ethnicity, the pieces all begin with the men introducing themselves and saying what they do for a living. “We wanted to find a common human thread” in the videos, says AHF program manager Bradley Estrin, who came up with the idea for the campaign, which was funded through a grant.

AHF works a lot with minority communities in south and east Los Angeles, sending mobile units to those areas to help with testing, along with health and medication information. Engeran says it’s important for his organization to know its audience and to respond appropriately.

“If we talk about knowing your status and knowing your health [with people of color] and stay away from some of those things that are hot-button issues in certain cultural contexts—whether it be homosexuality or feelings about masculinity— we’re more successful,” he says. “[We’ll say] to faith-based communities, ‘I’m not here to convince you about biblical tenets, I’m here to talk to you about the health of your parishioners, and that when you know you’re positive and on treatment, you’re much less likely to spread the virus.”

Engeran stresses the point that he hates the term down low, which for him and many others implies black men, specifically, creeping around and spreading sexually transmitted diseases, like HIV. Campaigns like “Greater Than AIDS,” “I Love My Boo,” “Th is is Me, Raw,” and even “First Ladies Care” flip the script on down low by presenting a different notion of black sexual identity—one’s that informed and honorable and encourages people to lead by example.

“I respond to things that relate to me,” says GMHC’s Alicia Heath-Toby. “So when we couple messages of prevention and antistigma with talking honestly about sexuality, and those images look like we do, we’re more likely to engage in conversations and behavior in a much more powerful, positive way.” ✜

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WE SHALL OVERCOME AGAIN

As the HIV epidemic hits record highs among African-Americans, the country’s biggest civil rights groups become a force against the virus

By MICHELLE GARCIA

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imee elizabeth lang initially learned about AIDS in the second grade, when she first encountered the AIDS Memorial Quilt in Washington, D.C. Throughout her school years, she became particularly interested in learning about sexuality and health and, as a result, decided to work as a peer mentor at her Buffalo, N.Y., high school, providing fellow students with safer-sex and HIV/AIDS information. “If our peers had questions about sex or didn’t feel comfortable talking to the school nurse or their teachers about it, we were the people to come to,” she says. Lang’s now the program associate and project coordinator for HIV/AIDS awareness at the Harlem, N.Y., offices of the National Coalition of 100 Black Women (NC100BW), a post she took upon graduating from New York University in 2009.

As a child Lang was taught about HIV and AIDS, but it wasn’t until her work as a peer educator that she began to understand how the disease disproportionately affects blacks. According to the Kaiser Family Foundation, African-Americans make up nearly half of the 1.1 million people in the country with HIV, while representing only 12% of the total U.S. population.

“I’ve always grown up with HIV awareness around me,” Lang says, adding, “My mom brought it to my and my brother’s attention. Eventually, I learned about how devastating [HIV is] for women of color and their families. HIV is the leading cause of death for 25-34-year-old black women, and a lot of it is because they don’t have access to HIV/ AIDS treatment or general awareness.”

While Lang was learning, America’s civil rights organizations were learning as well, grappling with long-held notions about AIDS. As these groups’ attention has turned to the spread of HIV in the U.S., African-Americans are being recognized as a population needing specific education, outreach, and treatment. So naturally, one of the best avenues for those three things are civil rights groups that have been reaching out to and advocating for black people on a grassroots level for generations.

Just recently the largest and oldest of these organizations, the National Association for the Advancement of Colored People, which represents black Americans with its many active chapters and prominent national assembly, began to tackle AIDS as a civil rights issue, though the work has not been without its obstacles.

Shavon Arline, the director of health programs for the NAACP, has built her career around speaking frankly as a way to empower communities to face wide-reaching health issues. Before joining the national group in September 2009, she served a local Washington, D.C., chapter with health-related outreach to youth in the area. That experience, she says, prepared her to engage a national audience who were hung up on old notions about addressing HIV and sexuality. Overcoming squeamishness about sex is no small feat within the context of a civil rights movement whose members are so often closely linked to churches.

“We have to get to a point where we can talk about sexuality,”

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Arline says. “It’s one of the biggest taboos in the black community. So many people are raised in churches and taught that [HIV prevention equals] abstinence, and that’s it. But you find young people in communities of faith who hear that and nothing else—then they go off and experiment and expose themselves to risky situations. We have to expand the conversation to say ‘Abstinence is best, but experimenting safely is OK too.’ ” Arline’s move to the national NAACP offices coincided with a growing national dialogue on wellness: health care reform in Congress, the Centers for Disease Control and Prevention’s Act Against AIDS Leadership Initiative, and the release of the Obama administration’s National HIV/AIDS Strategy. At the time, the NAACP had gone nearly three years without anyone officially overseeing its health strategies on a national scale. Since she took on her role, HIV/ AIDS has become one of the first disease-specific initiatives that the organization has addressed. Typically, the organization has pushed for access to fair and affordable health care, but it saw HIV and childhood obesity as two issues that were in dire need of direct action among African-Americans.

The CDC sees the expansion of civil rights missions to include HIV/ AIDS as a way to further the agency’s initiatives as well as help these groups with their own projects. Robert Bailey, leader of the Prevention Partnerships Team within the CDC’s HIV/AIDS prevention division, says the fight against HIV goes further than simply condom and pamphlet distribution. “We need to turn the tide about this disease, so we’ll have to get this and all of its causes,” he says. “It’s not only HIV, but we’re also talking about other sexually transmitted diseases, lower income levels, education—all of which are major factors in HIV.” Lang also sees that socioeconomics play a role in the high rate of HIV among African-Americans. “According to the census, a quarter of African-Americans live in poverty,” she says. “We know that HIV is more prevalent in impoverished areas of the country. People who live in poverty tend to have unsafe sex or multiple partners, which certainly contributes to the high rates of STDs, specifically in women.”

This is where many of these civil rights groups—which have worked on issues such as education parity, voting rights, and housing discrimination for decades—can play a multidimensional role. Launched in April 2009, the CDC’s Act Against AIDS Leadership Initiative is a $16 million, six-year partnership between the government agency and several national organizations, such as the NAACP and Lang’s NC100BW. Since the program’s launch, at least 200,000 people have attended more than 1,400 outreach events, many set up in conjunction with these civil rights organizations, according to the CDC. Act Against AIDS also aims to increase outreach to Latinos and men who have sex with men. Along with blacks, these populations are the hardest-hit when it comes to HIV—a harsh reality, as one of the most basic barriers the black population must overcome with HIV is its stigma and its association with homosexuality.

“If you look at the HIV epidemic, you have many men who don’t

“We have to get to a point where we can talk about sexuality. It’s one of the biggest taboos in the black community. So many people are raised in churches and taught that [HIV prevention equals] abstinence.”

—Shavon Arline, director of health programs for the NAACP

From top: Aimee Elizabeth Lang of the National Coalition of 100 Black Women; the NAACP’s Shavon Arline; Robert Bailey of the CDC’s HIV/ AIDS prevention division

want to get involved because of the fear of being associated with gay men, or being gay,” Arline says. “It makes no sense—the disease is killing everybody.”

During her tenure, Arline says she’s seen the focus on HIV among organizations like hers shift dramatically. She attributes this as a direct response to efforts by the CDC, the federal Office of Minority Health, and other groups to expand their outreach to include HIV education and prevention. “Looking back at our accomplishments over the last year and a half, we’ve had the greatest amount of changes, simply because we were able to receive funding,” she says.

Leaders from other groups have also realized the crisis status of HIV and are acting accordingly. The National Council of Negro Women’s AIDS-related programs are small, communitybased outreach initiatives in the United States as well as in parts of Africa such as Zimbabwe, Senegal, and Egypt. The local chapters of 100 Black Men of America focus on various health issues— usually depending on the greatest need of each chapter. In New York City, for example, members recently held a youth symposium on teens living with and dating with HIV. The Reverend Al Sharpton’s National Action Network has launched a five-year campaign called “I Choose Life,” which recruits clergy, celebrities, government officials, and local leaders to become ambassadors for HIV outreach. And members of the Congressional Black Caucus recently submitted resolutions and legislation addressing HIV.

Rep. Maxine Waters of California got her 2009 Stop AIDS in Prison Act through the House, but it was never granted a vote in the Senate.

HIV/AIDS is not entirely new to all civil rights groups.

It has been a key issue for the NC100BW since 1989. But some of that group’s more recent efforts have been to foster casual discussion about HIV. Its Beauty Shop Chats, Lang says, are laid-back talks about HIV in a familiar, comfortable atmosphere where women are already having a dialogue about topical issues. “This way, it’s not such a formal thing,” she says. “Some people become intimidated if you have one-onone chats, so this makes it easier for people to talk or just listen.”

As so many projects like the Beauty Shop Chats demonstrate, having an open dialogue about sexuality and sexual health helps people learn about HIV and therefore helps them stay protected. Lang stresses that people of all ages do want to talk about HIV, but the opportunity may not always present itself. To remedy that, local chapters of the NC100BW sponsor events to educate elderly women on HIV as well as go to high schools to provide information about the virus—an important step, as African-Americans make up 61% of newly diagnosed young people ages 13-24.

While the rates of infection, AIDS-related deaths, and undereducation are alarming, the hope is that a new focus, appropriate funding, and a national strategy will alleviate the epidemic among blacks and the overall population. ✜

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FASHION FORWARD With designer Mondo Guerra’s announcement on Project Runway, a new HIV-positive star is born

BY NEAL BROVERMAN

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easier to break the news there than in Denver with his parents, who had no idea of his status. Four days before the dramatic episode’s September 30 broadcast, Guerra arranged an intimate dinner with his parents, his sister Tanisha, and his partner, Ben. Aside from being swamped with creating a collection for the final challenge, his procrastination in telling his parents stemmed from uncertainty about their reaction—especially since millions of people would find out about his HIV

just a few dozen hours after his parents did.

“I just didn’t know what kind of dynamic putting it out there would create with them,” he says. “I’m just so connected with my mom and dad that it would affect me in a bad way if they didn’t really accept it.”

As soon as dinner was served, Guerra cut to the chase, telling everyone what transpired with the pants and about the announcement that followed.

“The first thing they said is that they really

COURTESY LIFE TIME

“ when i first got to the show I was very scared of Tim Gunn,” Project Runway finalist Mondo Guerra says. “In the first couple of critiques I was shaking; I couldn’t really talk to him because I was so intimidated.”

Intimidated is probably not an adjective most would use to describe Guerra, who narrowly lost the reality competition’s eighth season to Gretchen Jones. Guerra’s bold designs, matched with his consistent candor and composure, made him a fan favorite and critical darling. But it was his spontaneous decision to come out as HIV-positive in the show’s 10th episode that solidified him not only as one of Runway’s most memorable contestants, but an inspiration and role model.

Guerra says it was a completely unscripted moment when he told judges Heidi Klum, Michael Kors, Nina Garcia, and Rachel Roy about his status.

“I didn’t really mind talking about it; it really was at that moment that I decided to speak out,” Guerra says from his home in Denver.

That episode’s challenge required the contestants to create fabric with which to design an outfit that said something about their personal lives; Guerra designed glamorous highwaisted pants festooned with plus signs.

“When Nina said, ‘I wish I knew what the story was about the pants,’ it allowed me to really open up,” Guerra says. “She didn’t force it; the producers weren’t begging me to speak about it. They weren’t saying, ‘You need to talk about this for ratings.’ It was really about my own decision, and I’m very happy that I was able to talk about it.”

The usually unflappable Gunn was deeply affected by Guerra’s announcement, and it initiated a bond between the two.

“I was moved to tears by Mondo’s HIVpositive admission before the judges on the runway,” Gunn says, describing how he watched from behind the cameras. “I could read his emotions through his body language; while Heidi was talking and pushing, there eventually came a moment when I could see a visible release of the tense muscles in his back, then he relaxed his shoulders, and then he declared his condition. There was a palpable hush and then tears everywhere.”

There was no embarrassment on Guerra’s part regarding his HIV, Gunn believes. Guerra’s tension “had to do with the fact that he had been in such psychological agony about talking about his condition and had been concealing it from everyone,” he says.

Even though the impulsive announcement was made in front of celebrities, his fellow contestants, and a slew of cameras, it was

“It was scarier for me to come out positive than gay. Living with HIV is hard enough, and then there’s the stigma attached to it. People wonder how you caught it or they just think it’s simply a gay disease.”

Clockwise from far left: Guerra on the Runway set; with Gunn (right) and the show’s three other finalists; looking sharp at the finale; and the HIV-inspired pants he created

love me,” Guerra recalls. “They said we’re a strong family, we’ll get through it together, and they left it at that. It was a good night.

You know, with maternal instinct I think my mother already knew—she was just waiting for me to talk to her about it.”

Coming out as gay to his family at only 17, Guerra has not typically hidden much from his parents. It says much about how much judgment HIV-positive people face that it took a decade for someone as forthright as

Guerra to be honest about his status.

“It was scarier for me to come out positive [than gay], just because it’s newer, it’s fresher,” Guerra says. “Living with HIV is hard enough, and then there’s the stigma attached to it. People wonder how you caught it or they think it’s simply a gay disease. There’s just not enough education, so it puts fear into people.

It put so much fear into me that it took 10 years for me to talk about it.”

It’s imperative that people discuss HIV

more, Guerra says. He’s hoping to lead by example: On December 1, Guerra spoke in Washington, D.C., for World AIDS Day. The 32-year-old also wastes no time in plugging Jeans for Life, a program he got involved with through his relationship with Los Angeles’s AIDS Healthcare Foundation.

“The drive is about donating jeans that are recycled and resold,” Guerra says. “All the money goes to free health care for people with HIV/AIDS. Everybody has extra jeans, so I definitely encourage everybody to check out JeansForLife.org.”

Attitudes regarding HIV are evolving, albeit slowly, Guerra believes. He references Jack Mackenroth, the Project Runway contestant from season 4 who announced his HIV-positive status after leaving the show for health reasons.

“In Jack’s season they didn’t really go into his HIV very much, [the show just explained] he has a staph infection and is leaving the show,” Guerra says. Regarding this season, “I say ‘thank you’ to Lifetime for taking the chance to really talk about such a subject on the network. I think it definitely shows growth in society.”

While Guerra is happy to contribute to some of that progress, he, like so many people with HIV, doesn’t want to be defined by his disease.

“It’s not just about me living with HIV/ AIDS, it’s about living with any type of hardship or anything that you’re scared to talk about, anything that you don’t want to be open about,” he says. “And I think me speaking out about my personal life has really given people strength and courage to start letting go of certain things they’ve held on to for a long time.” ✜

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HAART BEATS

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Under Control

GE T T Y IMAGES

Research now shows why there are some people who have lived with HIV for years without ever showing symptoms on average, people with untreated HIV progress to AIDS in about 10 years. However, a small group of HIV-positive people develop very few or no symptoms of AIDS, even without the use of antiretroviral drugs. Now researchers led by a Massachusetts General Hospital team have found that about one in 300 people with HIV never display symptoms of their infection because of the way their immune system reacts to the virus.

These “controllers”—as the researchers classify the one in 300—have immune systems that, because of a genetic variation, alert the body’s virus-killing T cells of HIV’s presence, thereby preventing HIV from replicating and destroying immune cells.

Mass General and other institutions recruited thousands of HIVers in North America, Europe, and Australia for the study, whose results were published in the journal Science in November. The researchers found that the controllers showed very little of the virus in their blood, and in some cases it was entirely undetectable. Still, the patients had tested positive for HIV antibodies, indicating that they had indeed contracted the virus.

Bruce Walker, MD, a professor at Harvard Medical School and Mass General’s director of AIDS research, fi rst became involved with controllers when the Reverend Robert Massie, a young Episcopal minister, came to his office in 1994, a decade after learning he had HIV, but still showing no symptoms. He came to Walker to find out why he was still alive and well, and he thought his case might provide information that could help others. Walker at fi rst was

One in 300 people with HIV never display symptoms of their infection. These “controllers”—as the researchers classify the one in 300—have immune systems that alert the body’s virus-killing T cells of HIV’s presence, thereby preventing HIV from replicating and destroying immune cells.

certain that Massie had received a false-positive HIV antibody test result.

After Walker took his own tests and confirmed that Massie was truly HIV-positive, Massie became the fi rst subject in a study that has grown to include 3,500 volunteers.

Florencia Pereyra, MD, who worked on the research team, told HIV Plus that it is still unclear how the data from the study will aid in development of drug therapies, but she said the intense examination of the immune system will help scientists understand how to manipulate cell operations. For instance, researchers might be able to determine how to artificially replicate the controllers’ natural response in others with HIV. ✜

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HAART BEATS

Bio Rhythms A composer in Georgia is raising money for an HIV vaccine through the music of the virus itself

Empowerment, in Gel Form New science gives women more choices in controlling the spread of HIV women currently have a robust variety of birth control options. Now advances in microbicide gels that can be applied to the vagina raise the possibility of providing women greater choices when it comes to preventing the spread of HIV. A microbicide gel containing the antiretroviral drug tenofovir had a 39% success rate in protecting women from acquiring HIV from their sexual partners, according to results released last year from a clinical trial in South Africa. Though the success rate is relatively low, a microbicide may appear on the market within a few years, pending other studies of the gel’s effectiveness. Scientists are hopeful that further advances in the microbicide’s composition will improve the success rate, providing women with the first form of protection they can use against infection.

“Tenofovir gel could fi ll an important HIV prevention gap by empowering women who are unable to successfully negotiate mutual faithfulness or condom use with their male partners,” study co–principal investigator Quarraisha Abdool Karim, Ph.D., told Science Daily.

A further microbicide trial under way, known as VOICE, is comparing the effectiveness of tenofovir gel versus oral pre-exposure prophylaxis (PrEP)—the use of antiretroviral pills to prevent HIV transmission. Results from that study are expected by 2013.

Even though researchers expect that a PrEP regimen might be approved before the tenofovir gel, the gel still has advantages.

Since the drug contained in the gel remains in the vaginal tissue, it’s unlikely that a woman who becomes infected while using the gel would develop a drug-resistant form of the virus. And microbicides show promise in preventing other sexually transmitted diseases, including genital herpes.

Scientists are also working to develop a rectal microbicide gel, designed for the 95% of gay men and 40% of heterosexual women who have engaged in anal sex at least once during their lifetime. Because tissues in the rectum are more fragile than vaginal tissue, a different type of gel is needed. Large-scale human trials for a rectal gel are not expected to begin for another two to three years, according to The New York Times.

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Where most see nucleotides and amino acids, Alexandra Pajak hears music.

A recent graduate of Georgia Institute of Technology and a composer, Pajak drew inspiration for her album Sounds of HIV from the DNA of HIV. Using the virus’s genome, as mapped in 2009 by researchers at the University of North Carolina at Chapel Hill, Pajak assigned musical notes to the structure’s nucleotides and pitches to the amino acids of the virus. The 17 tracks, performed by the Sequence Ensemble, are a direct musical translation of the genetic code of the virus. She chose a somber A-minor scale for the compositions to reflect the grave impact of the disease.

Pajak, who studied social work, previously composed music based on the DNA structure of the West Nile virus and the DNA of Agnes Scott, namesake of the women’s liberal arts school Agnes Scott College, which Pajak attended as an undergraduate.

Pajak told Scientific American that she took this particular work very seriously.

For accuracy, Pajak spent time double-checking that the 9,181 notes in her compositions corresponded exactly to the nucleotides of HIV’s DNA, taking no artistic liberties for the sake of the music. “Just knowing that the disease is so devastating and personal,” she said in the article, “I just wanted to make sure all the notes were right.”

A portion of the proceeds from the album, available from Azica Records (Azica.com), will go toward HIV vaccine research at the Emory University Vaccine Center. (Available on Amazon.com for $8.99)

Waste Not HIVers with kidney problems don’t need to live in fear of a transplant

Count It Out

GE T T Y IMAGES

Determining the pace at which a person with HIV loses CD4 proteins may signal the ideal time to begin antiretroviral treatment people newly infected with HIV might be able to better manage their treatment by learning their CD4-cell count shortly after infection. CD4, a protein on the surface of certain white blood cells, is sought out by the virus seeking cells to infect. A study of 516 people with HIV that appeared in AIDS Research and Human Retroviruses shows that early tabulation of CD4 counts can help doctors better determine when patients should begin antiretroviral therapy.

The virus’s infiltration of the cells leads to a drop in CD4 cell count, then a small wave of recovery, followed by a slow decline in CD4 count over time. Once the CD4 count falls below 350 cells per microliter of blood, doctors usually prescribe antiretro-

viral drugs. Once a person falls below 200 cells per microliter, he or she is considered to have AIDS. Those considered fast progressors—developing AIDS within 7.5 years of contracting HIV—had lower peak CD4 cell counts early in infection than slower progressors did.

According to the study’s authors, quick, permanent loss of CD4 proteins shows signs of long-term immune system damage in people who were classified as fast progressors.

Researchers caution that further study must be done to see if fast progressors’ protein levels may recover after beginning antiretroviral therapy, but the results of more research may help doctors better evaluate who needs antiretroviral treatment sooner than others.

As the lifespan for people with HIV grows—and the drug treatments wreak havoc on survivors’ kidneys—the need for kidney transplants has drastically increased. And even though there has been little in the way of research on the effectiveness of organ transplants in people with HIV, a new study led by the University of California, San Francisco, shows most HIVers with kidney disease are healthy enough to survive a transplant.

Because of the toxicity of HIV drug treatments and the shorter lifespan of people with HIV before the 1990s, many of those who required transplants were deemed unable to survive such an operation—and were therefore denied the treatment. But as more people began to live longer with more advanced HIV treatment drugs, surgeons in a handful of hospitals opted to OK the transplants. New findings published in The New England Journal of Medicine in November 2010 show that patient and graft survival are high enough to sanction these transplants.

One hundred fifty patients were examined in 19 medical centers across the country. The patients were followed for up to three years, exhibiting a 95% survival rate at one year and a 88% rate by year 3. Of the 11 who did not survive after three years, their deaths were caused by heart problems or lung infections as well as cancer in the old kidney.

Despite the findings, the incidence of kidney rejection among people with HIV was higher than average. Peter Stock, MD, who led the study, told Reuters that while most rejection episodes were reversed, each instance of rejection “takes a little bit of life out of a kidney.

So instead of lasting 20 years, it might last 15 years.” Still, 15 years with a well-functioning kidney is a contrast to not being cleared for a transplant at all.

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STATUS+SYMBOLS MIND MOOD

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Gary McClain, Ph.D.

Speech Therapy Talking about your status with friends shouldn’t be complicated, but it often is; here’s how to make it easier

ANDREA MORINI / THINKSTOCK

my clients frequently say how difficult it is to have a conversation with their friends about being HIV-positive, even with friends who also are.

A client I’ll call Marco had this to say about his friendship network: “My friends are all about having fun. With them, I have to pretend my HIV doesn’t exist. I’m supposed to be the funny guy even when I don’t feel very funny.”

Another client, who I’ll call Shannon, put it this way: “I’m always the rock. But once in a while, I just want to talk about how I still feel a little bit scared when I’m facing my next doctor’s appointment. When I bring it up with my friends, all I get back is ‘Oh, don’t worry. You’re fine.’ And I probably am fine.

But I still need to be able to talk about it.”

While it’s important to face HIV with a positive attitude, sometimes being told to stay positive can feel more like “don’t ask, don’t tell” than words of encouragement. Silence isn’t always so golden.

Friends, frenemies, real friends?

Many of my clients living with HIV have created a network that includes people who, whether they mean to or not, basically encourage them to keep their HIV, and their feelings about their diagnosis, under wraps. The message they get is “Don’t rock the boat.” But they find that the boat they’re on is not taking them to a “come as you are” party, rather a place where they’re given a script to follow.

Is HIV the elephant in the room?

While you may feel that you can’t talk about what’s going on around your HIV because your friends don’t want to hear about it, they

may also be assuming that this is a topic you don’t want to talk—or hear—about. The elephant is in the room, but everyone has silently agreed to ignore it. Or your friends may fear that if they talk to you about HIV, they will also need to “fi x” you in some way, and they don’t know how to do that. The result is that you lose out on support that you need.

Stand back and watch. Turn on your internal video camera and focus it on the person you are in your relationships—how you behave, how you feel, what you give and receive. By doing this, you will gain a clearer picture of the role you’re playing and what you would like to change. Ask yourself: Am I sleepwalking through my friendships? Where are we holding back from being real with each other?

Get real. Let close friends know you need to be more open about what’s going on in your life—the fun stuff and the not-so-fun stuff. Also, communicate that all you really need is for them is to listen—no fi xing required. Tell them you are willing to do the same for them.

“Don’t ask, don’t tell” only works when… Actually, it never works. Make a resolution to attempt more satisfying communication with your friends. It’s definitely worth a try.

McClain is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

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PERFECTLY FLAWED

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Corey Saucier

With Confidence

RYAN MC VAY / THINKSTOCK

Convincing yourself of your worth—regardless of your HIV status—is the only way to win the dating game my last column was about relationships, and after a tirade on the inevitability of loneliness and the exhausting search for love and companionship, it ended with “just doing my best.”

Looking back, I don’t know where those weak, passive, self-effacing last four words came from. “Just doing my best”? What kind of wimp says something like that when discussing the most important thing in the universe—love? What kind of self-respecting person doesn’t have the courage to take some responsibility for the trajectory of a failed relationship? If those words came from me, I must have been more heartbroken than I realized, more emotionally shattered than I thought possible.

But the truth is that I’m one badass survivor. And “just doing my best” isn’t in my recondite vocabulary. When it comes to love, relationships, sex, and the complex interaction of souls on an intimate level, I get the job done. Subtlety and self-abasement are not my strong suits. Anyone I date is lucky to have me in his life, regardless of my HIV status.

That personal cheerleading is my armor, my technique, and the way I get through that first coffee date with a stranger. Pay no attention to the man behind the curtain—I am the great and powerful Oz! I’ve been HIV-positive for 10 years now.

I started dating six years before that, and

the one thing I’ve learned over the years is to show no fear. Yes, I’m insecure about my looks. Yes, I’m terrified of being rejected.

And yes, on some level I understand that my status is an added factor that could quickly change the rules of the game. But if I see my status as a detriment, others will too.

Dating is about bringing the best of you to the table—showcasing your charm, your wit, and that great new shirt that brings out the color of your eyes. It’s about laughing at his jokes, telling her your secrets, and waiting for the perfect moment to risk that first kiss—it’s about seeing the good, finding the beauty, and offering your little piece of magic.

HIV doesn’t lessen the possibility of finding someone miraculous—this is how I choose to believe. And this is how I choose to walk into a room—as if I have never known heartbreak and no one has ever told me no.

I’m single again. I’m back to searching through a myriad of strangers for that precious and rare thing called love. And I’m scared to death! But I am also beautiful and amazing and brilliant—and as far as they know, I’m the best thing that hasn’t yet happened to them.

Saucier is a writer, blogger, and performance artist based in Los Angeles. Find more of his work on HIVPlusMag.com.

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STATUS SYMBOLS ASK + TELL

Do you get the sense that things are improving in Africa? I’d like to think that every day something gets a little better for one or two people. I’ve been thinking about charities that seem to have existed for too long—which to me means they’re unsuccessful, but which to the charity business means they’re extremely successful.

So I’m trying to reconcile how I feel about charities in terms of their longevity, and therefore I find myself interested in checking things off the list. Like, “OK, if I get 40 pairs of shoes, 40 uniforms, and these children can go to school for one year, problem solved.” I think sometimes we have to do that—see the dent that we’re making, and you hope that in that dent, you’re educating someone who will educate someone else and alleviate the bigger problem.

when cch pounder isn’t playing strong women on TV (Warehouse 13) and in the movies (Avatar, Bagdad Café), the gracious actress is raising money and awareness for AIDS charities. More than 20 years ago, Pounder and a number of other celebrities, including Blair Underwood and Alfre Woodard, founded Artists for a New South Africa. Back then the charity’s goal was to support the struggle to end apartheid, but now the focus has shifted to AIDS prevention and treatment in the nation. Pounder, Emmynominated for her work on FX’s The Shield, says there is still much work to be done—both in Africa and here in the U.S. What first got you involved in fighting HIV and AIDS? I had a great friend, Fausto.

He was one of the men in my wedding party.

Fausto was the first person in my immediate life who passed away from AIDS. I went to see him in an AIDS hospital, and this is when drugs were experimental. He looked really, really wretched. Prior to that, [AIDS] was always sort of a rumor, and then Fausto, for me, was the impact. That educated me.

You cofounded Artists for a New South Africa more than 20 years ago.

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What were those early days like?

I came to Artists for a New South Africa when it was all about ending apartheid.

We thought, How amazing, how successful, Nelson Mandela is president and all will be well. Well, of course, after 50 years of that kind of [apartheid], we were watching a whole cycle of AIDS develop in South Africa. Work that we thought was over sort of began anew. In terms of political process, the problem was solved, but now the people needed healing. So it’s been around as part and parcel with my career for over 25 years.

Do you think there’s a stigma about HIV in the black community? When a society has been overburdened with negativity, the last thing you want to hear is, “Here comes yet another thing that belongs to our community.” So you have this extraordinary sense of denial—of “this is not us.” But it is us. We’re part of this society.

But I’m very keen on pushing things forward instead of the blame game on the lack of information. I would like to think we have made huge leaps since the onset in the ’80s compared to where we are now. ✜

GENEVA

Q+A: CCH Pounder

You’re also very active with the African Millennium Foundation, which works to help children orphaned by AIDS. How did you get involved? Neal Baer, the executive producer of Law & Order: SVU [Pounder has a recurring role on the show], had a visit with Malena Ruth, who’s the cofounder [of the African Millennium Foundation], on a project of photographing children.

When he came back and told their stories, people volunteered to help. There were stories like a 14-year-old taking care of these two kids—people here in the U.S. would offer to [financially] take care of their schooling and food for a year. So we parceled out the children that we met through those photographs to the celebrities and noncelebrities on the show. I took on a family—there were, at the time, eight of them. I’ve been with them now for four years. It’s been a great pleasure because I think children want to be accountable. I still write and say, “I want to see your grades.”

Updated guidelines* include starting HIV medicines at 500 or less T-cells.

I used to think just eating right would be enough.

Now I know, for me

TREATING HIV SOONER, IS BETTER.

Considering HIV treatment earlier may improve your chances of living a healthier life. Starting HIV medicines when your T-cell count is 500 or less is one of several factors to consider, because it may help preserve your immune system and possibly avoid some long-term complications. Talk to your doctor today about a plan that may lead to a longer, healthier life.

TAKE THE NEXT STEP. GO TO

hivtreatmentispower.com * Depar tment of Health and Human Ser vices ( DHHS )

Š 2010 Gilead Sciences, Inc. All rights reserved. UN5135 07/10